Successful triage of patients referred to a skin lesion clinic using teledermoscopy (IMAGE IT trial)

Abstract

Background Teledermatology is a rapidly growing field with studies showing high diagnostic accuracy when compared with face‐to‐face diagnosis. Teledermoscopy involves the use of epiluminescence microscopy to increase diagnostic accuracy. The utility of teledermoscopy as a triage tool has not been established. Objectives To assess teledermoscopy as a triage tool for a hospital skin lesion clinic. Methods Patients referred to a dermatology skin lesion clinic were recruited. Digital and dermoscopic photographs were taken of skin lesions of concern and the patients were then seen independently face‐to‐face by two out of three dermatologists. The digital images were evaluated 4 weeks later, as a teledermoscopy consultation, by two of these dermatologists. The diagnosis and management from both types of consultation were compared. Results Two hundred patients with a total of 491 lesions were seen. There was excellent agreement between teledermoscopy and face‐to‐face diagnosis with only 12·3% of lesions having disparate diagnoses of clinical significance. Twelve of 491 (2·4%) lesions appeared to have been under‐reported by teledermoscopy when compared with face‐to‐face diagnosis. However, when histopathology became available, only one malignant lesion had been missed (a basal cell carcinoma diagnosed as solar keratosis) by teledermoscopy. Teledermoscopy approximated 100% sensitivity and 90% specificity for detecting melanoma and nonmelanoma skin cancers. Importantly, 74% of all lesions were determined to be manageable by the general practitioner without needing to be seen face‐to‐face by a dermatologist. Conclusions This use of teledermoscopy as a triage tool offers the potential to shorten waiting lists and thus improve healthcare access and delivery.