Teledermatology in practice

Abstract

Teledermatology has been the focus of much interest in recent years. Potential uses include a simple supporting role for primary care, more accurate triage of dermatology patients or an 'advice only' service reducing the need for dermatology patients to attend outpatient clinics. With the current under-provision of dermatology services in the UK and the waiting list targets set by government, teledermatology systems have been proposed as a possible solution. 'Store and forward' teledermatology systems are easy to set up and it has been shown that accurate diagnoses can be made using digital images attached to an E-mailed history. In an area of geographical isolation a store and forward teledermatology system has been used successfully to reduce patient waiting times. In Peterborough we have been using a store and forward teledermatology system for over 4 years. Our experience has demonstrated that for only a small number of selected patients was it possible to provide an advice-only service, but the majority of patients still need to be seen in the outpatient clinic. Despite the technical simplicity of these systems today there is still little evidence that teledermatology will have a significant impact on patient workload in the average dermatology clinic. It must be recognized that teledermatology is potentially a useful communication tool for selected patients in primary care but is unlikely to solve waiting list problems or replace the need for local dermatology services.

Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic image tele-evaluation using cellular phones

“…One may speculate that the few mismatches that did occur resulted from reduced image quality due to the simple application of a standard pocket dermoscope without a special adapter for cellular phones or from loss of image details due to JPEG compression 22 . As slightly higher values of specificity were achieved by teledermoscopy for malignant nonmelanocytic skin lesions for which dermoscopic diagnoses have been reported to be more difficult to obtain, 23,24 it seems more likely that factors other than image quality had influenced results. For example, diagnostic limitations might have arisen because of the inability to palpate the lesions and the danger of putting too much emphasis on minute details.…”

Development of a teledermatopathology consultation system using virtual slides

“…In 1995, Perednia et al proposed teledermatology, in which dermatological macroscopic findings were captured by digital camera, and sent remotely via the Internet from personal computer for consultation [15]. The usefulness and some associated problems of this system have been reported [16-18]. The subsequent widespread use of digital devices and personal computers, together with the development of telecommunications, has led to the development [19] and gradual popularization [20-22] of teledermatopathology, which involves the digitization and remote transmission of microscopic dermatopathological findings.…”

Newer insights in teledermatology practice

“…[63] Self-practicing dermatologists [99][100][101][102] and NHS dermatologists [63,[103][104][105] use SAFT for routine practice. They use ODGs and AST to address DMCs [63] [ Figure 4h].…”