Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: A randomized teledermoscopy trial

Background: Teledermoscopy involves the use of dermoscopic images for remote consultation and decision-making in skin cancer screening. Objective: We sought to analyze the potential benefits gained from the addition of dermoscopic images to an internet-based skin cancer screening system. Methods: A randomized clinical trial assessed the diagnostic performance and cost-effectiveness of clinical teleconsultations (CTC) and clinical with dermoscopic teleconsultations. Results: A total of 454 patients were enrolled in the trial (n(CTC) = 226, n(clinical) (with) (dermoscopic) (teleconsultation) = 228). Teledermoscopy improved sensitivity and specificity (92.86% and 96.24%, respectively) compared with CTC (86.57% and 72.33%, respectively). Correct decisions were made in 94.30% of patients through clinical with dermoscopic teleconsultations and in 79.20% in CTC (P < .001). The only variable associated with an increased likelihood of correct diagnosis was management using teledermoscopy (odds ratio 4.04; 95% confidence interval 2.02-8.09; P < .0001). The cost-effectiveness analysis showed teledermoscopy as the dominant strategy, with a lower cost-effectiveness ratio (65.13 vs 80.84). Limitations: Potentially, a limitation is the establishment of an experienced dermatologist as the gold standard for the in-person evaluation. Conclusions: The addition of dermoscopic images significantly improves the results of an internet-based skin cancer screening system, compared with screening systems based on clinical images alone.