Comparison of Skin Biopsy Triage Decisions in 49 Patients With Pigmented Lesions and Skin Neoplasms

Abstract

To determine the relative efficacy of storeand-forward teledermatology vs face-to-face dermatology consultations in triage decisions about the need for a biopsy of neoplastic skin changes.Design: Prospective study of consecutive patients judged by an internist to require dermatologic consultation for a skin growth.Setting: Private primary care and dermatology practices and an academic dermatology practice.Patients: Patients requiring dermatology consultation for evaluation of skin growths. Patients were seen by a single primary care physician between July 10, 1998, and August 4, 2000.Intervention: Digital photographs of skin growths were obtained by the primary care physician and evaluated by a teledermatologist. The patient was then seen face-to-face by a dermatologist. A biopsy was performed if either dermatologist favored biopsy.Main Outcome Measures: Decisions to perform a biopsy. Agreement between the dermatologists was assessed.Results: Of the 49 patients with evaluable photographs, the face-to-face dermatologist and teledermatologist recommended a biopsy for the same 26 patients, yielding a sensitivity of the teledermatologist of 1.00 (95% confidence interval [CI], 0.87-1.00) and a specificity of 1.00 (95% CI, 0.85-1.00). The agreement between the dermatologists () was 1.00 (95% CI, 0.72-1.00). Conclusion:Store-and-forward teledermatology may provide an accurate and cost-effective method of determining whether skin growths in patients presenting to primary care physicians should undergo biopsy.

Application of mobile teledermatology for skin cancer screening

“…This management concordance is comparable with previously reported values that range from 55% to 100% in studies using traditional store-and-forward teledermatology where a digital camera and a computer were used for capturing and transmission of clinical images. 27,28 High management concordance is clinically relevant because management decisions will likely have the highest impact on patients' outcomes.…”

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

“…All studies used a repeated measures study design with the exception of one randomized controlled trial. 11 Based on location, most of the studies were conducted in the United States (n = 14), [3][4][5][6]22,24,25,33,35,37,[41][42][43]45 followed by the United Kingdom (n = 9), 11,12,15,18,29,30,32,38,44 Italy (n = 6), 7,8,20,21,36,39 Spain (n = 4), 9,10,13,17 Australia/New Zealand (n = 3), 14,31,40 Turkey (n = 2), 16,19 and one study each from Germany, 23 Netherlands, 24 Pakistan, 27 Brazil, 28 and Switzerland. 34 Patient and skin condition characteristics.…”

Accuracy of teledermatology for nonpigmented neoplasms

“…Macro images, the standard method used in most teledermatology settings at the onset of the study, [15][16][17][18][19][20] and PLD images were obtained for each lesion. Two macro images (distance and close-up; digital Nikon Coolpix 4500 with a Nikon SL-1 ring flash [Nikon, Melville, NY]) were obtained of each lesion.…”