Vestergaard T, Prasad S C, Schuster A, Laurinaviciene R, Andersen M K, Bygum A
Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
J Eur Acad Dermatol Venereol. 2020 Jul;34(7):1601-1608. doi: 10.1111/jdv.16275. Epub 2020 Mar 27.
Skin cancer incidences are increasing and early diagnosis, especially of malignant melanoma, is crucial. Teledermatology including teledermoscopy (TDS) can be used to triage referrals of suspicious skin lesions, however, this is not currently recommended in Denmark.
To evaluate diagnostic accuracy, sensitivity, specificity and interobserver concordance of TDS, and to evaluate the number of incidental lesions potentially missed by TDS.
Fifty general practices were invited to send images of suspicious skin lesions for evaluation using smartphone TDS. Simultaneously, the patient was referred for a face-to-face (FTF) consultation. Images for TDS were independently evaluated by two dermatologists; a third dermatologist performed the FTF consultation. Diagnosis, management plan and level of diagnostic confidence were noted. For TDS photo quality was rated, and for FTF any incidental findings were described.
Six hundred lesions in 519 patients were included. The diagnostic accuracy was significantly higher on FTF evaluation than on TDS (P < 0.01). However, this was associated with a significant difference in specificity (P ≤ 0.012) whereas no significant difference was found in sensitivity. The concordance between FTF and TDS, and the interobserver concordance of two TDS evaluations was moderate to substantial (AC1 = 0.57-0.71). Incidental melanomas were found in 0.6% of patients on FTF evaluation, adding an extra 13% of melanomas. However, on TDS these patients' photographed lesions all warranted FTF follow-up, where these melanomas would have been identified.
In this large prospective study, no significant difference in sensitivity was observed between FTF and TDS, but specificity was lower on TDS than FTF. Taking management plans into account, we would, however, potentially have dismissed 2 of 23 melanomas, if only TDS had been used for assessment. One of these was a melanoma located on the scalp, an anatomic region less suitable for TDS.
皮肤癌发病率呈上升趋势，早期诊断，尤其是恶性黑色素瘤的早期诊断至关重要。包括远程皮肤镜检查（TDS）在内的远程皮肤病学可用于对可疑皮肤病变的转诊进行分流，然而，丹麦目前不推荐这样做。
评估TDS的诊断准确性、敏感性、特异性和观察者间一致性，并评估TDS可能漏诊的偶然病变数量。
邀请50家普通诊所使用智能手机TDS发送可疑皮肤病变的图像进行评估。同时，患者被转诊进行面对面（FTF）咨询。两名皮肤科医生独立评估TDS图像；第三名皮肤科医生进行FTF咨询。记录诊断、管理计划和诊断信心水平。对TDS的照片质量进行评分，对FTF描述任何偶然发现。
纳入了519例患者的600个病变。FTF评估的诊断准确性显著高于TDS（P<0.01）。然而，这与特异性的显著差异相关（P≤0.012），而敏感性未发现显著差异。FTF和TDS之间的一致性以及两次TDS评估的观察者间一致性为中度至高度（AC1=0.57-0.71）。在FTF评估中，0.6%的患者发现了偶然的黑色素瘤，使黑色素瘤的比例增加了13%。然而，在TDS上，这些患者拍摄的病变都需要FTF随访，在那里这些黑色素瘤会被识别出来。
在这项大型前瞻性研究中，FTF和TDS之间在敏感性上未观察到显著差异，但TDS的特异性低于FTF。然而，考虑到管理计划，如果仅使用TDS进行评估，我们可能会漏诊23例黑色素瘤中的2例。其中1例是位于头皮的黑色素瘤，这是一个不太适合TDS的解剖区域。
