Histopathological outcomes of teledermatology-based assessment for cutaneous melanoma: analysis of patient care flow

Methods Observational study including all cases with a diagnostic hypothesis of CM seen between 2015–2019, who attended the public TD system in Florianópolis and Joinville, cities located in a Brazilian state characterized by a high incidence of CM. Clinical assessments performed by primary care physicians and teledermatologists were compared with available histopathological reports, which were considered the definitive diagnostic reference. Results Among the 912 hypotheses of CM indicated by the primary health care team, 111 (12.2%) were validated by the teledermatologist. Further 289 suspected cases were identified by the teledermatologist based on the analysis of different primary care hypotheses, totaling 400 lesions compatible with CM. Of these, 190 (47.5%) histopathological reports were validated and there were 51 confirmed cases. Using histopathological diagnosis as the reference standard, the positive predictive value of the teledermatologist’s assessment was 26.8%. In Florianópolis, the interval between primary care consultation and teledermatologist assessment or histopathological report was 30.4 or 95.4 days, respectively. These intervals could not be defined in Joinville because the TD system was filled out after the primary care consultation. The median interval between teledermatologist assessment and histopathological diagnosis was 89.9 days considering both cities. The use of TD increased by 312% during the study period, without a corresponding increase in diagnostic agreement between primary care physicians and teledermatologists. Discussion Teledermatology contributed to the diagnostic pathway of cutaneous melanoma by facilitating access to specialist assessment and reducing unnecessary referrals; however, histopathological examination remained indispensable for definitive diagnosis. The high proportion of suspected cases without histopathological confirmation highlights a relevant loss to diagnostic follow-up, particularly among older patients.