Diagnostic accuracy and interobserver concordance: teledermoscopy of 600 suspicious skin lesions in Southern Denmark

Abstract

BackgroundSkin cancer incidences are increasing and early diagnosis, especially of malignant melanoma, is crucial. Teledermatology including teledermoscopy (TDS) can be used to triage referrals of suspicious skin lesions, however, this is not currently recommended in Denmark.ObjectivesTo evaluate diagnostic accuracy, sensitivity, specificity and interobserver concordance of TDS, and to evaluate the number of incidental lesions potentially missed by TDS.MethodsFifty general practices were invited to send images of suspicious skin lesions for evaluation using smartphone TDS. Simultaneously, the patient was referred for a face‐to‐face (FTF) consultation. Images for TDS were independently evaluated by two dermatologists; a third dermatologist performed the FTF consultation. Diagnosis, management plan and level of diagnostic confidence were noted. For TDS photo quality was rated, and for FTF any incidental findings were described.ResultsSix hundred lesions in 519 patients were included. The diagnostic accuracy was significantly higher on FTF evaluation than on TDS (P < 0.01). However, this was associated with a significant difference in specificity (P ≤ 0.012) whereas no significant difference was found in sensitivity. The concordance between FTF and TDS, and the interobserver concordance of two TDS evaluations was moderate to substantial (AC1 = 0.57–0.71). Incidental melanomas were found in 0.6% of patients on FTF evaluation, adding an extra 13% of melanomas. However, on TDS these patients’ photographed lesions all warranted FTF follow‐up, where these melanomas would have been identified.ConclusionIn this large prospective study, no significant difference in sensitivity was observed between FTF and TDS, but specificity was lower on TDS than FTF. Taking management plans into account, we would, however, potentially have dismissed 2 of 23 melanomas, if only TDS had been used for assessment. One of these was a melanoma located on the scalp, an anatomic region less suitable for TDS.

Value of Teledermoscopy in Primary Healthcare Centers: Preliminary Results of the TELESPOT Project in Belgium

“…As very high sensitivity and specificity rates of the TDS system have already been published, our study did not include an FTF control. In fact, no significant difference in sensitivity was observed between FTF consultations and TDS referrals, especially concerning distinguishing benign versus malignant: diagnostic accuracy for primary diagnosis and benign versus malignant triage with TDS were 58.2% (95% CI 52.3-63.9) and 80.1% (95% CI 75.0-84.5), respectively [9]. In detail, this situation reflects better the final aims of TDS in real-life healthcare conditions: downsizing unnecessary FTF visits and accelerating management of suspicious lesions.…”

“…This is less operator dependent compared with teledermatology, as acquisition of images is standardized and highly reproducible [8]. The sensitivity and specificity of TDS have been established previously [9].…”

Definitions, survey methods, and findings of patient satisfaction studies in teledermatology: a systematic review

“…Accuracy of results is an unlikely cause for this discrepancy. Recent reviews have shown exceptional diagnostic concordance with store-and-forward teledermatology [38,39]. A review published in 2019 by Andrees et al showed that live-interactive teledermatology was similarly time effective and accurate [40].…”

Teledermatology in the wake of COVID -19 scenario: An Indian perspective

“…found that teledermatology has the potential to diagnose suspicious skin lesions faster, limit the number of direct consultations, triage patients directly for surgical procedures, and provide meaningful feedback to the general practitioners but they also observed that the diagnostic accuracy of teledermatology was significantly lower than that of a face-to-face consultations in identifying benign and malignant conditions. [ 25 ]…”