Mr. Onur Gilleard
Qualifications & Experience
Mr Onur Gilleard is a distinguished consultant plastic surgeon on the GMC specialist register. He previously held an NHS consultant post at St Bartholomew’s Hospital in London, specialising in skin cancer and microsurgical reconstruction. In 2021, Mr Gilleard transitioned from the NHS to dedicate himself fully to private practice, allowing him to focus exclusively on providing personalised, high-quality care to his patients. He is recognised as an expert in laser treatments, having conducted research and developed advanced treatment protocols using cutting-edge laser technology to optimise both clinical outcomes and cosmetic results.
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Teledermatology is not one thing, and the distinction decides whether it works. Store-and-forward assessment performs well when the images include proper dermoscopy captured by a trained operator — which is why the NHS uses it in its urgent skin cancer pathway. It performs badly when the image is a patient’s phone photograph. Same label, opposite reliability, and the difference is not the doctor at the other end.
The Two Things Called Teledermatology
| Clinical store-and-forward | Patient-submitted photo service | |
|---|---|---|
| Who takes the image | A trained operator, in clinic | The patient, at home |
| Dermoscopy included | Yes — that is the point | No |
| Conditions | Standardised lighting, distance, magnification | Whatever the room and phone provide |
| Scale reference | Present | Usually absent |
| Palpation | Performed at capture | None |
| Whole-skin context | Available | One lesion in isolation |
| Performance | Good — used in NHS cancer pathways | Unreliable |
When a GP refers a suspicious lesion urgently in London, the assessment is frequently made through exactly this route: a teledermatology clinic where dermoscopic images are captured properly and reviewed by a specialist. That is a well-founded use of the technology, and it is part of why the urgent pathway moves quickly.
What Goes Wrong Without Dermoscopy
Six things, and none is fixable by a better camera.
- No subsurface structures
- The features a melanoma diagnosis rests on sit beneath the stratum corneum: atypical pigment network, irregular streaks, blue-white veil, regression structures, polymorphous vessels. A dermatoscope reveals them by eliminating surface reflection. An ordinary photograph records the reflection, so the diagnostic information is absent from the file — see digital dermoscopy explained.
- No palpation
- A firm nodule reads as flat in a photograph. That matters most for the subtype where it matters most: nodular melanoma is often symmetrical and evenly coloured, and is identified by being firm and growing rather than by looking irregular.
- No scale
- Without a reference in frame, size is guesswork, and diameter is one of the assessed criteria.
- Colour distortion
- Ambient lighting and the phone’s own image processing both alter apparent colour. Colour variegation within a lesion is a diagnostic feature, so distortion is not cosmetic — it corrupts the finding.
- No whole-body context
- The ugly duckling sign is a comparison across a person’s other lesions. A single submitted photograph makes it impossible.
- No prior image
- Change cannot be assessed against nothing. Since melanoma is diagnosed by change at least as reliably as by appearance, this removes half the diagnostic method.
The Failure Runs in One Direction
Any diagnostic process makes both kinds of error, and in remote assessment they are not symmetrical in consequence.
A false alarm produces an unnecessary appointment. Irritating, occasionally expensive, resolved in an afternoon.
False reassurance produces a delay of months in someone who has now been told there is nothing to worry about — and in melanoma, months translate directly into Breslow thickness, which determines the width of the definitive excision, whether a sentinel lymph node biopsy is offered, and the eventual outlook.
“A false alarm costs an appointment. False reassurance costs months, and months change Breslow thickness.”— Mr Onur Gilleard, Consultant Plastic Surgeon
This is why a remote service that hedges and asks you to attend is behaving correctly, and one that reassures confidently on a phone photograph is not.
When Remote Assessment Is Reasonable
Being categorical about this would be wrong. There are legitimate uses:
- Triage inside a clinical pathway, where the images are captured with dermoscopy by trained staff — the NHS model.
- Follow-up of a known condition where the diagnosis is already established and the question is progress rather than identity.
- Deciding urgency, where the honest output is how soon to be seen rather than what the lesion is.
- Widespread inflammatory conditions — eczema, psoriasis — where distribution is visible in an ordinary photograph and dermoscopy adds little.
What it is not suited to is the question people most often use it for: is this pigmented lesion a melanoma? That is precisely the question requiring the information a phone cannot capture.
Not the Same as an App, But the Same Gap
Teledermatology at least puts a clinician at the other end, which is a meaningful difference from an algorithm scoring a photograph. The imaging gap, however, is identical: both are working from a surface image without dermoscopy, scale, palpation or a baseline.
The evidence on the algorithmic version is unambiguous. A systematic review in the BMJ found smartphone applications for skin cancer risk had sensitivity that was poor, inconsistent and below the level needed to safely rule out melanoma (Freeman et al., 2020). More on that in mole-check apps vs clinical examination.
What to Do Instead
If a lesion has changed, an in-person examination with dermoscopy answers the question that a photograph cannot. Assessment is by a consultant plastic surgeon, and where removal is the answer it happens at the same appointment rather than after a further referral.
| Item | Price |
|---|---|
| Consultation and mole check | £100 |
| Mole mapping — complete package | £300 |
| Mole removal | £350 |
| Histological analysis | £180 |
If a lesion looks genuinely suspicious, the NHS urgent pathway through a GP is fast and is the right route — across London 95.2% of patients start treatment within 31 days of a decision to treat. Criteria in removal on the NHS. Otherwise: mole removal, mole mapping or contact the clinic.
Frequently Asked Questions
- Does teledermatology work for moles?
- It depends entirely on how the images were taken. Store-and-forward assessment with proper dermoscopy captured by a trained operator performs well and is used within NHS cancer pathways. Assessment from a patient’s phone photograph does not, because the diagnostic information is not in the image.
- The NHS uses teledermatology. Why is that different?
- Because the images are dermoscopic, captured in clinic under standardised conditions by someone trained to do it, and often accompanied by an in-person examination. The specialist reviewing them is looking at the same information they would see themselves.
- Can I just send a photo of my mole?
- You can, and it may help decide how soon you should be seen. It cannot establish what the lesion is: no subsurface structures, no palpation, no scale, distorted colour and no previous image to compare against.
- Which lesions does remote assessment miss?
- Nodular melanoma is the clearest concern. It is often symmetrical and evenly coloured, and it is identified by being firm and growing rapidly. Firmness cannot be photographed, so the most aggressive subtype is the least visible remotely.
- Which error matters more?
- False reassurance, by a wide margin. A false alarm costs an appointment. Being wrongly reassured costs months, and in melanoma months translate into Breslow thickness, which determines treatment and outcome.
- Is there any good use for it?
- Yes — triage within a clinical pathway, follow-up of an established diagnosis, deciding urgency, and widespread inflammatory conditions where distribution is the relevant finding. The unsuitable use is deciding whether a pigmented lesion is a melanoma.
- How can I take a photograph that is actually useful?
- Consistent distance and lighting, a ruler or coin in frame for scale, and repeated monthly so a change can be seen. That produces a record worth bringing to an appointment, which is a different thing from a diagnosis.
- Is this the same as a mole-check app?
- Not quite — teledermatology puts a clinician at the other end, which matters. The imaging limitation is identical though: both work from a surface photograph without dermoscopy, palpation, scale or a baseline.
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