title: Reliability of store and forward teledermatology for skin neoplasms.
abstract: BACKGROUND
  Teledermatology may be less optimal for skin neoplasms than for rashes.
  
  
  OBJECTIVE
  We sought to determine agreement for skin neoplasms.
  
  
  METHODS
  This was a repeated measures study. Each lesion was examined by a clinic dermatologist and a teledermatologist; both generated a primary diagnosis, up to 2 differential diagnoses, and management. Macro images and polarized light dermoscopy images were obtained; for pigmented lesions only, contact immersion dermoscopy image was obtained.
  
  
  RESULTS
  There were 3021 lesions in 2152 patients. Of 1685 biopsied lesions, there were 410 basal cell carcinomas (24%), 240 squamous cell carcinomas (14%), and 41 melanomas (2.4%). Agreement was fair to substantial for primary diagnosis (45.7%-80.1%; kappa 0.32-0.62), substantial to almost perfect for aggregated diagnoses (primary plus differential; 78.6%-93.9%; kappa 0.77-0.90), and fair for management (66.7%-86.1%; kappa 0.28-0.41). Diagnostic agreement rates were higher for pigmented lesions (52.8%-93.9%; kappa 0.44-0.90) than nonpigmented lesions (47.7%-87.3%; kappa 0.32-0.86), whereas the reverse was found for management agreement (pigmented: 66.7%-79.8%, kappa 0.19-0.35 vs nonpigmented: 72.0%-86.1%, kappa 0.38-0.41). Agreement rates using macro images were similar to polarized light dermoscopy; contact immersion dermoscopy, however, significantly improved rates for pigmented lesions.
  
  
  CONCLUSIONS
  We studied a homogeneous population.
  
  
  CONCLUSIONS
  Diagnostic agreement was moderate to almost perfect whereas management agreement was fair. Polarized light dermoscopy increased rates modestly whereas contact immersion dermoscopy significantly increased rates for pigmented lesions.
authors.affiliation: Minneapolis Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota School of Medicine, Minneapolis, Minnesota. Electronic address: erin.warshaw@va.gov.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Warshaw
authors.affiliation: Minneapolis Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota.
authors.forename: Amy A
authors.initials: AA
authors.lastname: Gravely
authors.affiliation: Minneapolis Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota; Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota.
authors.forename: David B
authors.initials: DB
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D046169:Dermoscopy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012878:Skin Neoplasms / Q000473:pathology*; D017216:Telemedicine / Q000706:statistics & numerical data; D055815:Young Adult
keywords: dermoscopy; diagnosis; management; reliability; skin cancer; teledermatology