title: Teledermatology-based presurgical management for nonmelanoma skin cancer: a pilot study.
abstract: BACKGROUND
  To date, no previous experiences of teledermatology (TD) as a preoperative management facility have been published.
  
  
  OBJECTIVE
  The objective was to evaluate a store-and-forward TD (SFTD) system aimed at the presurgical management of nonmelanoma skin cancer patients.
  
  
  METHODS
  This was a multicenter, longitudinal, descriptive, and evaluative pilot study. Patients included in the TD-based surgical referral system presented with a nonmelanoma skin cancer or a fast-growth vascular tumor suitable for surgery under local anesthesia. Waiting intervals and on-the-day cancellation rates were evaluated and compared with a sample of patients managed through the conventional system. The accuracy of the diagnoses yielded and of the surgical techniques planned through teleconsultation was also calculated.
  
  
  RESULTS
  A total of 134 patients were enrolled in the study. The mean waiting interval was 26.10 days [95% confidence interval (CI), 24.51-27.70] in patients managed through TD and 60.57 days (95% CI, 56.20-64.93 days; n=92; p < .001) in the conventional system. On-the-day surgery cancellation was 2.99% (95% CI, 1.52%-4.46%) for the TD series and 8.85% (95% CI, 5.62%-11.81%; p<.005) in the conventional system. The accuracy of the telediagnoses was kappa=0.86 (95% CI, 0.83-0.89). The agreement rate between the surgical technique planned through teleconsultation and the technique finally performed was kappa=0.75 (95% CI, 0.04-0.79).
  
  
  CONCLUSIONS
  SFTD has been demonstrated to be effective and accurate as a preoperative tool for nonmelanoma skin cancer, avoiding unnecessary visits to the hospital and shortening the waiting intervals to the surgical treatment.
authors.affiliation: Pigmented Lesion, Skin Cancer and Teledermatology Clinic, University Hospital Virgen Macarena, Seville, Spain. ferrandizpulido@e-derma.org
authors.forename: Lara
authors.initials: L
authors.lastname: Ferrandiz
authors.forename: David
authors.initials: D
authors.lastname: Moreno-Ramirez
authors.forename: Adoracion
authors.initials: A
authors.lastname: Nieto-Garcia
authors.forename: Rafael
authors.initials: R
authors.lastname: Carrasco
authors.forename: Pedro
authors.initials: P
authors.lastname: Moreno-Alvarez
authors.forename: Rafael
authors.initials: R
authors.lastname: Galdeano
authors.forename: Esther
authors.initials: E
authors.lastname: Bidegain
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Rios-Martin
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Camacho
mesh_terms: D000368:Aged; D003880:Dermatology / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019114:Remote Consultation / Q000458:organization & administration; D012878:Skin Neoplasms / Q000601:surgery*