The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood. We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows. Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017. 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. Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias. Implementation is critical to the effectiveness of teledermatology.
Comparative Effectiveness Study of Face-to-Face and Teledermatology Workflows for Diagnosing Skin Cancer
Authors: Marwaha SS; Fevrier H; Alexeeff S; Crowley E; Haiman M; Pham N; Tuerk MJ; Wukda D; Hartmann M; Herrinton LJ
J Am Acad Dermatol. 2019 Nov;81(5):1099-1106. Epub 2019-02-07.