Evaluation of Skin Cancer in Northern California Kaiser Permanente's Store-and-Forward Teledermatology Referral Program

Objective:To determine whether teledermatology referrals yield a shorter time to biopsy of the most common types of skin cancer versus conventional dermatology referrals.Subjects and Methods:A retrospective chart review was performed of California's Central Valley Kaiser Permanente conventional dermatology or teledermatology referrals that yielded a positive skin cancer biopsy over a 7-month period. Four primary care clinics at Kaiser Permanente's Stockton Medical Center in California's Central Valley were included. Patients who were studied were treated for squamous cell carcinoma of skin, basal cell carcinoma of skin, and malignant melanoma. We compared the time interval between initial evaluation and biopsy of the most common types of skin cancer for teledermatology versus traditional referrals from primary care.Results:Our study criteria were met by 293 patient cases (58% conventional referrals and 42% teledermatology referrals). The mean time to biopsy of skin cancer was 13.8 days for conventional referrals (median, 12.0 days) versus a mean of 9.7 days (median, 9.0 days) for teledermatology referrals (p<0.0001).Conclusions:The use of teledermatology in remote areas results in a shorter time to biopsy than traditional referral methods as a result of improved triaging measures.