Reliability of Telemedicine in Evaluating Skin Tumors

Phillips, Charles M.; Burke, William A.; Allen, Mary; Stone, Debbie; Wilson, James L.

doi:10.1089/tmj.1.1998.4.5

Cited by 64 publications

(44 citation statements)

References 3 publications

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“…[39][40][41][42][43][44] Behavioral interventions, nutritional counseling, and specialist referrals for pediatric obesity treatment have demonstrated variable short-term as well as long-term success with respect to weight loss or maintenance, depending on the content and intensity of intervention components. [45][46][47][48][49] Patients included in our study did demonstrate significant short-term improvements in diet, activity and weight status while patients were in treatment.…”

Section: Discussionmentioning

confidence: 99%

Clinical Management and Patient Outcomes Among Children and Adolescents Receiving Telemedicine Consultations for Obesity

Shaikh

Cole

Marcin

et al. 2008

Telemedicine and e-Health

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Section: Discussionmentioning

confidence: 99%

Clinical Management and Patient Outcomes Among Children and Adolescents Receiving Telemedicine Consultations for Obesity

Shaikh

Cole

Marcin

et al. 2008

Telemedicine and e-Health

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“…Most of these studies demonstrate high accordance for the diagnosis of inflammatory and neoplastic skin diseases [17, 18, 19, 20, 21], and particularly for the diagnosis of pigmented skin lesions (teledermoscopy) [22, 23, 24, 25, 26]. Up to now only a few reports have discussed the use of teledermatology in the diagnosis and care of patients with leg ulcers [27, 28, 29, 30].…”

Section: Discussionmentioning

confidence: 99%

Wound Teleconsultation in Patients with Chronic Leg Ulcers

Salmhofer¹,

Hofmann‐Wellenhof²,

Gabler

et al. 2005

Dermatology

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Background: The treatment of chronic leg ulcers requires frequent assessments of local wound status and adjustment of therapy. The availability of reasonably priced photographic equipment and quick electronic transfer of high-quality digital images should make it possible that the assessment of wound status can be made by remote experts. Objective: This study examines the feasibility of using teledermatology for wound assessment and therapeutic suggestions for patients with chronic leg ulcers. Methods: One hundred ten chronic leg ulcers of different origins were examined in face-to-face consultations. The examining doctor assessed the wound, made therapeutic recommendations and took 1–4 photographs of the wound using a digital camera. The digital images and relevant clinical information were then transmitted via a web application to an expert in wound care, who provided an independent teledermatological assessment of wound status and therapeutic recommendations. Results: In our study, a high accordance between direct consultations and electronic consultations was found in the assessment of chronic leg ulcers, especially for important features like slough (concordance: 84.6%), necrosis (concordance: 98.2%) and granulation tissue formation (concordance: 76.4%). Furthermore, the teledermatologist generally felt confident in recommending further treatment strategies and in planning further wound assessments via the internet. Conclusions: Our results suggest that teledermatology offers great potential for the future in chronic wound care. By reducing the need to travel long distances to the hospital or to consult a physician with expertise in wound care, wound teleconsultation might lower health care costs and improve the quality of life for patients with chronic wounds, while still maintaining a high quality of wound care.

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“…22 Few studies on TD have dealt with the evaluation of validity in terms of sensitivity and specificity. 3,23,28 Moreover, to our knowledge, no evaluation study of TD has dealt with other indicators of diagnostic performance recommended by the STARD (Standards for Reporting of Diagnostic Accuracy) guidelines, which may strengthen the results obtained by the simple assessment of sensitivity and specificity. 12 In these terms, the finding of a posttest likelihood higher than the pretest likelihood suggests that this tool is useful for the diagnosis of skin cancer.…”

Section: 3mentioning

confidence: 99%

Store-and-Forward Teledermatology in Skin Cancer Triage

Ferrándiz²,

et al. 2007

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To evaluate a store-and-forward teledermatology system aimed at the routine triage of patients with skin cancer.Design: A multicenter, longitudinal, 4-phase, descriptive and evaluation study of a referred sample of patients attended through teleconsultation between March 2004 and July 2005. Clinical and dermoscopical examination and histopathological study were considered the gold standard.Setting: A skin cancer unit of a public university hospital and 12 primary care centers in southern Spain. Patients:The study population comprised patients with circumscribed lesions fulfilling at least 1 of the following criteria: changes in ABCD criteria (asymmetry, border irregularity, color variegation, and diameter Ͼ6 mm), recent history, multiple melanocytic lesions, symptoms, and/or patient's application for surgical treatment and concern about moles.Interventions: Diagnosis, diagnostic category (malignant lesions, high-risk lesions, benign lesions, special lesions, and other lesions), diagnostic confidence level on a 3-point scale, and management decision (referral vs nonreferral) were listed after the evaluation of each teleconsultation. A face-to-face evaluation and biopsy of selected patients were performed. Main Outcome Measures:The filtering percentage, as the percentage of patients not referred to the face-to-face clinic, as well as waiting intervals and pick-up or skin cancer detection rates were evaluated as effectiveness indicators. Reliability measures ( agreement), accuracy, and diagnostic performance indicators (validity) were also evaluated.Results: The filtering percentage was 51.20% (95% confidence interval [CI], 49.00%-53.40%). The waiting interval to attend the clinic was 12.31 days (95% CI, 8.22-16.40 days) through teledermatology and 88.62 days (95% CI, 38.42-138.82 days; PϽ.001) for the letter referral system. Pick-up rates were 2.02% (95% CI, 1.10%-2.94%) for malignant melanoma and 27.94% (95% CI, 24.98%-30.90%) or 1:3.71 for patients with any malignant or premalignant lesion. Intraobserver agreement was =0.91 (95% CI, 0.89-0.93) for the management decision and =0.95 (95% CI, 0.94-0.96) for the diagnosis. Interobserver concordance was =0.83 (95% CI, 0.78-0.88) for the management decision and = 0.85 (95% CI, 0.79-0.91) for the diagnosis. Accuracy was =0.

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Reliability of Telemedicine in Evaluating Skin Tumors

Abstract: The concern about the malignancy of a particular skin lesion and the recommendation whether to do a biopsy were not significantly affected by telemedicine technology.

Cited by 64 publications

References 3 publications

Clinical Management and Patient Outcomes Among Children and Adolescents Receiving Telemedicine Consultations for Obesity

Clinical Management and Patient Outcomes Among Children and Adolescents Receiving Telemedicine Consultations for Obesity

Wound Teleconsultation in Patients with Chronic Leg Ulcers

Store-and-Forward Teledermatology in Skin Cancer Triage

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