The utility of teledermatology in the evaluation of skin lesions

Abstract

Introduction Past studies have shown mixed results about the accuracy of store-and-forward (SAF) teledermatology in the evaluation of skin lesions. The objective of this study is to determine the accuracy of SAF teledermatology in the diagnosis of skin lesions and biopsy decision compared to in-person clinical evaluation. Methods Histories and photographs of skin lesions gathered at clinic visits were sent as SAF consults to teledermatologists, whose diagnoses and biopsy decisions were recorded and compared statistically to the clinic data. Results and Discussion: We enrolled 206 patients with 308 lesions in the study. The study population was composed of 50% males ( n = 104), and most patients were white ( n = 179, 87%) and not Hispanic/Latino ( n = 167, 81%). There was good concordance for biopsy decision between the clinic dermatologist (CD) and teledermatologist (TD) (Cohen’s kappa (κ) = 0.51), which did not significantly differ when melanocytic lesions were excluded (κ = 0.54). The sensitivity and specificity of teledermatology based on biopsy decision was 0.71 and 0.85, respectively. Overall concordance in first diagnosis between the CD and TD was good (κ = 0.60). While there was no difference between CD and TD in proportion of correct diagnoses compared to histopathology, two skin cancers presentations were missed by TD. Study limitations included sample size, enrolment bias and differing amounts of teledermatologist case experience. Teledermatology has good concordance in diagnosis and biopsy decision when compared to clinic dermatology. Teledermatology may be utilized in the evaluation of skin lesions to expand access to dermatologic care.

Assessing the Diagnostic Accuracy of Teledermatology Consultations at a Local Veterans Affairs Dermatology Clinic

“…In the patients with a TD visit followed by an IP visit, the diagnostic concordance was 75.3%. This is relatively consistent with previously reported concordance values that compare SAF diagnoses with followup IP diagnoses [4][5][6][7][8][9][10]. Two dermatologists at our site were utilizing TD during the period analyzed for our study.…”

“…The literature has demonstrated a strong diagnostic concordance between TD and IP evaluations. Studies comparing the SAF technique with IP evaluations demonstrate a concordance ranging from 54% to 91% [3][4][5][6][7][8][9][10]. Despite this large range of concordance, these studies elucidate the potential for strong diagnostic accuracy when using TD.…”

Emergency Use and Efficacy of an Asynchronous Teledermatology System as a Novel Tool for Early Diagnosis of Skin Cancer during the First Wave of COVID-19 Pandemic

“…Some studies have excluded patients under the age of 18, while we did not. This could result in higher diagnostic parameters in the diagnosis of skin cancers and other non-malignant lesions [ 64 ].…”

Developing and Evaluating a Mobile-based Teledermatology System for Skin Lesion Diagnosis in Iran

“…Two previous studies which implemented a mobile app reported the inter-observer kappa values of excellent (0.958), (12) and good (0.6). (13) Previous surveys have reported mixed ndings for the accuracy of TD for pigmented lesions (14)(15)(16) Some studies have shown good diagnostic concordance when compared to face-to-face dermatology (ranging from good to excellent kappas: 0.4-0.9). (2,(13)(14)(16)(17)(18) These variations make the comparisons between the ndings of this study and those of the former studies and literature di cult, although the existing literature suggests that TD is accurate.…”

“…(13) Previous surveys have reported mixed ndings for the accuracy of TD for pigmented lesions (14)(15)(16) Some studies have shown good diagnostic concordance when compared to face-to-face dermatology (ranging from good to excellent kappas: 0.4-0.9). (2,(13)(14)(16)(17)(18) These variations make the comparisons between the ndings of this study and those of the former studies and literature di cult, although the existing literature suggests that TD is accurate. It should be noted that there were signi cant methodological variations in previous studies.…”