In-Person Dermatology More Accurate than Teledermatology for Skin Lesions
Teledermatology has the potential to radically expand and improve cost-effective, high-quality dermatological care. However, correct diagnosis and management is critical, particularly because of the potential for mortality and morbidity associated with malignant skin lesions (or neoplasms). Due to improved digital photography and Internet availability, at least two-thirds of teledermatology programs use store-and-forward technology - still images of skin viewed by remote dermatologists. This study compared the accuracy of store-and-forward teledermatology for non-pigmented skin lesions with in-person dermatology. Participants included 728 Veterans who had a skin lesion diagnosed at the Minneapolis VAMC dermatology clinic. Investigators assessed diagnostic accuracy, defined as agreement of the primary or any differential diagnoses with histopathology results, as well as the appropriateness of the treatment plan.
Findings show that the diagnostic accuracy of teledermatology was inferior to in-person dermatology, but the accuracy of treatment plans was equivalent. The addition of polarized light dermatoscopy (PLD) to macro images (standard method used in teledermatology) yielded significantly better diagnostic accuracy for teledermatology overall, but there remained no significant difference in the accuracy of treatment plans. Although the diagnostic accuracy of teledermatology was inferior to standard clinical dermatology, this study confirms the clinical utility of teledermatology for management of non-pigmented lesions and underscores the important role of PLD images for diagnosis of malignant non-pigmented lesions.
Warshaw E, Lederle F, Grill J, et al. Accuracy of teledermatology for non-pigmented neoplasms. Journal of the American Academy of Dermatology April 2009;60(4):579-588.
This study was funded by HSR&D. Several authors including Drs. Warshaw and Lederle, and Mr. Grill are part of HSR&D's Center for Chronic Disease Outcomes Research in Minneapolis.