title: Accuracy of teledermatology for nonpigmented neoplasms.
abstract: BACKGROUND
  Studies of teledermatology utilizing the standard reference of histopathology are lacking.
  
  
  OBJECTIVE
  To compare accuracy of store-and-forward teledermatology for non-pigmented neoplasms with in-person dermatology.
  
  
  METHODS
  This study was a repeated-measures equivalence trial involving veterans with non-pigmented skin neoplasms. Each lesion was evaluated by an in-person dermatologist and a teledermatologist; both generated a primary diagnosis, up to two differential diagnoses, and management plan. The primary outcome was aggregated diagnostic accuracy (percent correct matches of any chosen diagnosis with histopathology). Secondary outcomes included management plan accuracy (percent correct matches with expert panel management plan). Additional analyses included evaluation of the incremental effect of using polarized light dermatoscopy in addition to standard macro images, and evaluating benign and malignant lesion subgroups separately.
  
  
  RESULTS
  Most of the 728 participants were male (97.8%) and Caucasian (98.9%). The aggregated diagnostic accuracy (primary outcome) of teledermatology (macro images) was not equivalent (95% confidence interval [CI] for difference within +/-10%) and was inferior (95% CI lower bound <10%) to in-person dermatology for all lesions and the subgroups of benign and malignant lesions. However, management plan accuracy was equivalent. Teledermatology aggregated diagnostic accuracy using polarized light dermatoscopy was significantly better than for macro images alone (P = .0017). The addition of polarized light dermatoscopy showed the same pattern for malignant lesions, but not for benign lesions. Most interestingly, for malignant lesions, the addition of polarized light dermatoscopy yielded equivalent aggregated diagnostic accuracy rates.
  
  
  CONCLUSIONS
  Non-diverse study population.
  
  
  CONCLUSIONS
  Using macro images, the diagnostic accuracy of teledermatology was inferior to in-person dermatology, but accuracy of management plans was equivalent. The addition of polarized light dermatoscopy yielded significantly better aggregated diagnostic accuracy, but management plan accuracy was not significantly improved. For the important subgroup of malignant lesions, the addition of polarized light dermatoscopy yielded equivalent diagnostic accuracy between teledermatologists and clinic dermatologists.
authors.affiliation: Minneapolis Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota 55417, USA. erin.warshaw@med.va.gov
authors.forename: Erin M
authors.initials: EM
authors.lastname: Warshaw
authors.forename: Frank A
authors.initials: FA
authors.lastname: Lederle
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Grill
authors.forename: Amy A
authors.initials: AA
authors.lastname: Gravely
authors.forename: Ann K
authors.initials: AK
authors.lastname: Bangerter
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Fortier
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Bohjanen
authors.forename: Karen
authors.initials: K
authors.lastname: Chen
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lee
authors.forename: Harold S
authors.initials: HS
authors.lastname: Rabinovitz
authors.forename: Robert H
authors.initials: RH
authors.lastname: Johr
authors.forename: Valda N
authors.initials: VN
authors.lastname: Kaye
authors.forename: Sacharitha
authors.initials: S
authors.lastname: Bowers
authors.forename: Rachel
authors.initials: R
authors.lastname: Wenner
authors.forename: Sharone K
authors.initials: SK
authors.lastname: Askari
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kedrowski
authors.forename: David B
authors.initials: DB
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003880:Dermatology / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012878:Skin Neoplasms / Q000473:pathology*; D017216:Telemedicine; D055815:Young Adult