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.
Background The increasing incidence of skin cancers poses a burden to health care systems. General practitioners (GPs) play an important role in triaging these diseases and referring relevant patients to specialists. It is challenging to distinguish benign from malignant skin lesions, and GPs may benefit from diagnostic support from teledermoscopy (TD). Objectives To assess whether the introduction of TD in general practice was feasible and might reduce the number of unnecessary referrals to specialists and to assess the diagnostic accuracy and confidence of participating GPs. Methods Fifty general practices in Southern Denmark participated. Adult patients presenting to their GP with suspected skin cancer could be included. Images including dermoscopy were taken by the GP and sent for evaluation by specialized dermatologists at a university hospital. Patients were simultaneously referred for a face-to-face evaluation at the university hospital. Diagnoses proposed by the GPs and by TD were compared to the final diagnoses obtained by histopathology or, if not available, face-to-face evaluation. Results Five hundred and nineteen patients with 600 suspected skin cancers were included. The final diagnosis was benign in 72.3%. The photo quality was good or fair in 90.5%. GPs reported uncertainty about their diagnoses in 41.5% of cases. The GPs’ positive predictive values for any malignancy and for malignant melanoma were 49.5% and 26.3%, respectively. On evaluation by TD, 31.5% of lesions did not need further in-person assessment. Conclusion Useful images of suspicious skin lesions were obtained from general practice, and GPs could benefit from TD to improve their diagnostic accuracy and confidence.
Background The diagnostic criteria for hereditary hemorrhagic telangiectasia (HHT) include the presence of telangiectatic lesions in common sites (nose, fingers, oral cavity, and lips). Telangiectatic lesions are described as red spots in the skin, but this description is inadequate. Few studies have investigated the characteristics of telangiectatic lesions in HHT, and we aimed to describe the distribution and morphology of telangiectatic lesions in HHT patients. Methods We reviewed the telangiectatic lesions in 34 adult HHT patients seen at our HHT center. Photo documentation was used to describe the morphology and distribution of the lesions. ResultsThe telangiectatic lesions in both HHT1 and HHT2 patients were predominantly round and either flat or slightly elevated. However, elongated flat lesions and larger round, elevated lesions were also observed. Patients with HHT1 had more lesions in the mucosa (tongue and oral cavity) compared with HHT2 patients. There was no difference between HHT1 and HHT2 patients in the total number of lesions in the skin and mucosa. Conclusions The typical round, flat telangiectatic lesion is the most common lesion in HHT, but it is very often accompanied by elevated or elongated lesions. The total number of lesions did not vary between gender, but women had significantly more lesions in the mucosa (p = 0.027). The presentation of telangiectatic lesions may vary a little between HHT1 and HHT2 patients but not in such a way that allows the morphology and location of the lesions to predict the HHT subtype.
BackgroundSkin cancer constitutes a significant and growing disease burden. To deal with this, teledermoscopy (TDS) can be useful. However, image quality is a concern for implementing TDS. High image quality can be obtained at a dermatology department, but in many occasions it is more sensible to acquire TDS images in general practice.ObjectivesTo compare image quality, diagnostic confidence, suggested management, sensitivity, specificity and diagnostic accuracy between two sets of dermoscopic images of the same skin tumour, where one set was acquired in general practice and the other was obtained at a dermatology department.MethodsTwo sets of dermoscopic images of 192 skin lesions were evaluated by the same dermatologist at two different occasions approximately four years apart (2018 versus 2022). At both occasions, the images were evaluated in regards to image quality, diagnostic confidence, whether the lesion was benign or malignant, primary diagnosis and suggested management.ResultsThere were statistically significant differences of diagnostic confidence and suggested management (P = 0.00 for respective parameter), but not for image quality (P = 0.37), sensitivity (P = 0.67), specificity (P = 0.66) and diagnostic accuracy (P = 0.81). The intraobserver agreements were slight for image quality (κ = 0.012), fair for diagnostic confidence (κ = 0.313) and moderate for suggested management (κ = 0.467).ConclusionsThe image quality of both sets of dermoscopic images was most often good. Although we did not find a statistically significant difference in image quality between the two sets of images, our minimal level of intraobserver agreement suggests otherwise. However, this should not hinder TDS image acquisition in general practice as our results indicate that with the availability of referral notes, TDS images taken in general practice can achieve a similar sensitivity, specificity and diagnostic accuracy as dermoscopic images obtained at a dermatology department.This article is protected by copyright. All rights reserved.
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