Where no skin specialist is available: using teledermoscopy for regional collaboration in West Wales

My Topol fellowship problem / project:

The dermatology service in West Wales collapsed six years ago, and no consultant dermatologists have been in place since. The current service is fragmented and fragile, with some input from the private sector, and is not sustainable in the long term.

My project aims to roll out a Teledermoscopy service using peripheral medical photography hubs, ideally suited to this area, where the population served is relatively sparse. Using high quality images with dermoscopy (a special magnifying glass with a light), in most cases reporting can be done remotely and confidently by consultant dermatologists in other Welsh health boards. This would be limited to skin cancers in the first instance, and based on a successful model from Newport, South Wales, it has the potential to divert over 80% of skin lesion referrals from needing a face-to-face appointment. Appropriate discharge of benign skin lesions is facilitated and this is capacity releasing for the patients who most need to be seen face-to-face. As skin lesions make up over half of referrals, this would equate to a significant number. It would allow other dermatology teams across Wales to support West Wales, taking shared ownership to provide more sustainable long term solutions. This can also be expanded to inflammatory dermatology such patients with eczema and psoriasis and the aim is to roll out a similar teledermoscopy service for skin cancer across all of South Wales.

I am a final year Dermatology Registrar, based at the Welsh Institute of Dermatology in Cardiff, Wales.

My dermatology training has been split between Newcastle and South Wales, allowing me to experience the best of both rotations. Duration my foundation training I did a PG Cert in Clinical Leadership for Health Service Modernisation from Lancaster University, which introduced me to the concept of health service redesign in order to optimise utilisation of NHS resources and the workforce for our patients. I am passionate about technology and teledermatology in particular, having implemented and evaluated several different teledermatology pilot projects and new services across South Wales, ranging from skin cancer to inflammatory dermatology and inpatient referrals.

I look forward to my time as a Topol Fellow and hope to gain the right skills to become an interface between clinicians and technology for the future, keeping patients at the heart of our efforts.