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Review
March 2017

Teledermatology for the Diagnosis and Management of Skin CancerA Systematic Review

Author Affiliations
  • 1Dermatology Research Centre, The University of Queensland, School of Medicine, Level 5, Translational Research Institute, Brisbane, Australia
  • 2Centre for Online Health, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Australia
  • 3School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
  • 4Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia
  • 5Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
 

Copyright 2016 American Medical Association. All Rights Reserved.

JAMA Dermatol. 2017;153(3):319-327. doi:10.1001/jamadermatol.2016.4361
Key Points

Question  How accurate is teledermatology for skin cancer diagnosis compared with face-to-face (FTF) consultation, and what are the enablers and barriers to implementation in practice?

Findings  Diagnostic accuracy of FTF consultation remains higher for diagnosis of skin cancer compared with teledermatogy. Teledermatology reduces waiting times and reported patient satisfaction is high.

Meaning  Considering high satisfaction and reduced waiting times associated with teledermatology, robustly designed studies are needed to determine whether the level of diagnostic accuracy of teledermatology is acceptable to be used as an alternative to FTF consultation.

Abstract

Importance  As technology becomes more commonplace in dermatological practice, it is essential to continuously review the accuracy of teledermatology devices and services compared with in-person care. The last systematic review was conducted over 5 years ago.

Objective  To synthesize and assess the quality of the evidence to address 3 research questions: (1) How accurate is teledermatology for skin cancer diagnosis compared with usual care (face-to-face [FTF] diagnosis)? (2) Does teledermatology save clinician and/or patient time, compared with usual care? (3) What are the enablers and barriers to adoption of teledermatology in clinical practice for the diagnosis of skin cancer?

Evidence Review  The review protocol was registered in the PROSPERO database. Six databases (Cochrane, PubMed, Medline, Science Direct, Embase, and Web of Science) were searched for studies investigating the diagnostic accuracy and concordance, management accuracy and concordance, measures of time (waiting times, delay to diagnosis), and enablers and barriers to implementation. Potentially eligible articles were screened by 2 reviewers. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to evaluate the risk of bias and applicability of individual studies assessing diagnostic accuracy.

Findings  Twenty-one studies were reviewed. The diagnostic accuracy (defined as agreement with histopathology for excised lesions or clinical diagnosis for nonexcised lesions) of FTF dermatology consultation remains higher (67%-85% agreement with reference standard, Cohen κ, 0.90) when compared with teledermatology (51%-85% agreement with reference standard, κ, 0.41-0.63), for the diagnosis of skin cancer. However, some studies do report high accuracy of teledermatology diagnoses. Most studies of diagnostic accuracy and concordance had significant methodological limitations. Studies of health service outcomes found teledermatology reduced waiting times and could result in earlier assessment and treatment. Patients reported high satisfaction and were willing to pay out of pocket for access to such services.

Conclusions and Relevance  Robust implementation studies of teledermatology are needed, paying careful attention to reducing risk of bias when assessing diagnostic accuracy. Teledermatology services consistently reduced waiting times to assessment and diagnosis, and patient satisfaction was high.

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