title: Application of mobile teledermatology for skin cancer screening.
abstract: BACKGROUND
  With advancements in mobile technology, cellular phone-based store-and-forward teledermatology may be applied to skin cancer screening.
  
  
  OBJECTIVE
  We sought to determine diagnostic and management concordance between in-person and teledermatology evaluations for patients at skin cancer screening whose clinical images and history were transmitted through mobile phones.
  
  
  METHODS
  A total of 86 patients with 137 skin lesions presented to a skin cancer screening event in California. These patients' clinical history and skin images were captured by a software-enabled mobile phone. Patients were assessed separately by an in-person dermatologist and a teledermatologist, who evaluated the mobile phone-transmitted history and images. Diagnostic and management concordance was determined between the in-person and teledermatology evaluations.
  
  
  RESULTS
  The primary categorical diagnostic concordance was 82% between the in-person dermatologist and the teledermatologist (95% confidence interval 0.73-0.89), with a Kappa coefficient of 0.62 indicating good agreement. The aggregated diagnostic concordance between the in-person dermatologist and the teledermatologist was 62% (95% confidence interval 0.51-0.71), with Kappa coefficient of 0.60 indicating good agreement. Management concordance between the in-person dermatologist and the teledermatologist was 81% (95% confidence interval 0.72-0.88), with a Kappa coefficient of 0.57, which indicates moderate agreement between the dermatologists. Multivariate analysis showed that older age and presentation of atypical nevus were significantly associated with disagreement in diagnosis between the teledermatologist and in-person dermatologist, after adjusting for other factors.
  
  
  CONCLUSIONS
  Dermatoscopic images were not captured via mobile phones, which might improve diagnostic accuracy.
  
  
  CONCLUSIONS
  Mobile teledermatology using cellular phones is an innovative and convenient modality of providing dermatologic consultations for skin cancer screening.
authors.affiliation: Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, California 95816, USA.
authors.forename: Sonia A
authors.initials: SA
authors.lastname: Lamel
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Haldeman
authors.forename: Haines
authors.initials: H
authors.lastname: Ely
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Kovarik
authors.forename: Hon
authors.initials: H
authors.lastname: Pak
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
mesh_terms: D000328:Adult; D002140:California; D040421:Cell Phone / Q000295:instrumentation*; D003880:Dermatology / Q000295:instrumentation* / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation / Q000458:organization & administration / Q000706:statistics & numerical data; D008875:Middle Aged; D015588:Observer Variation; D011230:Precancerous Conditions / Q000175:diagnosis; D015397:Program Evaluation; D012878:Skin Neoplasms / Q000175:diagnosis*; D012984:Software; D017216:Telemedicine / Q000295:instrumentation* / Q000458:organization & administration*