Teledermatology for skin cancer prevention: an experience on 690 Austrian patients

Background Recent studies investigated the value of teledermatology (TD) as a valid tool for a dermatologist-directed triage systems. Objective To investigate the feasibility of a store-and-forward TD triage system in a large number of patients. Methods Previously trained general practitioners selected suspicious skin tumours in the setting of a general preventive medicine screening programme and transmitted their dermoscopic images via virtual private network for decision-making. Within 48 h, two teleconsultants highly experienced in dermoscopy first assessed image quality, then made a diagnosis and answered if lesions were to follow-up, to excise or to be re-evaluated at face-to-face (FTF). Results A total of 955 lesions were telediagnosed [743 (78%) benign melanocytic, six (0.6%) malignant melanocytic, 186 (19%) benign non-melanocytic and 20 (2%) malignant non-melanocytic]. Excision was recommended for 111 (12%) lesions, 10 lesions (1%) were referred to FTF examination. Follow-up was recommended for 707 (74%) lesions. The vast majority of the lesions (82%) were screened as benign and an intervention was requested in only 18% of cases. Eighty-two patients (12% of the total) were lost at follow-up. The diagnostic accuracy was of 94% with sensitivity of 100% and specificity of 95.8%. Conclusions We confirm that TD is suitable to triage skin cancers.