title: Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: A randomized teledermoscopy trial.
abstract: BACKGROUND
  Teledermoscopy involves the use of dermoscopic images for remote consultation and decision-making in skin cancer screening.
  
  
  OBJECTIVE
  We sought to analyze the potential benefits gained from the addition of dermoscopic images to an internet-based skin cancer screening system.
  
  
  METHODS
  A randomized clinical trial assessed the diagnostic performance and cost-effectiveness of clinical teleconsultations (CTC) and clinical with dermoscopic teleconsultations.
  
  
  RESULTS
  A total of 454 patients were enrolled in the trial (nCTC= 226, nclinical with dermoscopic teleconsultation= 228). Teledermoscopy improved sensitivity and specificity (92.86% and 96.24%, respectively) compared with CTC (86.57% and 72.33%, respectively). Correct decisions were made in 94.30% of patients through clinical with dermoscopic teleconsultations and in 79.20% in CTC (P < .001). The only variable associated with an increased likelihood of correct diagnosis was management using teledermoscopy (odds ratio 4.04; 95% confidence interval 2.02-8.09; P < .0001). The cost-effectiveness analysis showed teledermoscopy as the dominant strategy, with a lower cost-effectiveness ratio (65.13 vs 80.84).
  
  
  CONCLUSIONS
  Potentially, a limitation is the establishment of an experienced dermatologist as the gold standard for the in-person evaluation.
  
  
  CONCLUSIONS
  The addition of dermoscopic images significantly improves the results of an internet-based skin cancer screening system, compared with screening systems based on clinical images alone.
authors.affiliation: Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain. Electronic address: lara.ferrandiz.sspa@juntadeandalucia.es.
authors.forename: Lara
authors.initials: L
authors.lastname: Ferrándiz
authors.affiliation: Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ojeda-Vila
authors.affiliation: Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain.
authors.forename: Araceli
authors.initials: A
authors.lastname: Corrales
authors.affiliation: Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Martín-Gutiérrez
authors.affiliation: Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Ruíz-de-Casas
authors.affiliation: Seville Primary Health Care District, Seville, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Galdeano
authors.affiliation: North Seville Primary Health Care District, Seville, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Álvarez-Torralba
authors.affiliation: North Seville Primary Health Care District, Seville, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sánchez-Ibáñez
authors.affiliation: North Seville Primary Health Care District, Seville, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Domínguez-Toro
authors.affiliation: North Seville Primary Health Care District, Seville, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Encina
authors.affiliation: Seville Primary Health Care District, Seville, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Narbona
authors.affiliation: Information and Communication Technologies Department, Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Herrerías-Esteban
authors.affiliation: Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Moreno-Ramírez
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003880:Dermatology / Q000191:economics / Q000379:methods*; D046169:Dermoscopy; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D010781:Photography / Q000191:economics; D010808:Physical Examination; D011230:Precancerous Conditions / Q000175:diagnosis / Q000191:economics; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D012871:Skin Diseases / Q000175:diagnosis / Q000191:economics; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000191:economics; D017216:Telemedicine / Q000191:economics / Q000379:methods*
keywords: dermoscopy; information and communication technologies; melanoma; nonmelanoma skin cancer; pigmented lesions; seborrheic keratosis; teledermatology; teledermoscopy