Successful triage of patients referred to a skin lesion clinic using teledermoscopy (IMAGE IT trial).
BACKGROUND
Teledermatology is a rapidly growing field with studies showing high diagnostic accuracy when compared with face-to-face diagnosis. Teledermoscopy involves the use of epiluminescence microscopy to increase diagnostic accuracy. The utility of teledermoscopy as a triage tool has not been established.


OBJECTIVE
To assess teledermoscopy as a triage tool for a hospital skin lesion clinic.


METHODS
Patients referred to a dermatology skin lesion clinic were recruited. Digital and dermoscopic photographs were taken of skin lesions of concern and the patients were then seen independently face-to-face by two out of three dermatologists. The digital images were evaluated 4 weeks later, as a teledermoscopy consultation, by two of these dermatologists. The diagnosis and management from both types of consultation were compared.


RESULTS
Two hundred patients with a total of 491 lesions were seen. There was excellent agreement between teledermoscopy and face-to-face diagnosis with only 12.3% of lesions having disparate diagnoses of clinical significance. Twelve of 491 (2.4%) lesions appeared to have been under-reported by teledermoscopy when compared with face-to-face diagnosis. However, when histopathology became available, only one malignant lesion had been missed (a basal cell carcinoma diagnosed as solar keratosis) by teledermoscopy. Teledermoscopy approximated 100% sensitivity and 90% specificity for detecting melanoma and nonmelanoma skin cancers. Importantly, 74% of all lesions were determined to be manageable by the general practitioner without needing to be seen face-to-face by a dermatologist.


CONCLUSIONS
This use of teledermoscopy as a triage tool offers the potential to shorten waiting lists and thus improve healthcare access and delivery.
Tan
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E
Department of Dermatology, Waikato Hospital, Hamilton, Waikato 3204, New Zealand. spinothalamic@yahoo.co.nz
Yung
A
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Jameson
M
M
Oakley
A
A
Rademaker
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003880:Dermatology / Q000191:economics / Q000379:methods* / Q000639:trends; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012871:Skin Diseases / Q000175:diagnosis*; D017216:Telemedicine / Q000191:economics / Q000379:methods* / Q000639:trends; D014218:Triage / Q000379:methods; D055815:Young Adult