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Store-and-Forward Teledermatology vs Face-to-Face Dermatology

Michael Shapiro, MD; William D. James, MD; Rex Kessler, MD; Francis C. Lazorik, MD; Kenneth A. Katz, MD; John Tam, MD; David S. Nieves, MD; Jeffrey J. Miller, MD

Arch Dermatol. 2004;140:525-528.

Objective  To determine the relative efficacy of store-and-forward teledermatology vs face-to-face dermatology consultations in triage decisions about the need for a biopsy of neoplastic skin changes.

Design  Prospective study of consecutive patients judged by an internist to require dermatologic consultation for a skin growth.

Setting  Private primary care and dermatology practices and an academic dermatology practice.

Patients  Patients requiring dermatology consultation for evaluation of skin growths. Patients were seen by a single primary care physician between July 10, 1998, and August 4, 2000.

Intervention  Digital photographs of skin growths were obtained by the primary care physician and evaluated by a teledermatologist. The patient was then seen face-to-face by a dermatologist. A biopsy was performed if either dermatologist favored biopsy.

Main Outcome Measures  Decisions to perform a biopsy. Agreement between the dermatologists was assessed.

Results  Of the 49 patients with evaluable photographs, the face-to-face dermatologist and teledermatologist recommended a biopsy for the same 26 patients, yielding a sensitivity of the teledermatologist of 1.00 (95% confidence interval [CI], 0.87-1.00) and a specificity of 1.00 (95% CI, 0.85-1.00). The agreement between the dermatologists () was 1.00 (95% CI, 0.72-1.00).

Conclusion  Store-and-forward teledermatology may provide an accurate and cost-effective method of determining whether skin growths in patients presenting to primary care physicians should undergo biopsy.

From the Departments of Dermatology (Drs Shapiro, James, Lazorik, and Katz) and Internal Medicine (Dr Kessler), University of Pennsylvania, and the Department of Dermatology, Penn State Milton S. Hershey Medical Center (Dr Miller), Philadelphia, Pa; the Department of New Product Development, Advisory Board Company, Washington, DC (Dr Tam); and the Department of Dermatology, University of Rochester, Rochester, NY (Dr Nieves). The authors have no relevant financial interest in this article.
Dr Lazorik is deceased.

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