Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: A randomized teledermoscopy trial

Published:January 14, 2017DOI:https://doi.org/10.1016/j.jaad.2016.10.041

      Background

      Teledermoscopy involves the use of dermoscopic images for remote consultation and decision-making in skin cancer screening.

      Objective

      We sought to analyze the potential benefits gained from the addition of dermoscopic images to an internet-based skin cancer screening system.

      Methods

      A randomized clinical trial assessed the diagnostic performance and cost-effectiveness of clinical teleconsultations (CTC) and clinical with dermoscopic teleconsultations.

      Results

      A total of 454 patients were enrolled in the trial (n CTC = 226, n clinical with dermoscopic teleconsultation = 228). Teledermoscopy improved sensitivity and specificity (92.86% and 96.24%, respectively) compared with CTC (86.57% and 72.33%, respectively). Correct decisions were made in 94.30% of patients through clinical with dermoscopic teleconsultations and in 79.20% in CTC ( P < .001). The only variable associated with an increased likelihood of correct diagnosis was management using teledermoscopy (odds ratio 4.04; 95% confidence interval 2.02-8.09; P < .0001). The cost-effectiveness analysis showed teledermoscopy as the dominant strategy, with a lower cost-effectiveness ratio (65.13 vs 80.84).

      Limitations

      Potentially, a limitation is the establishment of an experienced dermatologist as the gold standard for the in-person evaluation.

      Conclusions

      The addition of dermoscopic images significantly improves the results of an internet-based skin cancer screening system, compared with screening systems based on clinical images alone.

      Key words

      Abbreviations used:

      CI ( confidence interval), CTC ( clinical teleconsultation), OR ( odds ratio), TD ( teledermatology)
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