A retrospective review of cutaneous vascular lesions referred to a teledermatology clinic

Abstract

ABSTRACT: INTRODUCTION: Most cutaneous vascular lesions are benign and do not require treatment. Many are referred to specialist dermatologists from primary care. AIM: This study aimed to investigate the characteristics of cutaneous vascular lesions and the reasons for their referral from primary care. METHODS: Lesions diagnosed as cutaneous vascular abnormalities or dermatoses were retrospectively selected from a database of patients attending the Waikato Virtual Lesion Clinic. Demographic data, diagnosis and clinic outcome were recorded for each imaged lesion. Primary care referrals were reviewed to determine the reasons for referral. RESULTS: In total, 229 referrals for vascular lesions were received between January 2010 and February 2019. Patient ages ranged from 6 to 95 years and 64.2% of patients were female. Nearly half the lesions (47.2%) were located on the head and neck; 64.1% had a dermatological diagnosis of a vascular tumour and 18.7% had a malformation. The most common reason for referral was pigmentation (45.7%) and bleeding was least common (8.2%). No diagnosis was given in 34.2% of referrals and less than one-quarter had a correct diagnosis. Malignancy was suspected in 40.2% of referrals; however, the dermatologists found that 95.2% of patients did not require further treatment. Half of excisions (n = 2) were for bleeding and all were histologically benign. DISCUSSION: Diagnostic uncertainty and suspected malignancy commonly result in referral of benign cutaneous vascular lesions to public dermatology services. This study highlights the usefulness of teledermatology in the timely access of specialist input, minimising the need for intervention or excision.