Reliability of store and forward teledermatology for skin neoplasms - 15/02/15
, Amy A. Gravely, MA a, David B. Nelson, PhD a, cAbstract |
Background |
Teledermatology may be less optimal for skin neoplasms than for rashes.
Objectives |
We sought to determine agreement for skin neoplasms.
Methods |
This was a repeated measures study. Each lesion was examined by a clinic dermatologist and a teledermatologist; both generated a primary diagnosis, up to 2 differential diagnoses, and management. Macro images and polarized light dermoscopy images were obtained; for pigmented lesions only, contact immersion dermoscopy image was obtained.
Results |
There were 3021 lesions in 2152 patients. Of 1685 biopsied lesions, there were 410 basal cell carcinomas (24%), 240 squamous cell carcinomas (14%), and 41 melanomas (2.4%). Agreement was fair to substantial for primary diagnosis (45.7%-80.1%; kappa 0.32-0.62), substantial to almost perfect for aggregated diagnoses (primary plus differential; 78.6%-93.9%; kappa 0.77-0.90), and fair for management (66.7%-86.1%; kappa 0.28-0.41). Diagnostic agreement rates were higher for pigmented lesions (52.8%-93.9%; kappa 0.44-0.90) than nonpigmented lesions (47.7%-87.3%; kappa 0.32-0.86), whereas the reverse was found for management agreement (pigmented: 66.7%-79.8%, kappa 0.19-0.35 vs nonpigmented: 72.0%-86.1%, kappa 0.38-0.41). Agreement rates using macro images were similar to polarized light dermoscopy; contact immersion dermoscopy, however, significantly improved rates for pigmented lesions.
Limitations |
We studied a homogeneous population.
Conclusions |
Diagnostic agreement was moderate to almost perfect whereas management agreement was fair. Polarized light dermoscopy increased rates modestly whereas contact immersion dermoscopy significantly increased rates for pigmented lesions.
Le texte complet de cet article est disponible en PDF.Key words : dermoscopy, diagnosis, management, reliability, skin cancer, teledermatology
Plan
| This research was supported by the Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service IIR 01-072-2. During this study, Dr Warshaw was supported by a VA Cooperative Studies Clinical Research Career Development Award. |
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| Conflicts of interest: None declared. |
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| The findings and conclusions presented in this report are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or Health Services Research and Development Service. |
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| Reprints not available from the authors. |
Vol 72 - N° 3
P. 426-435 - mars 2015 Retour au numéro
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