Full end to end training video covering Isla, EMIS and e-RS video – view here

This service enables GPs to send photos of skin conditions for review by Homerton Dermatology Consultants. Following review, the service will issue a management plan to the GP or process an onward referral - if this is needed.

Please ensure that the Teledermatology request process is followed carefully. Homerton have received a number of requests that they have needed to reject. This results in a poor experience for the patient and wastes clinician time in primary/secondary care. For information on the process- see the Standard Operating Procedure and Checklists in downloads.

Rejected Referrals:
Please ensure that the Teledermatology referral process is followed carefully so that your referral is not rejected by the Homerton, resulting in a poor experience for the patient and a waste of clinician time in primary/secondary care. 

Rejections are for one of the following reasons:

• Poor image – re-refer using a new UBRN
• Incomplete history / no consent – re-refer using a new URBN
• Ineligible for service – refer via a different route

Referral pathway via Isla (from May 2025)
The Isla digital platform allows for high resolution images to be safely captured and stored. Images, clinical history and patient consent are automatically saved to the patient’s Emis medical record from Isla.

The following referrals can be made via Isla:

• Routine referrals for rashes
• Routine referrals for lesions (one lesion per referral)
• Urgent Suspected Skin Cancer (USSC) referrals (one lesion per referral)

Routine referrals for rashes:

1. Add a patient folder to Isla
2. Complete the routine telederm clinical history form
3. Tick patient consent box
4. Take 3 clear images via Isla using iPhone
5. Download the above form and images to Emis 
6. Add code “referred to Teledermatology” on Emis
7. Make e-RS referral – attach Isla form and images
8. View Teledermatology response on e-RS

Routine referrals for lesions (one lesion per referral)

1. Add a patient folder to Isla
2. Complete the routine telederm clinical history form
3. Tick patient consent box
4. Take 3 clear images via Isla using iPhone – a dermatoscopic image must be included 
5. Download the above form and images to Emis 
6. Add code “referred to Teledermatology” on Emis
7. Make e-RS referral – attach Isla form and images
8. View Teledermatology response on e-RS

Urgent Suspected Skin Cancer (USSC) referrals (one lesion per referral)

1. Add a patient folder to Isla
2. Complete the USSC telederm clinical history form
3. Tick patient consent box
4. Take 3 clear images via Isla using iPhone – a dermatoscopic image must be included 
5. Download the above form and images to Emis
6. Complete ISLA June’25 (USC) Pan London Urgent Suspected Skin Cancer referral form on Emis
7. Make 2ww e-RS referral – attach Isla form, Emis USSC form and images
8. View Teledermatology response on e-RS

 

Isla should be used for all teledermatology referrals, but is dependent on a wi-fi connection.  If a practice is unable to make referrals via Isla then the “previous” pathway should be used.

Previous referral pathway
Only routine referrals can be made via the previous pathway:

• Routine referrals for rashes
• Routine referrals for lesions (one lesion per referral)

Routine referrals for rashes

1. Complete the CEG - EMIS RP Teledermatology RASHES CEG referral form fully
2. Ensure you have ticked patient consent box on the referral form
3. Take 3 clear images using iPhone (patient images are not accepted)
4. Email images (as large size) for saving onto Emis
5. Make e-RS referral – attach referral form and images 
6. View Teledermatology response on e-RS

Routine referrals for lesions (one lesion per referral) 

1. Complete the CEG - EMIS RP Teledermatology LESIONS CEG referral form fully
2. Ensure you have ticked patient consent box on the referral form
3. Take 3 clear images using iPhone (patient images are not accepted) - a dermatoscopic image must be included 
4. Email images (as large size) for saving onto Emis
5. Make e-RS referral – attach referral form and images 
6. View Teledermatology response on e-RS

---

Taking Images 

Please note that images taken by patients are NO LONGER ACCEPTED

 

	RASHES Plain background Good lighting Autofocus on iPhone	Wipe the skin first 3 clear in focus images	1 x “locator” image 1-1.5m away 2 x “close up” images 30cm away
	LESIONS (One lesion per referral) Plain background Good lighting Autofocus on iPhone	Wipe the skin first 3 clear in focus images Dermatoscopic image must be included for lesions Mark specific lesion with pen or surgical tape Dermatoscope should be in contact with the skin and the light turned on	1 x “locator” image 1-1.5m away 1 x “close up” image 30cm away 1 x dermatoscopic image

 

For information on the process:
•    Refer to the guidance documents in downloads section
•    Refer to the training videos in external links section

---

Eligibility criteria

Inclusions

Skin conditions that do not meet the exclusion criteria.

Exclusions

• Patients whose dermatological condition is causing extreme psychological distress
• Patients with widespread rashes or severe inflammatory conditions with systemic symptoms/of an urgent nature
• Patients with a widespread dermatological condition where it is not appropriate/practical to take images
• Patients with 2 or more lesions for assessment
• Breast, perianal and genital rashes or lesions
• Patients with existing safeguarding concerns (adults and children/young people)
• Patients who lack mental capacity to consent, unless the clinician is satisfied that making a teledermatology referral is in the patient’s best interest.

The following exclusions also apply for children only:

• Images where faces can be identified
• Known chronic inflammatory skin conditions (e.g. eczema, psoriasis)
• Children with existing safeguarding concerns

Further Guidance from Homerton on using Teledermatology

1.    GP sees a patient FACE TO FACE and examines a skin lesion that meets 2WW criteria / they are suspicious of cancer
I.    Refer patient using 2WW form, traditional route to clinic
2.    GP sees a patient FACE TO FACE  and examines a skin lesion that doesn’t meet 2WW criteria, but they are not sure of the diagnosis  and so cant reassure the patient

I.    Refer via Teledermatology (e-RS RAS and using proformo)

3.    GP reviews a patient via VIRTUAL CONSULTATION (eg. over the phone or zoom) and the patients sends photos to the GP of their mole or skin lesion, for review.
I.    If pictures are poor/unclear arrange FACE TO FACE examination and then follow 2ww wait or Teledermatology referral pathway as appropriate.
II.    If pictures are good quality and clear then follow 2ww wait or Teledermatology referral pathway as appropriate.

Please ensure you complete the form and gain patient consent. It is important when sending images to ensure they meet the criteria and are clear. It is pointless sending pictures that are blurred, too distant. Lesions should always have a dermatascope picture otherwise they will result in a clinic referral anyway and you will have wasted the your time including the consultants and patients.

---

How to refer

The following clinicians can refer to this service: GPs, Nurses

---

External Links