Comparison of Skin Biopsy Triage Decisions in 49 Patients With Pigmented Lesions and Skin Neoplasms: Store-and-Forward Teledermatology vs Face-to-Face Dermatology | Dermatology | JAMA Dermatology | JAMA Network
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Wagner Jr  RFWagner  DTomich  JMWagner  KDGrande  DJ Diagnoses of skin disease  J Dermatol Surg Oncol. 1985;11476- 479PubMedGoogle ScholarCrossref
McCarthy  GMLamb  GCRussell  TJYoung  MJ Primary care–based dermatology practice: internists need more training  J Gen Intern Med. 1991;652- 56PubMedGoogle ScholarCrossref
Cassileth  BRClark Jr  WLusk  EJFrederick  BEThompson  CJWalsh  WP How well do physicians recognize melanoma and other problems?  J Am Acad Dermatol. 1986;14555- 560PubMedGoogle ScholarCrossref
Basarab  TMunn  SEJones  R Diagnostic accuracy and appropriateness of general practitioner referrals to a dermatology out-patient clinic  Br J Dermatol. 1996;13570- 73PubMedGoogle ScholarCrossref
Federman  DHogan  DTaylor  JRCaralis  PKirsner  RS A comparison of diagnosis, evaluation, and treatment of patients with dermatologic disorders  J Am Acad Dermatol. 1995;32726- 729PubMedGoogle ScholarCrossref
Ramsay  DLFox  AB The ability of primary care physicians to recongnize the common dermatoses  Arch Dermatol. 1981;117620- 622PubMedGoogle ScholarCrossref
Pariser  RJPariser  DM Primary care physicians' errors in handling cutanaeous disorders  J Am Acad Dermatol. 1987;17239- 245PubMedGoogle ScholarCrossref
Brodkin  RHRickert  RMachler  BC The dermatologist and managed care  Cutis. 1996;58352PubMedGoogle Scholar
Gerbert  BMaurer  TBerger  T  et al.  Primary care physicians as gatekeepers in managed care  Arch Dermatol. 1996;1321030- 1038PubMedGoogle ScholarCrossref
Perednia  DA Store-and-forward teledermatology  Telemed Today. July-August1996;18- 21PubMedGoogle Scholar
Perednia  DA Fear, loathing, dermatology, and telemedicine  Arch Dermatol. 1997;133151- 155PubMedGoogle ScholarCrossref
Suneja  TSmith  EDChen  GJZipperstein  KJFleischer Jr  ABFeldman  SR Waiting times to see a dermatologist are perceived as too long by dermatologists: implications for the dermatology workforce  Arch Dermatol. 2001;1371303- 1307PubMedGoogle ScholarCrossref
Fleiss  JL Statistical Methods for Rates and Proportions. 2nd ed New York, NY John Wiley & Sons Inc1981;
Bittorf  AFartasch  MSchuler  GDiepgen  TL Resolution requirements for digital images in dermatology  J Am Acad Dermatol. 1997;37195- 198PubMedGoogle ScholarCrossref
Ratner  DThomas  COBickers  D The uses of digital photography in dermatology  J Am Acad Dermatol. 1999;41749- 756PubMedGoogle ScholarCrossref
Whited  JDMills  BJHall  RPDrugge  RJGrichnik  JMSimel  DL A pilot trial of digital imaging in skin cancer  J Telemed Telecare. 1998;4108- 112PubMedGoogle ScholarCrossref
Zelickson  BDHoman  L Teledermatology in the nursing home  Arch Dermatol. 1997;133171- 174PubMedGoogle ScholarCrossref
Whited  JDHall  RPSimel  DL  et al.  Reliability and accuracy of dermatologists' clinic-based and digital image consultations  J Am Acad Dermatol. 1999;41693- 702PubMedGoogle ScholarCrossref
Eedy  DJWootton  R Teledermatology  Br J Dermatol. 2001;144696- 707PubMedGoogle ScholarCrossref
Tait  CPClay  CD Pilot study of store and forward teledermatology services in Perth, Western Australia  Australas J Dermatol. 1999;40190- 193PubMedGoogle ScholarCrossref
Phillips  CMBurke  WAAllen  MHStone  DWilson  JL Reliability of telemedicine in evaluating skin tumors  Telemed J. 1998;45- 9PubMedGoogle ScholarCrossref
Collins  KNicolson  PBowns  IWalters  S General practitioners' perceptions of store-and-forward teledermatology  J Telemed Telecare. 2000;650- 53PubMedGoogle ScholarCrossref
Loane  MABloomer  SECorbett  R  et al.  Patient cost-benefit analysis of teledermatology measured in a randomized control trial  J Telemed Telecare. 1999;5(suppl 1)S1- S3PubMedGoogle ScholarCrossref
Oakley  AMMKerr  PDuffill  M  et al.  Patient cost-benefits of realtime teledermatology  J Telemed Telecare. 2000;697- 101PubMedGoogle ScholarCrossref
Not Available, Medicare Part B Fee Schedule Calculator  HGS Administrators Web site. Available at December 19, 2002Google Scholar
Not Available, Digital cameras. Best Buy Web site Available at: August 21, 2003
Not Available, Computers  Dell Inc Web site Available at: August 21, 2003Google Scholar
Not Available, AOL for broadband  AOL Web site Available at: August 21, 2003Google Scholar
Perednia  DAWallace  JMorrisey  M  et al.  The effect of a teledermatology program on rural referral patterns to dermatologists and the management of skin disease  Medinfo. 1998;9290- 293PubMedGoogle Scholar
Feldman  SRFleischer  AB Skin examinations and skin cancer prevention counseling by US physicians: a long way to go  J Am Acad Dermatol. 2000;43234- 237PubMedGoogle ScholarCrossref
Cherry  DKWoodwell  DA National ambulatory medical care survey: 2000 summary  Advance Data from Vital and Health Statistics. June 5, 2002:No. 328. Available at: December 22, 2002Google Scholar
May 2004

Comparison of Skin Biopsy Triage Decisions in 49 Patients With Pigmented Lesions and Skin Neoplasms: Store-and-Forward Teledermatology vs Face-to-Face Dermatology

Author Affiliations

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.

Arch Dermatol. 2004;140(5):525-528. doi:10.1001/archderm.140.5.525

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 (κ) 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.