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Cited by 175Cutaneous Melanoma Detection and ManagementTelemedicine and Telehealth ImplementationAI in cancer detection

Accuracy of teledermatology for pigmented neoplasms

Warshaw, Erin M., Lederle, Frank A., Grill, Joseph P., Gravely, Amy A., Bangerter, Ann K., Fortier, Lawrence A., Bohjanen, Kimberly A., Chen, Karen +9 more·2009·Journal of the American Academy of Dermatology
DOI 10.1016/j.jaad.2009.04.032
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Abstract

Background Accurate diagnosis and management of pigmented lesions is critical because of the morbidity and mortality associated with melanoma.Objective We sought to compare accuracy of store-and-forward teledermatology for pigmented neoplasms with standard, in-person clinic dermatology.Methods We conducted a repeated measures equivalence trial involving veterans with pigmented skin neoplasms. Each lesion was evaluated by a clinic dermatologist and a teledermatologist; both generated a primary diagnosis, up to two differential diagnoses, and a management plan. The primary outcome was aggregated diagnostic accuracy (match of any chosen diagnosis with histopathology). We also compared the severity of inappropriately managed lesions and, for teledermatology, evaluated the incremental change in accuracy when polarized light dermatoscopy or contact immersion dermatoscopy images were viewed.Results We enrolled 542 patients with pigmented lesions, most were male (96%) and Caucasian (97%). The aggregated diagnostic accuracy rates for teledermatology (macro images, polarized light dermatoscopy, and contact immersion dermatoscopy) were not equivalent (95% confidence interval for difference within +/-10%) and were inferior (95% confidence interval lower bound <10%) to clinic dermatology. In general, the addition of dermatoscopic images did not significantly change teledermatology diagnostic accuracy rates. In contrast to diagnostic accuracy, rates of appropriate management plans for teledermatology were superior and/or equivalent to clinic dermatology (all image types: all lesions, and benign lesions). However, for the subgroup of malignant lesions (n = 124), the rate of appropriate management was significantly worse for teledermatology than for clinic dermatology (all image types). Up to 7 of 36 index melanomas would have been mismanaged via teledermatology.Limitations Nondiverse study population and relatively small number of melanomas were limitations.Conclusions In general, the diagnostic accuracy of teledermatology was inferior whereas management was equivalent to clinic dermatology. However, for the important subgroup of malignant pigmented lesions, both diagnostic and management accuracy of teledermatology was generally inferior to clinic dermatology and up to 7 of 36 index melanomas would have been mismanaged via teledermatology. Teledermatology and teledermatoscopy should be used with caution for patients with suspected malignant pigmented lesions.

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Authors
Warshaw, E. M., Lederle, F. A., Grill, J. P., Gravely, A. A., Bangerter, A. K., Fortier, L. A., Bohjanen, K. A., Chen, K., Lee, P. K., Rabinovitz, H. S., Johr, R. H., Kaye, V. N., Bowers, S., Wenner, R., Askari, S. K., Kedrowski, D. A., & Nelson, D. B.
Affiliations
  • University of Minnesota (US)
  • Minneapolis VA Medical Center (US)
  • University of Miami (US)
  • SIU Medicine (US)
  • Saint Louis University (US)
Corresponding author
Warshaw, Erin M.
ORCID
Venue
Journal of the American Academy of Dermatology
Publisher
Elsevier BV
Published
2009-11
Volume
61
Issue
5
Pages
753-765
ISSN
0190-9622 (ISSN-L)
DOI
10.1016/j.jaad.2009.04.032
OpenAlex
W2097509633
Semantic Scholar
95da652b850240a3f3c78890262d4b473f1d20e8
Cited by
175
References
37
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 8 · 2022: 9 · 2021: 8 · 2020: 15 · 2019: 5 · 2018: 10 · 2017: 18 · 2016: 7 · 2015: 16 · 2014: 13 · 2013: 9 · 2012: 8
FWCI
7.65
Type
journal article
Language
en
Update notices
erratum (2010-02-01)
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Dermatology (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
Topics
  • Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Physical Sciences › Computer Science › Artificial Intelligence › AI in cancer detection
Keywords
teledermatology, melanoma, diagnostic accuracy, store-and-forward telemedicine, veterans, lesion management, histopathology
MeSH terms
Adult, Aged, Aged, 80 and over, Basal Cell Carcinoma, Carcinoma, Squamous Cell, Cross-Sectional Studies, Dermatology, Diagnosis, Differential, Female, Humans, Male, Melanoma, Middle Aged, Nevus, Pigmented, Skin Diseases, Skin Neoplasms, Reproducibility of Results, Telemedicine, Young Adult

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