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Diagnostic agreement and interobserver concordance with teledermoscopy referrals

Journal article
Authors J. D. Gyllencreutz
John Paoli
M. Bjellerup
Z. Bucharbajeva
Helena Gonzalez
K. Nielsen
Carin Sandberg
I. Synnerstad
K. Terstappen
Ann-Marie Wennberg Larkö
Published in Journal of the European Academy of Dermatology and Venereology
Volume 31
Issue 5
Pages 898-903
ISSN 0926-9959
Publication year 2017
Published at Institute of Clinical Sciences, Section for Oncology, Radiation Physics, Radiology and Urology, Department of Dermatology and Venereology
Pages 898-903
Language English Ndis jr , 1977 , biometrics , v33 , p159
Links doi.org/10.1111/jdv.14147
Keywords skin-cancer, teledermatology, triage, care, Dermatology
Subject categories Dermatology and Venereal Diseases

Abstract

BackgroundMalignant melanoma and non-melanoma skin cancers are among the fastest increasing malignancies in many countries. With the help of new tools, such as teledermoscopy referrals between primary health care and dermatology clinics, the management of these patients could be made more efficient. ObjectiveTo evaluate the diagnostic agreement and interobserver concordance achieved when assessing referrals sent through a mobile teledermoscopic referral system as compared to referrals sent via the current paper-based system without images. MethodsThe referral information from 80 teledermoscopy referrals and 77 paper referrals were evaluated by six Swedish dermatologists. They were asked to answer questions about the probable diagnosis, the priority, and a management decision. ResultsTeledermoscopy generally resulted in higher diagnostic agreement, better triaging and more malignant tumours being booked directly to surgery. The largest difference between the referral methods was seen for invasive melanomas. Referrals for benign lesions were significantly more often correctly resent to primary health care with teledermoscopy. However, referrals for cases of melanoma in situ were also incorrectly resent five times. The interobserver concordance was moderate with both methods. ConclusionBy adding clinical and dermoscopic images to referrals, the triage process for both benign and dangerous skin tumours can be improved. With teledermoscopy, patients with melanoma especially can receive treatment more swiftly.

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