The use of teledermoscopy in the accurate identification of cancerous skin lesions in the adult population: A systematic review

Abstract

Background The use of teledermoscopy in the diagnostic management of pre-cancerous and cancerous skin lesions involves digital dermoscopic images transmitted over telecommunication networks via email or web applications. Teledermoscopy may improve the accuracy in clinical diagnoses of melanoma skin cancer if integrated into electronic medical records and made available to rural communities, potentially leading to decreased morbidity and mortality. Objective and method The purpose of this paper is to present a systematic review of evidence on the use of teledermoscopy to improve the accuracy of skin lesion identification in adult populations. The PRISMA method guided the development of this systematic review. A total of seven scholarly databases were searched for articles published between the years of 2000 and 2015. All studies were critically appraised using the Rosswurm and Larrabee critique worksheet, placed in a matrix for comparison evaluating internal and external validity and inspected for homogeneity of findings. Results Sixteen articles met inclusion criteria for this review. A majority of the studies were cross-sectional and non-experimental. Ten of the 16 focused on interobserver concordance and diagnostic agreement between teledermoscopy and another comparator. Instrumentation in conducting the studies showed inconsistency with reported results. Discussion Higher level evidence is needed to support clinical application of teledermoscopy for accuracy of diagnostic measurement in the treatment of pre-cancerous and cancerous skin lesions in adults. Future research is needed to develop a standardized, reliable and valid measurement tool for implementation in clinical practice.

Praxis der Teledermatologie

“…Auch aus diesem Forschungsbereich ist jedoch bekannt, dass trotz eindeutiger Evidenz und klinischem Nutzen die Implementierung telemedizinischer Versorgung in die Praxis verzögert ist . Ähnliche Befunde konstatieren auch die jüngsten Reviews zur Teledermatologie, nach deren Schlussfolgerungen selbst als valide und praxistauglich befundene Systeme nur schleppend in die Versorgung gelangen .…”

“…Die Teledermatoskopie ist eine Untergruppe der Teledermatologie, bei der dermatoskopische Bilder übertragen werden. Die meisten teledermatoskopischen Studien beschäftigen sich daher mit der Diagnose von Hauttumoren . Oft werden in diesen Studien klinische Bilder gemeinsam mit auflichtmikroskopischen Bildern zur Befundung übertragen.…”

The opinion of dermoscopy experts about teledermoscopy involving primary care physicians and dermatologists

“…Since there are only few studies published about teledermoscopy in the hand of PCP with poor level of evidence, we asked the opinion of dermoscopy experts (board members of the International Dermoscopy Society (IDS)). [1][2][3][4][5][6] Furthermore, we investigated the routing of patients with a suspicious pigmented skin lesion and the use of teledermoscopy in different countries.…”

“…On Reply to sentinel lymph node biopsy (SLNB) plus wide local excision vs. wide local excision alone for primary cutaneous melanoma: a systematic review and meta-analysis -SLNB is not associated with a significantly better outcome in melanoma survival Dear Editor, With interest I read the review about sentinel lymph node biopsy (SLNB) and wide local excision (WLE) compared to WLE alone for primary cutaneous melanoma written by Santos-Juanes J. et al 1 Authors took a heavy burden of work; however, I worry that the authors took prematurely conclusions, and their analysis leads to inadequate reasoning for a survival benefit in the SLNB group against the evidence of the data.…”

“…3 This is inconsistent and concerning as the Kachare's study was the single study that did draw all the other studies towards a positive result as stated by the authors. 1 So it is worth to take a closer look for confounding variables in this single strong positive trial included in this systematic review. And indeed, the selected positive SLNB cohort study by Kachare et al contains a confounding factor, that is significantly older patients in the control group.…”