Teledermatology for diagnosis and management of skin conditions: A systematic review

Warshaw, Erin M.; Hillman, Yonatan; Greer, Nancy; Hagel, Emily; MacDonald, Roderick; Rutks, Indulis; Wilt, Timothy J

doi:10.1016/j.jaad.2010.08.026

Cited by 276 publications

(258 citation statements)

References 79 publications

(284 reference statements)

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“…[1][2][3][4][5][6][7][8][9] Store-and-forward images can be more than eight times the resolution of live interactive, but diagnoses are delayed and, if images and histories are poor or incomplete, another store-and-forward or in-person consultation may be required. Live interactive examinations are immediate and allow image adjustments, but take longer and constrain consultation time and location.…”

Section: Introductionmentioning

confidence: 99%

“…5 Diagnostic agreement between examinations done remotely and in-person is considered the most appropriate standard for judging telemedicine interventions, since parity with face-to-face assessments, not superiority, needs to be proven. 1,2,[7][8][9] Studies of remote agreement with face-to-face assessments can be complete (with identical primary diagnoses) or partial (with one of the specialists including the primary diagnosis of the other in their differential). 10 Partial agreement is always higher than complete, since the agreement threshold is relaxed.…”

Section: Introductionmentioning

confidence: 99%

“…4,9 The way each review accounted for differential agreement, by aggregate agreement for different types of lesion 9 or partial agreement in individual studies 4 makes the reviews' overall range comparisons for partial agreement difficult. Moreover, review classifications of studies as either store-and-forward or live interactive do not inform about the specific type of technology employed or the resolution of the images or video.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Marchell

Locatis

Burges

et al. 2017

Telemedicine and e-Health

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Background: There is little teledermatology research directly comparing remote methods, even less research with two inperson dermatologist agreement providing a baseline for comparing remote methods, and no research using high definition video as a live interactive method. Objective: To compare inperson consultations with store-and-forward and live interactive methods, the latter having two levels of image quality. Methods: A controlled study was conducted where patients were examined in-person, by high definition video, and by store-and-forward methods. The order patients experienced methods and residents assigned methods rotated, although an attending always saw patients in-person. The type of high definition video employed, lower resolution compressed or higher resolution uncompressed, was alternated between clinics. Primary and differential diagnoses, biopsy recommendations, and diagnostic and biopsy confidence ratings were recorded. Results: Concordance and confidence were significantly better for in-person versus remote methods and biopsy recommendations were lower. Store-and-forward and higher resolution uncompressed video results were similar and better than those for lower resolution compressed video. Limitations: Dermatology residents took store-and-forward photos and their quality was likely superior to those normally taken in practice. There were variations in expertise between the attending and second and third year residents. Conclusion: The superiority of in-person consultations suggests the tendencies to order more biopsies or still see patients in-person are often

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Marchell

Locatis

Burges

et al. 2017

Telemedicine and e-Health

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“…The visual nature of skin cancer lends itself well to digital lesion imaging and teledermatology [11][12][13][14][15][16]. Skin cancer detection is enhanced using dermoscopy, which is a widely accepted imaging technique for recognizing, assessing, and managing skin lesions [17,18].…”

Section: Introductionmentioning

confidence: 99%

Understanding Visual Search Patterns of Dermatologists Assessing Pigmented Skin Lesions Before and After Online Training

et al. 2014

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The goal of this investigation was to explore the feasibility of characterizing the visual search characteristics of dermatologists evaluating images corresponding to single pigmented skin lesions (PSLs) (close-ups and dermoscopy) as a venue to improve training programs for dermoscopy. Two Board-certified dermatologists and two dermatology residents participated in a phased study. In phase I, they viewed a series of 20 PSL cases ranging from benign nevi to melanoma. The close-up and dermoscopy images of the PSL were evaluated sequentially and rated individually as benign or malignant, while eye position was recorded. Subsequently, the participating subjects completed an online dermoscopy training module that included a pre-and post-test assessing their dermoscopy skills (phase 2). Three months later, the subjects repeated their assessment on the 20 PSLs presented during phase I of the study. Significant differences in viewing time and eyeposition parameters were observed as a function of level of expertise. Dermatologists overall have more efficient search than residents generating fewer fixations with shorter dwells. Fixations and dwells associated with decisions changing from benign to malignant or vice versa from photo to dermatoscopic viewing were longer than any other decision, indicating increased visual processing for those decisions. These differences in visual search may have implications for developing tools to teach dermatologists and residents about how to better utilize dermoscopy in clinical practice.

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“…19 High levels of diagnostic agreement were found, which are comparable to other studies where agreement ranged between 81% and 89%. 19 Warshaw et al, 20 conducted a systematic review of teledermatology diagnosis agreement between a dermatologist following a faceto-face consultation, and a second using only photographs; this provided a weighted average agreement of 65.3%. In a study where a similar number of patients were assessed (n = 16), the κ coefficient of dermatologist agreement was similar to the British Journal of General Practice, August 2014 e474 Fundingcurrent study data when combining all four clinicians' diagnoses (κ = 0.67), 9 Warshaw et al 20 showed the overall κ coefficient in a number of studies ranging from 0.65 to 0.87.…”

mentioning

confidence: 99%

Development and validation of the Molluscum Contagiosum Diagnostic Tool for Parents: diagnostic accuracy study in primary care

et al. 2014

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BackgroundMolluscum contagiosum (MC) is diagnosed by its distinct appearance. Parental diagnosis of MC may reduce anxiety and lead to reductions in healthcare consultations, and may be particularly useful in large-scale epidemiological studies. However, there are currently no published, validated tools allowing parental diagnosis of MC. AimTo develop and validate a tool for parental diagnosis of MC. Design and settingThe Molluscum Contagiosum Diagnostic Tool for Parents (MCDTP) was developed and its diagnostic accuracy was compared with GP diagnosis in 12 GP surgeries in South Wales. MethodFollowing development, which involved three phases with dermatologists, nurses, GPs, and parents, parents completed the MCDTP (index test) in the practice waiting room, and rated their confidence in their diagnosis. A GP then examined their child for MC (reference test). Test characteristics were calculated for all responders and for those who expressed being confident or very confident in their diagnosis. ResultsA total of 203 parents completed the MCDTP. The MCDTP showed a sensitivity of 91.5% (95% confidence intervals (CI) = 81.3 to 97.2) and a specificity of 88.2% (95% CI = 81.8 to 93.0) in all parents and a sensitivity of 95.8% (95% CI = 85.7 to 99.5) and a specificity of 90.9% (95% CI = 83.9 to 95.6) in parents who were confident or very confident in their diagnosis. The positive predictive value was 76.1% (95% CI = 64.5 to 85.4) and negative predictive value was 96.2% (95% CI = 91.4 to 98.8) for all parents. ConclusionThe MCDTP performed well compared with GP diagnosis and is suitable for clinical use by parents and in population-based studies.

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Teledermatology for diagnosis and management of skin conditions: A systematic review

Cited by 276 publications

References 79 publications

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

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

Understanding Visual Search Patterns of Dermatologists Assessing Pigmented Skin Lesions Before and After Online Training

Development and validation of the Molluscum Contagiosum Diagnostic Tool for Parents: diagnostic accuracy study in primary care

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