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Teledermatology often matched clinical diagnoses of neoplasms in dermatologic exams

Diagnostic agreement between clinic dermatologic examination and store and forward teledermatology for skin neoplasms was moderate to almost perfect, whereas management agreement between the two was fair, according to recently published study results.

In a repeated-measures study, a clinic dermatologist and a teledermatologist examined 3,021 lesions from 2,152 patients, with both giving a primary diagnosis from a choice of 17 common diagnoses, up two differential diagnoses and a basic management plan from a choice of four basic management plans. Macro imaging and polarized light imaging was conducted for all lesions, and contact immersion dermoscopy was used for pigmented lesions only.

There were 410 basal cell carcinomas (24%), 240 squamous cell carcinomas (14%), 41 melanomas (2.4%) among 1,685 biopsied lesions. In primary diagnosis, agreement for skin neoplasms was fair to substantial (45.7%-80.1%; kappa 0.32-0.62). In primary plus differential diagnoses (aggregated diagnoses), agreement was substantial to almost perfect (78.6%-93.9%; kappa 0.77-0.9). However, for management, agreement was fair (66.7%-86.1%; kappa 0.28-0.41), according to the researchers.

The researchers also found that although 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), the reverse was true for management agreement (pigmented: 66.7%-79.8%; kappa 0.19-0.35 vs. nonpigmented: 72.0%-86.1%; kappa 0.38-0.41).

Macro images and polarized light dermoscopy produced similar agreement rates. The agreement rates for pigmented lesions were significantly improved when contact immersion dermoscopy was used, according to the researchers.

Disclosures: The researchers report no relevant financial disclosures.