Albert Einstein defined insanity as “doing the same thing over and over again and expecting different results.” In 2004, the conventional structure and work flows of dermatology departments of public university hospitals in our region and at the Spanish national health system were unable to fulfill the ethical obligation of providing proper care at the correct time for patients with skin cancer. Patients with malignant melanoma (MM) or basal cell carcinoma (BCC) shared the same waiting times as patients having common acquired melanocytic nevi or viral warts. In this regard, waiting lists were a quantitative problem (how many patients were waiting?) that obscured a qualitative concern (which types of lesions were awaiting examination?). Increasing staff resources rarely provided a definitive solution unless the work flows were meaningfully redesigned. By increasing the number of dermatologists, malignant tumors and common acquired melanocytic nevi, viral warts, and seborrheic keratoses would have been diagnosed and treated sooner, but this did not guarantee the prioritization and immediate attention that skin cancer merits.
Moreno-Ramírez D, Ferrándiz L. A 10-Year History of Teledermatology for Skin Cancer Management. JAMA Dermatol. 2015;151(12):1289-1290. doi:10.1001/jamadermatol.2015.3208