Diagnostic agreement and interobserver concordance with teledermoscopy referrals.
BACKGROUND
Malignant melanoma and non-melanoma skin cancers are among the fastest increasing malignancies in many countries. With the help of new tools, such as teledermoscopy referrals between primary health care and dermatology clinics, the management of these patients could be made more efficient.


OBJECTIVE
To evaluate the diagnostic agreement and interobserver concordance achieved when assessing referrals sent through a mobile teledermoscopic referral system as compared to referrals sent via the current paper-based system without images.


METHODS
The referral information from 80 teledermoscopy referrals and 77 paper referrals were evaluated by six Swedish dermatologists. They were asked to answer questions about the probable diagnosis, the priority, and a management decision.


RESULTS
Teledermoscopy generally resulted in higher diagnostic agreement, better triaging and more malignant tumours being booked directly to surgery. The largest difference between the referral methods was seen for invasive melanomas. Referrals for benign lesions were significantly more often correctly resent to primary health care with teledermoscopy. However, referrals for cases of melanoma in situ were also incorrectly resent five times. The interobserver concordance was moderate with both methods.


CONCLUSIONS
By adding clinical and dermoscopic images to referrals, the triage process for both benign and dangerous skin tumours can be improved. With teledermoscopy, patients with melanoma especially can receive treatment more swiftly.
Department of Dermatology and Venereology, Skaraborg Hospital, Skövde, Sweden.
J
J
Dahlén Gyllencreutz
Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J
J
Paoli
Department of Dermatology, Helsingborg Hospital, Clinical Sciences, Lund University, Lund, Sweden.
M
M
Bjellerup
Department of Public Health and Clinical Medicine, Dermatology and Venereology, Umeå University, Umeå, Sweden.
Z
Z
Bucharbajeva
Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
H
H
Gonzalez
Department of Dermatology, Helsingborg Hospital, Clinical Sciences, Lund University, Lund, Sweden.
K
K
Nielsen
Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
C
C
Sandberg
Division of Dermatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Linköping, Linköping, Sweden.
I
I
Synnerstad
Department of Dermatology and Venereology, Skaraborg Hospital, Skövde, Sweden.
K
K
Terstappen
Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
A-M
AM
Wennberg Larkö
D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D046169:Dermoscopy / Q000379:methods*; D006801:Humans; D008545:Melanoma / Q000175:diagnosis*; D015588:Observer Variation; D012017:Referral and Consultation; D012878:Skin Neoplasms / Q000175:diagnosis*; D013548:Sweden; D017216:Telemedicine