Basal cell carcinoma (BCC) accounts for 80% of skin cancers and stands as the most common skin malignancy in Hispanic patients and the second most common among Black patients in the U.S. Racial/ethnic health disparities affect the diagnosis of BCC. Hispanic and Black patients are less inclined to seek outpatient dermatologic care than non-Hispanic White patients. Contributing factors include education, income, and insurance coverage. We implemented a program, Teledermatology in Rural Georgia, (n=10 clinics) where primary care providers (PCPs) send referrals with dermoscopic pictures to a board-certified dermatologist using the DermEngineTM platform. Our approach includes Georgia Cancer Center’s “TeleECHOTM TeleDerm” (TETD) sessions to provide cancer detection education to PCPs. This initiative aims to address disparities in access to traditional dermatological care and enhance early cancer detection and prevention in rural, underserved communities.

Case Discussion

We screened patients (n=66) with suspected skin cancer lesions and identified 37 lesions that were recommended for biopsy. The mean time between referral submission and receiving advice was 25.8 minutes. We conducted a total of 21 monthly TETD sessions (~35 participants/session) that enabled didactic (n=21) and case (n=25) discussions among PCPs and dermatology specialists. Here, we report an 86-year-old Hispanic male, Fitzpatrick skin type IV, who presented with a pigmented lesion on his left cheek that had been present for 1 year. The lesion was biopsied and revealed a pigmented, ulcerated, nodular BCC. This case was discussed in a TETD session, emphasizing the importance of recognizing specific characteristics of pigmented BCC in individuals with skin of color.


This case highlights an innovative initiative to combine teledermatology and the Project ECHOTM educational platform to decrease barriers to skin cancer screening among rural, underserved populations, where access to dermatology specialty care remains limited.