Teledermatology as a filtering system in pigmented lesion clinics.

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.