title: Effect of teledermatology on the prognosis of patients with cutaneous melanoma.
abstract: OBJECTIVE
  To evaluate differences in the initial prognosis of patients with cutaneous melanoma managed by teledermatology (TD) vs other non-TD referral systems.
  
  
  METHODS
  Descriptive and longitudinal study of a store-and-forward TD system aimed at the triage of patients with suspicious pigmented lesions.
  
  
  METHODS
  In 2003, a store-and-forward TD triage system aimed at the selection of patients with skin growths suggestive of cancer was implemented at a skin cancer clinic. This system has been shown to be accurate and reliable and able to significantly shorten waiting periods for consultation with a dermatologist.
  
  
  METHODS
  Patients with primary cutaneous melanoma referred to the Melanoma Clinic of the Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain, by TD or non-TD tracks were included in the study.
  
  
  METHODS
  Decisions on the referral of patients with suspicious skin lesions by store-and-forward TD vs by a conventional referral system. Breslow thickness and tumor stage were recorded in each study group (TD and non-TD) and were compared.
  
  
  RESULTS
  Two hundred one patients with primary cutaneous melanoma were enrolled in the study. In total, 33.3% were managed at their primary care center by teleconsultation, whereas 66.7% were managed by a conventional referral system. The mean Breslow thickness was significantly lower among patients in the TD group than among patients in the non-TD group (1.06 vs 1.64 mm, P = .03). The frequency of melanoma with a favorable initial prognosis (tumor stages Tis and T1a) was significantly higher in the TD group (70.1% vs 56.9%, P = .03). The odds ratio of having a cutaneous melanoma with a favorable initial prognosis in the TD group was 1.96 (95% CI, 1.14-3.50; P = .04).
  
  
  CONCLUSIONS
  Teledermatology as a screening system for cutaneous melanoma has a favorable effect on the initial prognosis of patients with melanoma.
authors.affiliation: Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain. lferrandiz@e-derma.org
authors.forename: Lara
authors.initials: L
authors.lastname: Ferrándiz
authors.forename: Andres
authors.initials: A
authors.lastname: Ruiz-de-Casas
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Martin-Gutierrez
authors.forename: Francisco
authors.initials: F
authors.lastname: Peral-Rubio
authors.forename: Cristina
authors.initials: C
authors.lastname: Mendez-Abad
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Rios-Martin
authors.forename: David
authors.initials: D
authors.lastname: Moreno-Ramirez
mesh_terms: D003880:Dermatology / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology*; D017216:Telemedicine