Part II: Accuracy of Teledermatology in Skin Neoplasms

Abstract

Teledermatology has been proving to be of great help for delivering healthcare, especially now, during the SARS-CoV-2 pandemic. It is crucial to assess how accurate this method can be for evaluating different dermatoses. Such knowledge can contribute to the dermatologists' decision of whether to adhere to teledermatology or not. Our objective was to determine the accuracy of teledermatology in the 10 most frequent skin neoplasms in our population, comparing telediagnosis to histopathological report and in-person dermatologists' diagnosis. A retrospective cohort study was conducted in São Paulo, Brazil, where a store-and-forward teledermatology project was implemented under primary-care attention to triage surgical, more complex, or severe dermatoses. A total of 30,976 patients presenting 55,012 lesions took part in the project. Thirteen teledermatologists who participated in the project had three options to refer the patients: send them directly to biopsy, to the in-person dermatologist, or back to the general physician with the most probable diagnosis and management. In the groups referred to the in-person dermatologist and biopsy, we looked for the 10 most frequent International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) of skin neoplasms, which resulted in 289 histopathologic reports and 803 in-person dermatologists' diagnosis. We were able to compare the ICD-10 codes filled by teledermatologists, in-person dermatologists, and from histopathological reports. The proportion of complete, partial, and no agreement rates between the in-person dermatologist's, histopathologic report, and the teledermatologist's diagnosis was assessed. We also calculated Cohen's kappa, for complete and complete plus partial agreement. The mean complete agreement rate comparing telediagnosis to histopathological report was 54% (157/289; kappa = 0.087), being the highest for malign lesions; to in-person dermatologists was 61% (487/803; kappa = 0.213), highest for benign lesions. When accuracy of telediagnosis for either malign or benign lesions was evaluated, the agreement rate with histopathology was 70% (kappa = 0.529) and with in-person dermatologist, 81% (kappa = 0.582). This study supports that teledermatology for skin neoplasms has moderate accuracy. This result reassures that it can be a proper option for patient care, especially when the goal is to differentiate benign from malign lesions.

Teledermatology during the COVID ‐19 pandemic: Experience at a tertiary care centre in North India

“…[12][13][14] Two retrospective studies from Brazil reported high degree of accuracy with teledermatology in inflammatory dermatoses and moderate accuracy for neoplasms. 15,16 High levels of satisfaction with teleservices has been reported previously in patients having acne. 17 In this study, 62% of acne patients reported being satisfied or very satisfied with teleconsultation services.…”

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

“…In previous studies, overall diagnostic accuracy for malignancies varied between 51% and 87.3%, while concordance ranged from moderate to substantial agreement (κ = 0.41–0.63) [ 49 , 50 , 51 ]. We observed a diagnostic accuracy at the higher end by reaching 85.3%, while the diagnostic concordance was 0.644.…”

Non-melanoma skin cancer diagnosis: a comparison between dermoscopic and smartphone images by unified visual and sonification deep learning algorithms

“…Skin cancer detection through telemedicine channels is in agreement with histopathology in about 70% of diagnoses by dermatologists (Giavina-Bianchi et al 2020 ) and 50% by primary care physicians (Bridges et al 2019 ). These moderate performance levels leave room to further improvements, possibly by artificial intelligence-enhanced methods.…”