Oakley Amanda M M, Reeves Felicity, Bennett Jane, Holmes Stephen H, Wickham Hadley
Department of Dermatology, Health Waikato, Hamilton, New Zealand.
J Telemed Telecare. 2006;12(3):151-8. doi: 10.1258/135763306776738620.
We examined whether it is possible for a dermatologist to diagnose benign and malignant skin lesions by telemedicine, given a comprehensive history and/or clinical images. A medical student recorded a standardized history and description of 109 skin lesions and took digital photographs of the presenting lesion(s) immediately prior to a normal outpatient dermatology consultation. About 52 dermatologists were invited to participate in online diagnosis. In all, 38 took part and they were provided with the text and/or the image(s) online on a secure Website. When the images and text were provided, 53% of teledermatology diagnoses were the same as the face-to-face diagnosis. When images alone were provided, 57% of diagnoses were the same. When text alone was provided, 41% of diagnoses were the same. The relatively low diagnostic concordance may have been due to the inexperience of many teledermatologists and poor quality image display systems. The teledermatologists were less confident in their diagnoses than face-to-face specialists, especially in the absence of images. The teledermatology management plan was more likely to include biopsy, excision or review than was the case at the face-to-face consultation. Teledermatology may result in an increase in follow-up appointments and surgical procedures.
我们研究了在提供全面病史和/或临床图像的情况下，皮肤科医生通过远程医疗诊断良性和恶性皮肤病变是否可行。一名医学生记录了109例皮肤病变的标准化病史和描述，并在正常门诊皮肤科会诊前立即对出现的病变进行了数码拍照。约52名皮肤科医生受邀参与在线诊断。共有38名医生参与，他们在一个安全的网站上在线获取文本和/或图像。当同时提供图像和文本时，远程皮肤病学诊断中有53%与面对面诊断相同。当仅提供图像时，57%的诊断相同。当仅提供文本时，41%的诊断相同。相对较低的诊断一致性可能是由于许多远程皮肤科医生缺乏经验以及图像显示系统质量较差。与面对面的专家相比，远程皮肤科医生对自己的诊断信心较低，尤其是在没有图像的情况下。与面对面会诊相比，远程皮肤病学管理计划更有可能包括活检、切除或复查。远程皮肤病学可能会导致随访预约和外科手术的增加。
