Teledermatology Enables Earlier Diagnosis of Cutaneous Squamous Cell Carcinoma

For patients with cutaneous squamous cell carcinoma (cSCC), timely diagnosis and intervention are critical to minimizing surgical morbidity and improving long-term outcomes. However, traditional referral pathways often introduce significant delays, allowing tumors to progress while patients wait for specialist evaluation.

A retrospective observational study from Hospital Universitario San Cecilio in Spain suggests that implementing an asynchronous teledermatology workflow can drastically reduce these wait times and facilitate the diagnosis of smaller tumors before they require extensive surgical reconstruction. Here’s a look at what it found.

Streamlining the Diagnostic Pathway

The study compared clinical and histopathological data from 224 patients diagnosed with cSCC through conventional face-to-face consultation in 2019 (n=101) versus a teledermatology pathway in 2022 (n=123). Investigators specifically selected these years to represent pre- and post-pandemic periods, ensuring the observed differences were not confounded by COVID-19 disruptions to healthcare access. Patient demographics were comparable across both cohorts, with a mean age of 79 years, a predominance of male patients, and similar rates of immunosuppression.

In the teledermatology model, primary care physicians uploaded both macroscopic and dermoscopic images to a digital health platform. Dermatologists reviewed these images within 24 to 48 hours. Patients with suspicious lesions were then scheduled for an in-person consultation within one to three working days, effectively bypassing the traditional triage bottleneck.

Key Findings in Tumor Size and Wait Times

The implementation of this digital workflow yielded substantial improvements in healthcare delivery metrics and diagnostic timing:

• Referral delays plummeted from an average of 55 days in the face-to-face cohort to just three days in the teledermatology group.
• Surgical wait times were more than halved, decreasing from 28.7 days to 12.3 days.
• Tumors diagnosed via teledermatology had significantly smaller minor-axis diameters at the time of excision (0.56 ± 0.3 cm vs 1.09 ± 0.5 cm; p<0.001).

Interpreting the Histopathological Impact

In multivariate analysis, a smaller minor tumor diameter emerged as the strongest independent predictor of a teledermatology-based diagnosis (OR 0.01, 95% CI 0.001–0.02, p<0.001). Interestingly, while teledermatology successfully identified lesions at a smaller surface area, it did not significantly alter other high-risk histopathological features. Tumor thickness, differentiation grade, and high-risk anatomical locations showed no significant differences between the two diagnostic modalities. This indicates that while the digital pathway enables earlier detection, the inherent biological aggressiveness of the tumors may still vary.

Considerations for Clinical Implementation

Although the findings highlight the efficiency of teledermatology, the study's retrospective, single-center design limits broad generalizability. The authors also note that a prospective approach incorporating standardized diagnostic protocols across both modalities would provide stronger evidence regarding the true impact of teledermatology on long-term cSCC prognosis.

For healthcare systems managing high volumes of dermatologic referrals, these data support teledermatology as a highly viable tool to expedite cSCC diagnosis. By reducing referral bottlenecks and enhancing collaboration between primary care and specialists, clinicians can intervene when tumors are smaller, potentially minimizing the need for complex surgical procedures and optimizing overall resource utilization.

Reference:

Cebolla Verdugo M, Husein El-Ahmed H, Ruiz Villaverde R. Does Teledermatology Enable Earlier Diagnosis of Cutaneous Squamous Cell Carcinoma Than Face-to-face Consultation?. Acta Derm Venereol. 2025;105:adv44362. Published 2025 Oct 30. doi:10.2340/actadv.v105.44362