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Teledermatology requires fewer visits to detect skin cancer

In skin cancer diagnosis, teledermatology has a sensitivity greater than 90% and a specificity greater than 80% compared with direct referral from primary care, according to a retrospective study.

“These findings are consistent with anecdotal reports by dermatologists in our setting indicating that they have a better view of the lesion with dermoscopy than with plain eyesight because of good image resolution with use of a large viewing screen,” Sangeeta S. Marwaha, MD, a dermatologist at Kaiser Permanente, Sacramento, and colleagues wrote.

The cohort was made up of adult patients at Kaiser Permanente Northern California who had a primary care encounter via a face-to-face visit or a patient portal message for a skin lesion.

Stentor (now iSite, Philips) is a common high-resolution picture archiving and communications system used by practitioners and the most common workflow in this physician setting.

Out of 59,279 patients who had a lesion, 25,041 (42%) had teledermatology, 21,911 (37%) had direct referral to dermatology and 12,327 (21%) had referral to a roving dermatologist. One-third were aged 65 years or older, 57% of patients were women, 26% were nonwhite and 9% had a skin cancer history.

Among patients referred directly to dermatology, the frequency of biopsy was 35%. The likelihood of a biopsy was the highest for those with direct referral (RR < 1.0). Cancer detection was 12% in direct referrals.

The relative risk for the association of diagnostic workflow with skin cancer detection was 1.02 (95% CI, 0.93-1.12) for a roving encounter, 1.09 (95% CI, 1.02-1.16) for Stentor with dermoscopy and less than 1.0 for other teledermatology workflows, according to the study.

“All teledermatology workflows were associated with fewer dermatology visits to detect one skin cancer,” Marwaha and colleagues wrote.

Stentor with dermoscopy required 39% fewer visits to detect one skin cancer than direct referral (RR = 0.61; 95% CI, 0.57-0.65).

“Excellent” cancer detection resulted from the use of a dermatoscopic camera, a picture archiving and communication system, and a large high-resolution monitor, along with fewer visits to the dermatology clinic and reduced wait times, according to researchers. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.