Effect of teledermatology on the prognosis of patients with cutaneous melanoma.

OBJECTIVE

To evaluate differences in the initial prognosis of patients with cutaneous melanoma managed by teledermatology (TD) vs other non-TD referral systems.

DESIGN

Descriptive and longitudinal study of a store-and-forward TD system aimed at the triage of patients with suspicious pigmented lesions.

SETTING

In 2003, a store-and-forward TD triage system aimed at the selection of patients with skin growths suggestive of cancer was implemented at a skin cancer clinic. This system has been shown to be accurate and reliable and able to significantly shorten waiting periods for consultation with a dermatologist.

PARTICIPANTS

Patients with primary cutaneous melanoma referred to the Melanoma Clinic of the Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain, by TD or non-TD tracks were included in the study.

MAIN OUTCOME MEASURES

Decisions on the referral of patients with suspicious skin lesions by store-and-forward TD vs by a conventional referral system. Breslow thickness and tumor stage were recorded in each study group (TD and non-TD) and were compared.

RESULTS

Two hundred one patients with primary cutaneous melanoma were enrolled in the study. In total, 33.3% were managed at their primary care center by teleconsultation, whereas 66.7% were managed by a conventional referral system. The mean Breslow thickness was significantly lower among patients in the TD group than among patients in the non-TD group (1.06 vs 1.64 mm, P = .03). The frequency of melanoma with a favorable initial prognosis (tumor stages Tis and T1a) was significantly higher in the TD group (70.1% vs 56.9%, P = .03). The odds ratio of having a cutaneous melanoma with a favorable initial prognosis in the TD group was 1.96 (95% CI, 1.14-3.50; P = .04).

CONCLUSION

Teledermatology as a screening system for cutaneous melanoma has a favorable effect on the initial prognosis of patients with melanoma.