The role of dermatopathology in conjunction with teledermatology in resource-limited settings: lessons from the African Teledermatology Project.
BACKGROUND
Access to dermatology and dermatopathology services is scarce in sub-Saharan Africa. Teledermatology provides consultations for healthcare providers in resource-limited settings where specialty medical services are difficult to obtain, and the African Teledermatology Project has helped to bridge the gap in dermatological care in Africa. This program also allows for biopsy specimens to be sent to the USA for processing in cases where the clinical diagnosis is difficult and definitive diagnosis has implications for patient management. This study characterizes conditions diagnosed through clinicopathological correlation in conjunction with photos and tissue submitted to the African Teledermatology Project.


METHODS
Retrospective case review of tissue specimens submitted over three years.


RESULTS
Fifty-five biopsy specimens met inclusion criteria and represent cases of malignancy (35%), infection (7%), suspected infection (15%), lichenoid tissue reaction (5%), dermatitis (15%), and other various conditions (18%). Three biopsy specimens were non-diagnostic (5%). Clinicopathological concordance between submitting clinician and biopsy results occurred in 32 out of 55 cases (58%). Clinical and pathological diagnoses differed in 21 out of 55 cases (38%). Kaposi sarcoma (KS) represents the clinical diagnosis most often suspected in the evaluated biopsy specimens (42%) and was correctly recognized clinically in 13 out of 23 cases (57%).


CONCLUSIONS
Clinical images may not provide sufficient information to definitively diagnose certain infectious and malignant dermatological conditions submitted through telemedicine consultation. Microscopic examination of skin biopsy specimens is an important adjunct for accurate diagnosis of disease and determination of appropriate treatment strategies.
Department of Dermatology, University of Minnesota, Minneapolis, MN, USA.
Matthew W
MW
Tsang
Carrie L
CL
Kovarik
D017954:Africa South of the Sahara; D003880:Dermatology / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D005260:Female; D006078:Government Programs; D006801:Humans; D008297:Male; D015397:Program Evaluation; D012189:Retrospective Studies; D012871:Skin Diseases / Q000175:diagnosis* / Q000473:pathology; D017216:Telemedicine / Q000191:economics / Q000379:methods* / Q000458:organization & administration
J Am Acad Dermatol. 2010 Aug;63(2):346-8
20633808
J Eur Acad Dermatol Venereol. 2007 Jan;21(1):30-4
17207164
J Am Acad Dermatol. 2009 Jul;61(1):155-7
19539859
Sex Transm Infect. 2009 Aug;85(4):261-3
19625295
Pan Afr Med J. 2009 Nov 19;3:16
21532725
Am J Clin Pathol. 2004 Mar;121(3):335-42
15023037
Am J Clin Pathol. 2007 Feb;127(2):263-70
17210517
Curr Probl Dermatol. 2003;32:233-46
12472018
J Clin Microbiol. 2006 Dec;44(12):4616-8
17021066
Pediatr Infect Dis J. 2009 May;28(5):426-8
19295460
Am J Clin Pathol. 2004 Mar;121(3):330-4
15023036