Inpatient teledermatology in the era of COVID-19 and the importance of the complete skin examination

Teledermatology During COVID-19: An Updated Review

“…Deacon and Madigan report a case that underscores this very issue: while a TD visit was accurately able to diagnose a herpes infection, another serious lesion was narrowly missed. As this particular patient was located in a low-risk site and did not exhibit any COVID-19 symptoms, the dermatology team decided to follow-up with an in-person consult, during which they discovered another lesion (unrelated to the patient’s primary complaint) on the patient’s left lower leg that was biopsied and identified as malignant melanoma [ 21 ]. Of course, had this patient been in a high-risk setting or have reported characteristic COVID-19 symptoms, perhaps the in-person consult may have never taken place and the diagnosis of melanoma altogether missed.…”

The Role of Teledermatology During the COVID-19 Pandemic: A Narrative Review

“…Particularly, although teledermatology gave the opportunity to inspect and diagnose lesions pertinent to the chief complaint, several other lesions that would have been otherwise analyzed and correctly diagnosed, during a complete standard examination may be missed, or otherwise not correctly diagnosed. 106,107 Several studies showed that this may come from a non-adequate use of video or photo during the visit, due to the poor quality of shared clinical image, and/or to the inability of many patients to correctly share and take photos of their lesions, resulting in a difficult differential diagnosis process (ie, missing small/discrete details like small erythematous areas, scales, Pityriasis Folliculorum of the back thoracic area, discrimination between furunculosis/hidrosadenitis, acne/ rosacea, small nail signs), and hence in a higher rate of diagnosis error than in person visits. [108][109][110] These limitations may be the cause of low rate of patients satisfaction, and patients' preference for in person visits than teledermatology.…”

Inpatient Teledermatology: a Review

“…However, several factors can hinder accurate teledermatologic care, including technology failures, poor photographic technique, and missing patient history, all of which may contribute to diagnostic and management discrepancies between teledermatologists and their live dermatologist counterparts [ 33 ]. Some studies have questioned the accuracy of teledermatology on the grounds that it may miss crucial details when a patient’s skin is incompletely or improperly photographed (i.e., incidental melanoma) [ 34 , 35 ]. Though these concerns are worth considering, others have found that store-and-forward inpatient teledermatology using only smartphone cameras is comparable to face-to-face care, and in one illustrative example, staff members at the Singapore General Hospital who did not have any formal photographic training were able to achieve an 89.2% diagnostic concordance between inpatient SAFT and live dermatologic examination [ 26 , 35 ].…”

“…On the contrary, teledermatology requires access to secure technology capable of capturing and transmitting high-quality photographs. Additionally, in cases where patient history is sparse or in which physical palpation would significantly aid diagnosis, teledermatology may be a suboptimal approach [ 34 , 58 ]. For some complex patient populations, prior face-to-face experience seems to be required to conduct a remote evaluation in a high-quality manner, including full-body skin exams, so as not to miss potentially life-altering diagnoses [ 34 , 60 ].…”

“…Additionally, in cases where patient history is sparse or in which physical palpation would significantly aid diagnosis, teledermatology may be a suboptimal approach [ 34 , 58 ]. For some complex patient populations, prior face-to-face experience seems to be required to conduct a remote evaluation in a high-quality manner, including full-body skin exams, so as not to miss potentially life-altering diagnoses [ 34 , 60 ]. Reimbursement for teledermatologic consultation is currently insufficient to incentivize care [ 61 ].…”