51 ELEVEN YEARS OF TELEDERMOSCOPY IN THE NETHERLANDS INTRODUCTION Teledermoscopy is a possible approach to support general practitioners (GPs) in the early detection of skin cancer and to distinguish skin cancer from benign lesions by consulting a remote dermatologist based on patient history and dermoscopic images supplied by the GP. Currently, skin cancer is among 52% of all reported cancers the most common type of cancer in the Netherlands. Further, the Netherlands has the highest skin cancer incidence in Europe [1-4]. Skin cancer was diagnosed in 82,800 patients in the Netherlands in 2021 [5]. Out of all secondary care disciplines, dermatology secondary care received the most patient referrals from GP primary care [6]. Moreover, the number of patients suspected of having skin cancer is expected to rise further in the coming years [7,8]. Thereby resulting in an ever-increasing burden upon the Dutch healthcare system [9,10]. Teledermoscopy has been a field of interest since the early 1990s [11]. Since then, many studies have been published and presented teledermoscopy as a promising tool to overcome geographic distance and limited dermatologists available, thereby improving access to dermatology care resulting in an earlier detection of skin cancer [12-14]. Additional teledermoscopy advantages include an increase in the GPs’ knowledge of skin cancer and a reduction in waiting time to visit a dermatologist compared to conventional dermatology [7,15-18]. Even though teledermoscopy is presented as a promising service, numerous barriers have been mentioned in the literature, still resulting in a low acceptance of teledermoscopy in clinical practice. An example of such a barrier is the concern about diagnostic accuracy [19,20]. Despite these barriers, more rapid uptake of teledermoscopy was seen during the COVID-19 pandemic to prevent physical contact with patients but continue care [21]. In the Netherlands, teledermoscopy is implemented in primary care to support GPs in diagnosing, treating and managing skin lesions. Teledermoscopy has been reimbursed and integrated into the Dutch healthcare system as a nationwide, regular health service since February 2009. Thereafter, no long-term assessment of outcomes on the intended use of teledermoscopy by GPs, its effect on GP’s referral policy, GP’s valuation of teledermoscopy usefulness, cost evaluation and GP’s and teledermatologist’s time investments in performing teledermoscopy consultations in the Dutch general setting has been performed. The purpose of this study is to provide an overview of 11 years of the use of teledermoscopy by GPs in general practice by evaluating defined teledermoscopy quality and performance outcomes. 3
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