# Impact of a Teledermatology-Based Referral Model on Melanoma Diagnostic Pathways and Clinicopathologic Features: A Retrospective Comparative Study Between Face-to-Face Consultation (2019) and Teledermatology (2022) in a Tertiary Hospital

## TL;DR

Teledermatology for melanoma diagnosis in 2022 was linked to better tumor characteristics compared to in-person consultations in 2019.

## Contribution

This study is the first to compare melanoma clinicopathologic profiles under face-to-face and teledermatology referral models in a tertiary hospital.

## Key findings

- Melanomas diagnosed via teleconsultation had thinner Breslow thickness compared to in-person consultations.
- Teleconsultation was associated with less histologic regression and lower rates of immunosuppression in melanoma patients.
- The study found no significant differences in age, sex, or tumor location between the two diagnostic models.

## Abstract

Background/Objectives: Teledermatology has transformed access to dermatologic care, yet its association with melanoma prognostic parameters and diagnostic pathways in tertiary settings remains incompletely characterized. To compare the clinicopathologic profile of melanomas diagnosed under face-to-face consultation (2019) versus teledermatology-based referral (teleconsultation) (2022). Methods: A retrospective observational study comparing two patient cohorts: those diagnosed with melanoma via in-person consultation in 2019, and those diagnosed through teleconsultation in 2022. These years were selected to reflect the structural shift in care delivery models before and after the COVID-19 pandemic, during which teledermatology was formally implemented. Sociodemographic, clinical, and histopathological variables were collected. A multivariable logistic regression model assessed variables associated with being diagnosed in the 2022 teledermatology cohort versus the 2019 face-to-face cohort. Statistical analyses were performed using R (v. 4.4.3). Results: A total of 151 patients were included (89 in-person in 2019, 62 via teleconsultation in 2022). Multivariable analysis identified three variables independently associated with being diagnosed via teleconsultation. Increasing Breslow thickness was inversely associated with teleconsultation diagnosis (OR 0.60 per 1 mm increase; 95% CI 0.40–0.91; p= 0.017). Similarly, the presence of histologic regression (OR 0.28; 95% CI 0.09–0.90; p = 0.032) and immunosuppression (OR 0.08; 95% CI 0.008–0.86; p = 0.037) were inversely associated with teleconsultation diagnosis. No significant associations were found for sex, age, tumor location, ulceration, mitosis, or clinical stage. Conclusions: In this retrospective single-center comparison of two care models, melanomas diagnosed through teleconsultation in 2022 were associated with a more favorable clinicopathologic profile at diagnosis than those diagnosed via face-to-face consultation in 2019. These findings support the role of teledermatology-based referral pathways in facilitating timely melanoma assessment, although causal inference is limited by the observational design.