Comparative Effectiveness Study of Face-to-Face and Teledermatology Workflows for Diagnosing Skin Cancer

Publication date: Available online 7 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): S. Marwaha, H.B. Fevrier, S.E. Alexeeff, E. Crowley, M. Haiman, N. Pham, M.J. Tuerk, D. Wukda, M. Hartmann, L.J. Herrinton

Abstract

Background

The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood.

Objective

We compared the risks of biopsy and cancer diagnosis among two face-to-face workflows (direct referral, roving dermatologist) and four teledermatology workflows.

Methods

Retrospective study of 59,279 primary care patients with a lesion, January-June 2017.

Results

One teledermatology workflow achieved high resolution images using a dermatoscope-fitted digital camera, 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 9% greater probability of cancer detection (95% confidence interval [CI] 2% to 16%); 4% lower probability of biopsy (relative risk [RR] 0.96; CI 0.93-0.99); and 39% fewer face-to-face visits (RR 0.61; CI, 0.57-0.65). Other workflows were less effective.

Limitations

Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias.

Conclusion

Implementation is critical to the effectiveness of teledermatology

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