Teledermatology, teledermoscopy useful in actinic keratosis, field cancerization diagnosis

Teledermatology and teledermoscopy were associated with high sensitivity and specificity in diagnosing actinic keratosis and field cancerization, according to a study.

“Actinic keratosis (AK) and field cancerization are increasing health problems insufficiently diagnosed by primary care physicians,” Joaquin Sola-Ortigosa, MD, of the department of dermatology at Fundació Privada Hospital Asil de Granollers in Barcelona, Spain, and colleagues wrote.

The researchers used a gatekeeper health care model to evaluate the validity and reliability of teledermatology and teledermoscopy in the diagnosis of AK and field cancerization.

Specifically, the group aimed to compare a number of parameters — including diagnostic concordance, accuracy and performance — along with inter- and intraobserver concordance of teledermatology and teledermoscopy, with similar diagnostic parameters reported from face-to-face evaluation by a dermatologist or histopathology. They used a prospective diagnostic test evaluation to make these comparisons.

The analysis included 636 patients with 1,000 keratotic skin lesions.

Teledermatology yielded diagnostic concordance rates of 92.4% for AK and 96.7% for field cancerization. By comparison, physician diagnosis was associated with diagnostic concordance rates of 62.4% for AK and 51.8% for field cancerization (P < .001).

Findings for sensitivity, specificity, and positive and negative predictive values showed that teledermatology ranged from 82.2 to 95.0 for diagnosis of AK and field cancerization. Moreover, these sensitivity, specificity, and positive and negative predictive value rates were higher than those reported for diagnosis of AK and field cancerization reported by primary care physician diagnosis.

In terms of diagnostic concordance, performance parameters and AK subtyping, teledermoscopy “yielded better results,” according to the researchers.

Other findings showed that intra- and interobserver agreement was greater than 0.83.

Better results in diagnostic concordance, performance parameters and AK subtypes were seen with teledermoscopy.

“[Teledermatology] and, to a greater extent, teledermoscopy may be valid and reliable tools for the diagnosis of AK and field cancerization and may improve diagnosis and correct allocation and management in gatekeeper health care systems,” the researchers wrote. “It can be an alternative tool to training primary care physicians in direct diagnosis of these lesions.”