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Comparative effectiveness study of face-to-face and teledermatology workflows for diagnosing skin cancer

Published:February 07, 2019DOI:https://doi.org/10.1016/j.jaad.2019.01.067

      Background

      The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood.

      Objective

      We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows.

      Methods

      Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017.

      Results

      One teledermatology workflow achieved high-resolution images with use of a dermatoscope-fitted digital camera, a picture archiving and communication system, and image retrieval to a large computer monitor (in contrast to a smartphone screen). Compared with direct referral, this workflow was associated with a 9% greater probability of cancer detection (95% confidence interval [CI], 2%-16%), a 4% lower probability of biopsy (relative risk, 0.96; 95% CI, 0.93-0.99), and 39% fewer face-to-face visits (relative risk, 0.61; 95% CI, 0.57-0.65). Other workflows were less effective.

      Limitations

      Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias.

      Conclusion

      Implementation is critical to the effectiveness of teledermatology.

      Key words

      Abbreviations used:

      CI (confidence interval), EMR (electronic medical record), RR (relative risk)
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