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Nikolakis G, Vaiopoulos AG, Georgopoulos I, Papakonstantinou E, Gaitanis G, Zouboulis CC. Insights, Advantages, and Barriers of Teledermatology vs. Face-to-Face Dermatology for the Diagnosis and Follow-Up of Non-Melanoma Skin Cancer: A Systematic Review. Cancers (Basel) 2024; 16:578. [PMID: 38339329 PMCID: PMC10854718 DOI: 10.3390/cancers16030578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Teledermatology is employed in the diagnosis and follow-up of skin cancer and its use was intensified during and after the COVID-19 pandemic. At the same time, demographic changes result in an overall increase in non-melanoma skin cancer and skin precancerous lesions. The aim of this study was to elucidate the role of teledermatology in comparison to conventional face-to-face dermatology for such lesions and determine the advantages and limitations of this workflow for patients and physicians. METHODS Research was performed using relevant keywords in MEDLINE and CENTRAL. Relevant articles were chosen following a predetermined standardized extraction form. RESULTS Diagnostic accuracy and interrater/intrarater agreement can be considered comparable-although lower-than in-person consultation. Improvement of particular features such as image quality, medical history availability, and teledermoscopy can further increase accuracy. Further aspects of limitations and advantages (mean time-to-assessment, time-to-treatment, cost-effectiveness) are discussed. CONCLUSIONS Teledermatology has comparable diagnostic accuracy with face-to-face dermatology and can be utilized both for the effective triage of non-melanocytic epithelial tumors and precancerous lesions, as well as the follow-up. Easy access to dermatologic consultation with shorter mean times to diagnostic biopsy and/or treatment coupled with cost-effectiveness could compensate for the lower sensitivity of teledermatology and offer easier access to medical care to the affected populations.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany;
- Docandu Ltd., London Ν8 0ES, UK;
| | - Aristeidis G. Vaiopoulos
- Second Department of Dermatology and Venereology, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Ioannis Georgopoulos
- Docandu Ltd., London Ν8 0ES, UK;
- Surgical Department, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
| | | | - George Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany;
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Bourkas AN, Barone N, Bourkas MEC, Mannarino M, Fraser RDJ, Lorincz A, Wang SC, Ramirez-GarciaLuna JL. Diagnostic reliability in teledermatology: a systematic review and a meta-analysis. BMJ Open 2023; 13:e068207. [PMID: 37567745 PMCID: PMC10423833 DOI: 10.1136/bmjopen-2022-068207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES To compare teledermatology and face-to-face (F2F) agreement in primary diagnoses of dermatological conditions. DESIGN Systematic review and meta-analysis METHODS: MEDLINE, Embase, Cochrane Library (Wiley), CINAHL and medRxiv were searched between January 2010 and May 2022. Observational studies and randomised clinical trials that reported percentage agreement or kappa concordance for primary diagnoses between teledermatology and F2F physicians were included. Titles, abstracts and full-text articles were screened in duplicate. From 7173 citations, 44 articles were included. A random-effects meta-analysis was conducted to estimate pooled estimates. Primary outcome measures were mean percentage and kappa concordance for assessing diagnostic matches between teledermatology and F2F physicians. Secondary outcome measures included the agreement between teledermatologists, F2F dermatologists, and teledermatology and histopathology results. RESULTS 44 studies were extracted and reviewed. The pooled agreement rate was 68.9%, and kappa concordance was 0.67. When dermatologists conducted F2F and teledermatology consults, the overall diagnostic agreement was significantly higher at 71% compared with 44% for non-specialists. Kappa concordance was 0.69 for teledermatologist versus specialist and 0.52 for non-specialists. Higher diagnostic agreements were also noted with image acquisition training and digital photography. The agreement rate was 76.4% between teledermatologists, 82.4% between F2F physicians and 55.7% between teledermatology and histopathology. CONCLUSIONS AND RELEVANCE Teledermatology can be an attractive option particularly in resource-poor settings. Future efforts should be placed on incorporating image acquisition training and access to high-quality imaging technologies. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/FJDVG.
