title: Teledermoscopy in doubtful melanocytic lesions: is it really useful?
abstract: BACKGROUND
  The diagnosis of cutaneous pigmented lesions remains a challenge for both dermatologists and pathologists. Our aim was to determine the diagnostic concordance between the conventional face-to-face diagnosis and the telediagnosis of 10 dermatologists with expertise in dermato-oncology of 10 challenging pigmented lesions.
  
  
  METHODS
  Using a store-and-forward teledermatology method, clinical and dermoscopic digital images of all selected lesions were transmitted via e-mail to 10 dermatologists. Dermatologists were called to provide their telediagnoses with a step-by-step approach. When the dermatologists responded with their first clinical telediagnosis, they received a second email that contained dermoscopic images of the 10 cases. Final histopathological diagnosis was considered the gold standard for comparison with face-to-face and teledermatology diagnoses in statistical analysis.
  
  
  RESULTS
  Face-to-face results indicated moderate agreement between clinical and histopathological diagnoses (K = 0.6). After the first clinical step, interobserver concordance of telediagnosis was lower than face-to-face diagnosis (K = 0.52). After the second dermoscopy step, the concordance declined further (K = 0.38).
  
  
  CONCLUSIONS
  Teledermatology was inferior to face-to-face dermatology. Moreover, the diagnostic concordance of telediagnosis decreased after the teledermoscopic step. This finding may be justified by the dermoscopic difficulty of the selected lesions, including Spitzoid proliferations and atypical melanocytic nevi of the elderly. These lesions may represent a potential diagnostic pitfall given their confounding dermoscopic aspects.
authors.affiliation: Department of Dermatology, University of Florence, Florence, Italy. vincenzo.degiorgi@unifi.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: de Giorgi
authors.affiliation: Department of Dermatology, University of Florence, Florence, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Gori
authors.affiliation: Department of Dermatology, University of Florence, Florence, Italy.
authors.forename: Imma
authors.initials: I
authors.lastname: Savarese
authors.affiliation: Department of Dermatology, University of Florence, Florence, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: D'Errico
authors.affiliation: Department of Dermatology, University of Florence, Florence, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Grazzini
authors.affiliation: Department of Dermatology, University of Florence, Florence, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Papi
authors.affiliation: Department of Human Pathology and Oncology, University of Florence, Florence, Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Maio
authors.affiliation: Department of Surgery, University of Perugia, Perugia, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Covarelli
authors.affiliation: Department of Anatomic Pathology, Santa Maria Annunziata Hospital, Florence, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Urso
authors.affiliation: Department of Human Pathology and Oncology, University of Florence, Florence, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Massi
mesh_terms: D000328:Adult; D000368:Aged; D046169:Dermoscopy; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D018332:Nevus, Epithelioid and Spindle Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D015588:Observer Variation; D009819:Office Visits; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D017216:Telemedicine