title: Comparison of skin biopsy triage decisions in 49 patients with pigmented lesions and skin neoplasms: store-and-forward teledermatology vs face-to-face dermatology.
abstract: OBJECTIVE
  To determine the relative efficacy of store-and-forward teledermatology vs face-to-face dermatology consultations in triage decisions about the need for a biopsy of neoplastic skin changes.
  
  
  METHODS
  Prospective study of consecutive patients judged by an internist to require dermatologic consultation for a skin growth.
  
  
  METHODS
  Private primary care and dermatology practices and an academic dermatology practice.
  
  
  METHODS
  Patients requiring dermatology consultation for evaluation of skin growths. Patients were seen by a single primary care physician between July 10, 1998, and August 4, 2000.
  
  
  METHODS
  Digital photographs of skin growths were obtained by the primary care physician and evaluated by a teledermatologist. The patient was then seen face-to-face by a dermatologist. A biopsy was performed if either dermatologist favored biopsy.
  
  
  METHODS
  Decisions to perform a biopsy. Agreement between the dermatologists was assessed.
  
  
  RESULTS
  Of the 49 patients with evaluable photographs, the face-to-face dermatologist and teledermatologist recommended a biopsy for the same 26 patients, yielding a sensitivity of the teledermatologist of 1.00 (95% confidence interval [CI], 0.87-1.00) and a specificity of 1.00 (95% CI, 0.85-1.00). The agreement between the dermatologists (kappa) was 1.00 (95% CI, 0.72-1.00).
  
  
  CONCLUSIONS
  Store-and-forward teledermatology may provide an accurate and cost-effective method of determining whether skin growths in patients presenting to primary care physicians should undergo biopsy.
authors.affiliation: Departments of Dermatology, University of Pennsylvania, Penn State Milton S. Hershey Medical Center, Philadelphia, PA 19104, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Shapiro
authors.forename: William D
authors.initials: WD
authors.lastname: James
authors.forename: Rex
authors.initials: R
authors.lastname: Kessler
authors.forename: Francis C
authors.initials: FC
authors.lastname: Lazorik
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Katz
authors.forename: John
authors.initials: J
authors.lastname: Tam
authors.forename: David S
authors.initials: DS
authors.lastname: Nieves
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Miller
mesh_terms: D001706:Biopsy / Q000706:statistics & numerical data; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology; D003880:Dermatology / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007642:Keratosis / Q000175:diagnosis / Q000473:pathology; D010414:Pennsylvania; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019114:Remote Consultation; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016896:Treatment Outcome; D014218:Triage