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Affiliation(s)
| | - Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University Montreal, Montreal, Quebec, Canada
| | | | | | - Robert D J Fraser
- Nursing, Western University Arthur Labatt Family School of Nursing, London, Ontario, Canada
- Swift Medical, Toronto, Ontario, Canada
| | - Amy Lorincz
- Independent Researcher, Montreal, Qubec, Canada
| | - Sheila C Wang
- Swift Medical, Toronto, Ontario, Canada
- Dermatology, McGill University Department of Medicine, Montreal, Qubec, Canada
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Jones LK, Oakley A. Store-and-Forward Teledermatology for Assessing Skin Cancer in 2023: Literature Review. JMIR DERMATOLOGY 2023; 6:e43395. [PMID: 37632914 PMCID: PMC10335330 DOI: 10.2196/43395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/15/2023] [Accepted: 04/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The role of teledermatology for skin lesion assessment has been a recent development, particularly, since the COVID-19 pandemic has impacted the ability to assess patients in person. The growing number of studies relating to this area reflects the evolving interest. OBJECTIVE This literature review aims to analyze the available research on store-and-forward teledermatology for skin lesion assessment. METHODS MEDLINE was searched for papers from January 2010 to November 2021. Papers were searched for assessment of time management, effectiveness, and image quality. RESULTS The reported effectiveness of store-and-forward teledermatology for skin lesion assessment produces heterogeneous results likely due to significant procedure variations. Most studies show high accuracy and diagnostic concordance of teledermatology compared to in-person dermatologist assessment and histopathology. This is improved through the use of teledermoscopy. Most literature shows that teledermatology reduces time to advice and definitive treatment compared to outpatient clinic assessment. CONCLUSIONS Overall, teledermatology offers a comparable standard of effectiveness to in-person assessment. It can save significant time in expediting advice and management. Image quality and inclusion of dermoscopy have a considerable bearing on the overall effectiveness.
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Affiliation(s)
| | - Amanda Oakley
- Te Whatu Ora Waikato, Hamilton, New Zealand
- The University of Auckland, Auckland, New Zealand
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Gaydina TA, Dvornikova EG. Efficacy of smartphone-compatible optical instrument for assessing melanocytic nevi for malignancy. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Early detection of melanocytic nevus progression to malignant melanoma is a pressing concern. Traditionally, patients with multiple melanocytic nevi (MMN) are monitored for extended periods of time and excisional biopsies are performed on individual suspicious melanocytic nevi (MN). This approach is costly and tremendously time-consuming for both doctors and patients. The aim of this study was to evaluate the efficacy of a smartphone-compatible optical instrument in the assessment of MN for malignancy. Seven patients aged 43 to 65 years with MMN on the trunk and upper/lower extremities were followed-up for 4 years. Dermoscopy images of MN were taken and analyzed using a Handyscope smartphone-compatible optical system operated at 20x magnification and a Handyscope3 application. A total of 74 MN were surgically removed during the follow-up period. None of the patients had melanoma. The results of dermoscopy image analysis generated by the convolutional neural network coincided with histopathology findings in all cases. The optical Handyscope system demonstrated its efficacy in assessing MN for malignancy. AI can be used for primary screening of MMN dermoscopy images. However, histopathological verification of the diagnosis is still needed.
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Affiliation(s)
- TA Gaydina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - EG Dvornikova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Zink A. Trends in the treatment and prevention of keratinocyte carcinoma (non-melanoma skin cancer). Curr Opin Pharmacol 2019; 46:19-23. [PMID: 30660857 DOI: 10.1016/j.coph.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 12/11/2022]
Abstract
Keratinocyte carcinoma (KC), previously also known as non-melanoma skin cancer, is the most common malignancy worldwide. It comprises basal cell carcinoma, squamous cell carcinoma (SCC), and actinic keratoses as carcinoma in situ or precursors of SCC. With solar ultraviolet radiation being the main risk factor, several countries have accepted KC as an occupational disease of outdoor professions. The prevalence in these high-risk groups is substantial, but awareness and preventive behavior remains inadequate. Parallel to the development of improved treatments, such as daylight photodynamic therapy and PD1 inhibitors for progressive KC, target-oriented prevention strategies are requisite if the global burden of KC is to be lowered. Health-related communication, internet search analysis, and telemedicine could be the key to addressing this issue.
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Affiliation(s)
- Alexander Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany; Clinical Unit Allergology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany.
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Eber EL, Janda M, Arzberger E, Hofmann-Wellenhof R. Umfrage zur Situation der Teledermatologie in Österreich. J Dtsch Dermatol Ges 2019; 17:25-31. [DOI: 10.1111/ddg.13729_g] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Elena Lucia Eber
- Universitätsklinik für Dermatologie; Medizinische Universität Graz; Graz Österreich
| | - Monika Janda
- School of Public Health and Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane Queensland Australien
| | - Edith Arzberger
- Universitätsklinik für Dermatologie; Medizinische Universität Graz; Graz Österreich
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Eber EL, Janda M, Arzberger E, Hofmann-Wellenhof R. Survey on the status of teledermatology in Austria. J Dtsch Dermatol Ges 2018; 17:25-31. [PMID: 30549444 DOI: 10.1111/ddg.13729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/31/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of digital communication media is becoming increasingly important, with the primary aim of improving both treatment quality and patients' quality of life. In an effort to optimize telemedicine in the field of dermatology, we conducted a survey among dermatologists in Austria. METHODS Statistical analysis of a questionnaire that was developed by a working group and sent to 769 Austrian dermatologists. RESULTS Overall, 243 dermatologists (132 women/111 men) participated in the survey. Forty-seven percent of male respondents and 55 % of female respondents had already received requests for teledermatology consultations. Seventy-three percent felt that telemedicine was able to contribute to relieving the economic burden on the health care system. Telecommunication between dermatologists and experts (in a given field of dermatology) was deemed to be particularly useful. While telemedicine was also considered to be appropriate for patient follow-up, it was viewed to be less useful for initial consultations. Roughly 50 % of respondents used telemedicine to get a second opinion; one-third used it for initial consultations. CONCLUSIONS Our survey shows that the majority of participants consider teledermatology to be a useful supplement to the current practice of dermatology. Given its particular usefulness for triage purposes, teledermatology can help reduce the number of trips to the hospital and subsequent waiting times. This in turn leads to cost reduction and saves time for both patients and doctors. Legal regulations that include provisions for appropriate reimbursement of physicians would make using teledermatology more attractive.
