title: Teledermatoscopy as a triage system for pigmented lesions: a pilot study.
abstract: BACKGROUND
  Skin-cancer screening should rely on simple, low-cost and high-sensitivity diagnostic procedures.
  
  
  OBJECTIVE
  To compare diagnosis and management options after the evaluation of clinical and dermatoscopic teleconsultations with a store-and-forward teledermatology screening system for pigmented lesions.
  
  
  METHODS
  Kappa values between telediagnoses and the gold standard (histological examination) were assessed. Referral rates, diagnostic confidence level (DCL), sensitivity and specificity were evaluated in both approaches. Picture quality and time and cost investments were also measured. In total, 61 teleconsultations were evaluated.
  
  
  RESULTS
  Sensitivity of the clinical and dermatoscopic teleconsultations was 1 for both, whereas specificities were 0.65 and 0.78, respectively (P < 0.05). DCL was higher for the dermatoscopic teleconsultations (4.75 vs. 4.14, P < 0.05). Agreement between the clinical and dermatoscopic teleconsultation was kappa = 0.89 (95% CI 0.81-0.97). Agreement with the gold standard was 0.91 (95% CI 0.82-1.00) for the clinical teleconsultation and 0.94 (95% CI 0.88-1.00) for teledermatoscopy (P > 0.05). Teledermatoscopy increased the economic investment of a teledermatology facility by 2.4 times. The GP spent 1.5 times longer on dermatoscopic teleconsultations.
  
  
  CONCLUSIONS
  Teledermatoscopy has improved the DCL, specificity and referral rates of a teledermatology-based screening system for pigmented lesions. A more detailed economic analysis remains to be performed before recommending teledermatoscopy as a routine screening procedure in pigmented-lesion clinics.
authors.affiliation: Pigmented Lesion and Teledermatology Clinic, Department of Dermatology, University Hospital Virgen Macarena, Seville, Spain. dmoreno@e-derma.org
authors.forename: D
authors.initials: D
authors.lastname: Moreno-Ramirez
authors.forename: L
authors.initials: L
authors.lastname: Ferrandiz
authors.forename: R
authors.initials: R
authors.lastname: Galdeano
authors.forename: F M
authors.initials: FM
authors.lastname: Camacho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D046169:Dermoscopy / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012017:Referral and Consultation; D019114:Remote Consultation / Q000191:economics / Q000379:methods*; D012680:Sensitivity and Specificity; D012871:Skin Diseases / Q000175:diagnosis* / Q000473:pathology; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology; D014218:Triage / Q000379:methods*