Store-and-Forward Teledermatology in Skin Cancer Triage

Abstract

To evaluate a store-and-forward teledermatology system aimed at the routine triage of patients with skin cancer.Design: A multicenter, longitudinal, 4-phase, descriptive and evaluation study of a referred sample of patients attended through teleconsultation between March 2004 and July 2005. Clinical and dermoscopical examination and histopathological study were considered the gold standard.Setting: A skin cancer unit of a public university hospital and 12 primary care centers in southern Spain. Patients:The study population comprised patients with circumscribed lesions fulfilling at least 1 of the following criteria: changes in ABCD criteria (asymmetry, border irregularity, color variegation, and diameter Ͼ6 mm), recent history, multiple melanocytic lesions, symptoms, and/or patient's application for surgical treatment and concern about moles.Interventions: Diagnosis, diagnostic category (malignant lesions, high-risk lesions, benign lesions, special lesions, and other lesions), diagnostic confidence level on a 3-point scale, and management decision (referral vs nonreferral) were listed after the evaluation of each teleconsultation. A face-to-face evaluation and biopsy of selected patients were performed. Main Outcome Measures:The filtering percentage, as the percentage of patients not referred to the face-to-face clinic, as well as waiting intervals and pick-up or skin cancer detection rates were evaluated as effectiveness indicators. Reliability measures ( agreement), accuracy, and diagnostic performance indicators (validity) were also evaluated.Results: The filtering percentage was 51.20% (95% confidence interval [CI], 49.00%-53.40%). The waiting interval to attend the clinic was 12.31 days (95% CI, 8.22-16.40 days) through teledermatology and 88.62 days (95% CI, 38.42-138.82 days; PϽ.001) for the letter referral system. Pick-up rates were 2.02% (95% CI, 1.10%-2.94%) for malignant melanoma and 27.94% (95% CI, 24.98%-30.90%) or 1:3.71 for patients with any malignant or premalignant lesion. Intraobserver agreement was =0.91 (95% CI, 0.89-0.93) for the management decision and =0.95 (95% CI, 0.94-0.96) for the diagnosis. Interobserver concordance was =0.83 (95% CI, 0.78-0.88) for the management decision and = 0.85 (95% CI, 0.79-0.91) for the diagnosis. Accuracy was =0.

The impact of store-and-forward teledermatology on skin cancer diagnosis and treatment

“…The time intervals to diagnosis and to treatment of skin cancers provide a convenient, yet objective, measure to assess management by teledermatology since clinical diagnoses are usually confirmed unambiguously by histology of a biopsy specimen, and surgical intervention constitutes a definitive therapeutic end point, and delays in diagnosis and treatment can potentially lead to increased morbidity. 21 Consistent with previous reports that S/F teledermatology facilitates triage of skin cancer patients, 16,20 our results indicate that remote patients with skin cancers or suspected skin cancers were initially evaluated more quickly when referred via teledermatology as compared to conventional clinicbased referrals. Importantly, the overall results also demonstrate that diagnosis by biopsy and definitive treatment also occurred earlier with teledermatology than with conventional consultation.…”

“…3,4 Other clinical end points have also been examined, including patient satisfaction, [5][6][7][8][9][10][11] concordance in recommendations for management including biopsy, [11][12][13][14] and time to initial intervention. 11,[15][16][17] Beyond these surrogate or intermediate end points, however, few studies have addressed whether S/F teledermatology in actual practice affects the ultimate clinical outcomes or resolution of a dermatologic problem, Abbreviations used:…”

Comparing High Definition Live Interactive and Store-and-Forward Consultations to In-Person Examinations

“…10 The other studies had more than one teledermatologist. [14][15][16][17][18][19][20][21] Of the four studies, measuring inter-observational agreement for in-person exams, two showed significantly better agreement among in-person clinicians than distant teledermatologists, 11,12 especially for primary diagnoses, and two did not. 10,13 A PubMed search for teledermatology research done after the latest research reviews published in 2011 9 identified only one additional study having two in-person dermatologists.…”

“…In-person agreement is reported in only four, [12][13][14][15][16] however, one of which 13 appears to be a pilot for another. 10 The other studies had more than one teledermatologist.…”

Reliability and Validity of Mobile Teledermatology in Human Immunodeficiency Virus–Positive Patients in Botswana

“…For example, in a study of Spanish patients attending a pigmented lesion clinic, the sensitivity for the detection of malignant versus benign tumors by teledermatology was 0.99 (95% CI, 0.98-1.00) while specificity was 0.62 (95% CI, 0.56-0.69). 19 Further research into which conditions are better suited for teledermatology consultation, and mobile teledermatology in particular, is warranted.…”