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Affiliation(s)
- Elena Lucia Eber
- Department of Dermatology, Graz Medical University, Graz, Austria
| | - Monika Janda
- School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Edith Arzberger
- Department of Dermatology, Graz Medical University, Graz, Austria
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Boehmer D, Schuster B, Krause J, Darsow U, Biedermann T, Zink A. Prevalence and treatment of allergies in rural areas of Bavaria, Germany: a cross-sectional study. World Allergy Organ J 2018; 11:36. [PMID: 30473740 PMCID: PMC6241034 DOI: 10.1186/s40413-018-0218-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/12/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is a high prevalence of allergies in Germany, with approximately 20% of the population having at least one allergy and only about 10% of these being treated adequately. We conducted a cross-sectional study in a rural area of Bavaria (Southern Germany) to evaluate the prevalence of allergies and their treatment, because research regarding this topic is currently limited. METHODS Data were collected in 10 offices of non-dermatological doctors using a self-filled questionnaire to ask participants about allergies and treatment. RESULTS A total of 641 questionnaires were appropriate for analysis. The prevalence of allergies in the Bavarian countryside was higher than that reported for Germany (37.3% vs. 20.0%). Furthermore, almost a third (30.4%) of allergies were not treated at all. The most frequently consulted therapist was found to be a general practitioner. CONCLUSIONS Based on the study results, there is a need for prevention programs and establishment of treatments for certain allergies to minimize long-term health effects. Moreover, more studies are needed to analyze the prevalence of allergies in farmers who had a higher prevalence of allergies compared to previously reported prevalence in literature reviews. TRIAL REGISTRATIONS The study was approved by the ethical review committee of the Technical University Munich (EC number 548/16S).
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Affiliation(s)
- Danielle Boehmer
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
| | - Barbara Schuster
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
| | - Julia Krause
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
| | - Ulf Darsow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
| | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
- Clinical Unit Allergology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany
| | - Alexander Zink
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technical University of Munich, Biedersteiner Str. 29, 80802 Munich, Germany
- Clinical Unit Allergology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany
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Greis C, Meier Zürcher C, Djamei V, Moser A, Lautenschlager S, Navarini AA. Unmet digital health service needs in dermatology patients. J DERMATOL TREAT 2018; 29:643-647. [PMID: 29455570 DOI: 10.1080/09546634.2018.1441488] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Digital health services are rapidly gaining acceptance in healthcare systems. Dermatology as an image-centric specialty is particularly well suited for telemedical services. However, dermatology patients' demands of electronic services remain largely unexplored. METHODS This study investigated patients' views in primary, secondary, and tertiary referral centers. In August 2017, 841 questionnaires were filled in by dermatology patients. RESULTS 76.34% expressed interest in using digital healthcare services as part of medical consultations. 84.41% of all patients would complete their initial registration form electronically. Fewer patients were comfortable with sending pictures of skin changes to their doctors using email (40.89%) or mobile health applications (40.61%). Specific interest was indicated for arranging appointments online (90.80%) and electronically-placed prescriptions (76.56%), rather than online learning videos (42.03%), and actual online consultations (34.53%). 65.37% of patients would pay for online consultations themselves. CONCLUSIONS Taken together, interest in electronic health services is high in dermatology patients. Our data suggest that readily understandable electronic services such as online-arranged appointments and electronic prescriptions are of higher interest to patients than the current type of online consultations. Therefore, the full potential of teledermatology still remains to be tapped by newer, more attractive forms of services closely adapted to patients' demands.
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Affiliation(s)
- Christian Greis
- a Department for Dermatology , University Hospital Zurich , Zurich , Switzerland
| | | | - Vahid Djamei
- a Department for Dermatology , University Hospital Zurich , Zurich , Switzerland
| | - Andreas Moser
- c Novaderm , Medical Practice for Dermatology and Allergy , Affoltern a.A , Switzerland
| | | | - Alexander A Navarini
- a Department for Dermatology , University Hospital Zurich , Zurich , Switzerland
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