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Teledermoscopy in doubtful melanocytic lesions: is it really useful?
Author(s) -
Giorgi Vincenzo,
Gori Alessia,
Savarese Imma,
D'Errico Antonietta,
Grazzini Marta,
Papi Federica,
Maio Vincenza,
Covarelli Piero,
Urso Carmelo,
Massi Daniela
Publication year - 2016
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.13281
Subject(s) - teledermatology , medicine , concordance , dermatology , medical diagnosis , gold standard (test) , nevus , telemedicine , melanoma , pathology , radiology , health care , cancer research , economics , economic growth
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.