Positive Predictive Value of Melanoma Diagnosis in Store-and-Forward Teledermatology

Gemelas, Jordan; Capulong, Dana; Lau, Clayton; Mata-Diaz, Sandra; Raugi, Gregory J.

doi:10.1089/tmj.2018.0056

Cited by 6 publications

(10 citation statements)

References 11 publications

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“…Failure in this study could be due to the lack of tactile information and subtle examination of patch test sites, which have been cited as factors in other general teledermatology studies. 11,25 Image quality is also important, 9,[26][27][28] and not surprisingly, in this study disagreement correlated with TD ratings of image quality. Image quality has also been correlated with lower TD confidence in general teledermatology studies.…”

Section: Limitations Of Teledermatologysupporting

confidence: 69%

“…The use of teledermatology, especially store‐forward, has been studied for general dermatology 5‐11 . Data are limited on teledermatology for patch testing; nonetheless, it has been implemented in some settings 12,13 .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] The use of teledermatology, especially store-forward, has been studied for general dermatology. [5][6][7][8][9][10][11] Data are limited on teledermatology for patch testing; nonetheless, it has been implemented in some settings. 12,13 A previous, intrarater study by our group compared the same in-person dermatologist's (IPD) assessment with photographs (at 4 and 8 weeks later) in 101 patch tested patients; proportions of "success" (no impact on clinical management), "indeterminant" (possible impact on clinical management), and "failure" (definite clinical significance) were 54%, 40%, and 6%, respectively.…”

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confidence: 99%

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Inter‐rater variability in patch test readings and final interpretation using store‐forward teledermatology

et al. 2021

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Background Data regarding teledermatology for patch testing are limited. Objectives Compare patch test readings and final interpretation by two in‐person dermatologists (IPDs) with eight teledermatologists (TDs). Methods Patch tested patients had photographs taken of 70 screening series of allergens at 48 hours and second readings. Eight TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48 hours and second readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD–IPD agreement based on clinical significance (success, indeterminate, and failure) was calculated. Primary outcome was agreement at the second reading. Results Data were available for 99, 101, and 66 participants at 48 hours, second reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at second reading was 13.6% (range 7.9%‐20.4%). Pooled failure at 48 hours and final interpretation was 5.4% (range 2.9%‐6.8%) and 24.6% (range 10.2%‐36.8%), respectively. Confidence in readings was statistically correlated with quality of images and disagreement. Conclusion For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for second readings and 24.6% for final interpretation.

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Section: Limitations Of Teledermatologysupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Inter‐rater variability in patch test readings and final interpretation using store‐forward teledermatology

et al. 2021

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“…In the WDHB VLC pilot study, only IM and MIS were considered as true positives; whereas our current study amalgamated IM, MIS and severely atypical or dysplastic naevi as true positives, although there were only four severely atypical/dysplastic naevi. Our PPV and NNE remains unchanged from this definition and our PPV nevertheless compares favourably to a teledermatology study from the United States with a PPV of 21%, which included all atypical naevi in its definition for a true positive 33 …”

Section: Discussionsupporting

confidence: 51%

“…Our PPV and NNE remains unchanged from this definition and our PPV nevertheless compares favourably to a teledermatology study from the United States with a PPV of 21%, which included all atypical naevi in its definition for a true positive. 33 To determine the number of missed melanomas and a false negative rate, all patients referred in 2014 were followed through as a sample cohort for review of subsequent histopathology reports for an additional 3 years. Only two lesions initially considered benign were subsequently histopathologically proven as melanoma, giving an FNR of 7%.…”

Section: E36mentioning

confidence: 99%

Virtual lesion clinic – Evaluation of a teledermatology triage system for referrals for suspected melanoma

Teague¹,

Wang²,

Wen³

et al. 2021

Aust J Dermatology

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Introduction:The Virtual Lesion Clinic (VLC) of Waitemat a District Health Board (WDHB) improves melanoma assessment and treatment using teledermatology. The VLC is reserved for pigmented lesions referred as suspected melanoma from primary care but indeterminate at the initial triage.Objectives: To assess the efficacy of the VLC diagnosis of melanoma.Methods: A retrospective audit of suspected melanoma referrals (1 January 2012 to 31 December 2016) was conducted. Lesions were referred to the VLC if diagnostic uncertainty remained at the initial triage. VLC patients attended MoleMap imaging centres, a dermatologist reviewed history and images remotely and suggested a diagnosis and management plan. Post VLC provisional diagnosis of melanoma, all lesions subsequently excised were reviewed. A positive predictive value (PPV) was calculated using concordance between VLC diagnosis of melanoma and histopathological diagnosis of melanoma. Number needed to excise (NNE) for melanoma was derived, as well as an invasive to in-situ melanoma ratio (IM:MIS) and false negative rate (FNR). Results:The VLC received 1874 referrals for 3546 lesions during the 5-year study period. Six hundred and seventy-nine lesions were recommended excision/biopsy or specialist face-to-face assessment, and 504 lesions were subsequently excised. The PPV was 62%, NNE 1.62 and IM:MIS 0.76 for lesions suspected to be melanoma at VLC assessment. The VLC had a melanoma-specific FNR of 7%. Conclusions:The VLC is effective in early diagnosis of melanoma with a high positive predictive value, low number needed to excise and low false negative rate amongst lesions referred as suspected melanoma.

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Digital skin imaging applications, part I: Assessment of image acquisition technique features

Sun

Kentley

Wilson

et al. 2022

Skin Research and Technology

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Background:The rapid adoption of digital skin imaging applications has increased the utilization of smartphone-acquired images in dermatology. While this has enormous potential for scaling the assessment of concerning skin lesions, the insufficient quality of many consumer/patient-taken images can undermine clinical accuracy and potentially harm patients due to lack of diagnostic interpretability. We aim to characterize the current state of digital skin imaging applications and comprehensively assess how image acquisition features address image quality. Materials and methods:Publicly discoverable mobile, web, and desktop-based skin imaging applications, identified through keyword searches in mobile app stores, Google Search queries, previous teledermatology studies, and expert recommendations were independently assessed by three reviewers. Applications were categorized by primary audience (consumer-facing, nonhospital-based practice, or enterprise/health system), function (education, store-and-forward teledermatology, live-interactive teledermatology, electronic medical record adjunct/clinical imaging storage, or clinical triage), inapp connection to a healthcare provider (yes or no), and user type (patient, provider, or both).Results: Just over half (57%) of 191 included skin imaging applications had at least one of 14 image acquisition technique features. Those that were consumer-facing, intended for educational use, and designed for both patient and physician users had significantly greater feature richness (p < 0.05). The most common feature was the inclusion of text-based imaging tips, followed by the requirement to submit multiple images and body area matching.

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Positive Predictive Value of Melanoma Diagnosis in Store-and-Forward Teledermatology

Cited by 6 publications

References 11 publications

Inter‐rater variability in patch test readings and final interpretation using store‐forward teledermatology

Inter‐rater variability in patch test readings and final interpretation using store‐forward teledermatology

Virtual lesion clinic – Evaluation of a teledermatology triage system for referrals for suspected melanoma

Digital skin imaging applications, part I: Assessment of image acquisition technique features

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