89 TO REFER OR NOT TO REFER IN TELEDERMOSCOPY GPs’ referral decision based on self-administered questions In 3306 (51.9%) teledermoscopy consultations, the GPs adjusted their referral decision (Yes-No, No-Yes) after the TD assessment (Table 5.1). For the malignant diagnosis group, GPs indicated that they would initially not have referred 118 (19.9%) patients without teledermoscopy. For 67 (56.8%) of these 118 patients with a malignant TD diagnosis, the GPs adjusted their initial referral decision and referred the patient after teledermoscopy consultation. In the premalignant diagnosis group, the GPs indicated that they would not have referred for 162 (28.9%) patients without teledermoscopy. For 26 (16.0%) of these 162 patients with a premalignant TD diagnosis, the GPs changed their decision from nonreferral to referral. In the benign diagnosis group, 3384 (64.9%) patients with benign skin lesions, of which 784 (64.2%) had seborrheic keratosis and 163 (70.6%) had vascular lesions, would have been referred by the GP without the availability of teledermoscopy. The TD-provided benign diagnoses resulted in a change of the GPs’ decision from referral to nonreferral for 2534 (74.9%) patients. More specifically, GPs adjusted their referral decision to nonreferral after the TD assessment for 676 (86.2%) patients with a seborrheic keratosis TD diagnosis and 131 (80.4%) patients with a vascular lesion TD diagnosis. In addition, the group of “other benign skin lesions” included benign nevi as well as ICD-10 codes for eczema and insect bites. 5
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