title: Feasibility of a two-step teledermatologic approach for the management of patients with multiple pigmented skin lesions.
abstract: BACKGROUND
  Recent studies demonstrating accuracy of teledermatology and teledermoscopy in the evaluation of pigmented skin lesions (PSL) have been performed only on PSL previously selected by face-to-face examination.
  
  
  OBJECTIVE
  The objective was to investigate the feasibility of teledermatology for the management of individuals exhibiting multiple PSL with a two-step procedure.
  
  
  METHODS
  In the first step, remote consultants selected clinically equivocal lesions evaluating a teletransmitted clinical image of patients' backs. In the second step, dermoscopic images of selected lesions were evaluated. Management recommendations of both steps were compared with face-to-face.
  
  
  RESULTS
  For a total of 465 PSL in 18 patients, the agreement between the face-to-face and the two remote experts resulted moderate (kappa value, 0.530-0.565) in the first step and substantial (kappa value, 0.681-0.703) in the second step.
  
  
  CONCLUSIONS
  Although there are limitations of this pilot experience (population and technical restrictions), our results provide preliminary evidence that a two-step teledermatologic approach may be feasible in managing individuals with multiple PSL.
authors.affiliation: Department of Dermatology, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Stefani
authors.forename: Iris
authors.initials: I
authors.lastname: Zalaudek
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.forename: Sergio
authors.initials: S
authors.lastname: Chimenti
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
mesh_terms: D000293:Adolescent; D000328:Adult; D001415:Back; D002648:Child; D046169:Dermoscopy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000473:pathology* / Q000601:surgery*; D015588:Observer Variation; D010865:Pilot Projects; D019114:Remote Consultation; D015203:Reproducibility of Results