Moreno-Ramirez D, Ferrandiz L, Bernal A Perez, Duran R Carrasco, Martín J J Rios, Camacho F
Pigmented Lesion and Teledermatology Clinic of the Dermatology Department, University Hospital Virgen Macarena, Avda. Dr. Fedriani s/n, 41073 Seville, Spain.
J Telemed Telecare. 2005;11(6):298-303. doi: 10.1258/1357633054893364.
Teledermatology was evaluated as a filtering system for a pigmented lesion clinic (PLC). A total of 219 teleconsultations were received at the PLC in a 12-week period. The outcome of the teleconsultation was that 49% of patients were referred to the face-to-face clinic. Teleconsultation reports were available to the general practitioner (GP) in a mean time of 44 h and patients attended the face-to-face clinic within the following two weeks. Agreement between different dermatologists was almost perfect, with k =0.91 (95% confidence interval [CI] 0.87-0.96) for diagnosis and kappa =0.92 (95% CI 0.86-0.98) for management options ("referral" or "non- referral"). Agreement within observers was excellent, with kappa =0.93 (95% CI 0.87-0.98). The accuracy of diagnosis, as judged by the histology, was less good, with kappa =0.79 (95% CI 0.70-0.89). In all, 86% of patients and 97% of GPs stated that they were "very satisfied" with the new system. Teledermatology performed well as a filtering system for the PLC. However, more experience is needed to detect the real effect, if any, of teleconsultation on the early diagnosis and prognosis of melanoma.
远程皮肤病学被评估为色素沉着病变诊所（PLC）的一种筛选系统。在12周内，PLC共收到219次远程会诊。远程会诊的结果是，49%的患者被转诊至面对面诊所。全科医生（GP）平均在44小时后可获得远程会诊报告，患者在接下来的两周内前往面对面诊所就诊。不同皮肤科医生之间的一致性几乎完美，诊断的kappa值为0.91（95%置信区间[CI]0.87 - 0.96），管理选项（“转诊”或“不转诊”）的kappa值为0.92（95%CI 0.86 - 0.98）。观察者内部的一致性极佳，kappa值为0.93（95%CI 0.87 - 0.98）。经组织学判断，诊断的准确性稍差，kappa值为0.79（95%CI 0.70 - 0.89）。总体而言，86%的患者和97%的全科医生表示他们对新系统“非常满意”。远程皮肤病学作为PLC的筛选系统表现良好。然而，需要更多经验来检测远程会诊对黑色素瘤早期诊断和预后的实际影响（如果有）。
