Reliability of store and forward teledermatology for skin neoplasms

BackgroundTeledermatology may be less optimal for skin neoplasms than for rashes.ObjectivesWe sought to determine agreement for skin neoplasms.MethodsThis 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.ResultsThere 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.LimitationsWe studied a homogeneous population.ConclusionsDiagnostic 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.