Teledermoscopy with intergraded didactic feedback an effective intervention in enhancing dermoscopy adoption and skin cancer triage in primary care.

Abstract

Skin cancer incidence continues to rise, increasing pressure on healthcare systems and emphasizing the need for accurate decision-making in primary care. In the Netherlands, where melanoma incidence is among the highest worldwide, general practitioners (GPs) are the main gatekeepers for assessing suspicious skin lesions. However, many lesions are benign and still primarily evaluated using naked-eye examination, which contributes to unnecessary referrals and excisions, increasing specialist workload and healthcare costs. There is substantial evidence that dermoscopy improves the differentiation between benign and malignant lesions and supports diagnostic decision-making. Studies also demonstrate that adequately trained primary care clinicians can achieve high sensitivity with acceptable specificity, particularly when structured algorithms such as the Triage Amalgamated Dermoscopic Algorithm (TADA) are used. Despite this evidence, dermoscopy adoption in general practice remains limited. Qualitative studies suggest that many GPs continue to experience diagnostic uncertainty after brief training because of insufficient ongoing feedback and support. Educational research indicates that enduring clinical competence is best developed through repeated exposure, case-based learning, retrieval practice, and timely feedback. Teledermoscopy may integrate these principles into routine practice by combining diagnostic support with repeated expert feedback and learning opportunities. This thesis evaluated a Dutch blended-learning programme combining dermoscopy education, teledermoscopy, and structured didactic feedback for GPs. A retrospective longitudinal analysis of 194 GP practices and 3,394 teledermatology consultations showed that, without teledermoscopy support, 37% of cases would have resulted in referral or specialist consultation, compared with only 10% with teledermoscopy support. Most lesions were safely managed in primary care. Mean response time was 10.5 hours, and no missed melanomas or serious adverse events were documented. These findings suggest that teledermoscopy with structured didactic feedback may improve diagnostic confidence, enhance dermoscopy adoption, reduce unnecessary referrals, and improve the efficiency and safety of skin cancer triage in Dutch primary care.

Datum der Bewilligung	2026
Originalsprache	Englisch
Gradverleihende Hochschule	Medizinische Universität Graz
Betreuer/-in	Rainer Hofmann-Wellenhof (Betreuer*in)