Review
Teledermatology for diagnosis and management of skin conditions: A systematic review

Portions of this manuscript were presented at a Veterans Health Administration Office of Telehealth Services preconference workshop titled “Teledermatology: Evolving Practice, Research, and Guidelines,” Saint Louis, MO, May 11, 2010.
https://doi.org/10.1016/j.jaad.2010.08.026Get rights and content

Objective

We performed a systematic review of the literature addressing teledermatology: (1) diagnostic accuracy/concordance; (2) management accuracy/concordance; (3) clinical outcomes; and (4) costs.

Methods

Peer-reviewed controlled trials published in English between 1990 and 2009 were identified through MEDLINE and PubMed searches.

Results

Of 78 included studies, approximately two-thirds comparing teledermatology and clinic dermatology found better diagnostic accuracy with clinic dermatology. Diagnostic concordance of store and forward with clinic dermatology was good; concordance rates for live interactive and clinic dermatology were higher, but based on fewer patients. Overall rates of management accuracy were equivalent, but teledermatology and teledermatoscopy were inferior to clinic dermatology for malignant lesions. Management concordance was fair to excellent. There was insufficient evidence to evaluate clinical course outcomes. Patient satisfaction and preferences were comparable. Teledermatology reduced time to treatment and clinic visits and was cost-effective if certain assumptions were met.

Limitations

Heterogeneity in studies (design, skin conditions, outcomes) limited the ability to pool data.

Conclusion

The benefits of teledermatology need to be evaluated in the context of potential limitations.

Section snippets

Topic development and technical expert panel

This topic was nominated by the Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center in consultation with the Department of Veterans Affairs (VA) Evidence Synthesis Program. Three clinicians with clinical and/or research experience in teledermatology served on the Technical Expert Panel (TEP) for the project. The TEP and the VA Department of Health Services Research and Development collaborated with the Minneapolis VA Evidence Synthesis Program to identify

Literature flow

The OVID MEDLINE search yielded 560 references with 3 duplicates for a total of 557 references. The PubMed search yielded 587 references. When the results from these searches were combined, 486 duplicate references were eliminated resulting in 658 titles and abstracts for review. From the 658 titles and abstracts, 472 references were excluded. The full text of 186 references was then reviewed and another 108 references were excluded resulting in a total of 78 studies included in the report. Fig

Conclusions

In general, diagnostic accuracy of clinic dermatology was better than SAF teledermatology. Both SAF and LI teledermatology had acceptable diagnostic accuracy and concordance compared with clinic dermatology. Little information exists on the impact of teledermatology on clinical outcomes and management compared with management provided by in-clinic dermatologists. This may be particularly important for dermatologic conditions with potentially serious outcomes (eg, malignant conditions). Patient

References (79)

  • M. Bigby et al.

    Appraising systematic reviews and meta-analyses

    Arch Dermatol

    (2003)
  • P. Whiting et al.

    The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews

    BMC Med Res Methodol

    (2003)
  • K.E. Edison et al.

    Diagnosis, diagnostic confidence, and management concordance in live interactive and store-and-forward teledermatology compared to in-person examination

    Telemed J E Health

    (2008)
  • G. Fabbrocini et al.

    Telediagnosis and face-to-face diagnosis reliability for melanocytic and non-melanocytic ‘pink’ lesions

    J Eur Acad Dermatol Venereol

    (2008)
  • A. Di Stefani et al.

    Feasibility of a two-step teledermatologic approach for the management of patients with multiple pigmented skin lesions

    Dermatol Surg

    (2007)
  • L. Ferrandiz et al.

    Teledermatology-based presurgical management for nonmelanoma skin cancer: a pilot study

    Dermatol Surg

    (2007)
  • D. Moreno-Ramirez et al.

    Store-and-forward teledermatology in skin cancer triage: experience and evaluation of 2009 teleconsultations

    Arch Dermatol

    (2007)
  • I.R. Bowns et al.

    Telemedicine in dermatology: a randomized controlled trial

    Health Technol Assess

    (2006)
  • I.R. Bowns et al.

    Telemedicine in dermatology: a randomized controlled trial

    Health Technol Assess

    (2006)
  • D. Moreno-Ramirez et al.

    Teledermatoscopy as a triage system for pigmented lesions: a pilot study

    Clin Exp Dermatol

    (2006)
  • A.M. Oakley et al.

    Diagnostic value of written referral and/or images for skin lesions

    J Telemed Telecare

    (2006)
  • R. Mahendran et al.

    An evaluation of the role of a store-and-forward teledermatology system in skin cancer diagnosis and management

    Clin Exp Dermatol

    (2005)
  • M. Baba et al.

    A comparison of teledermatology using store-and-forward methodology alone, and in combination with Web camera videoconferencing

    J Telemed Telecare

    (2005)
  • D. Moreno-Ramirez et al.

    Teledermatology as a filtering system in pigmented lesion clinics

    J Telemed Telecare

    (2005)
  • W.F. Tucker et al.

    Digital imaging: a diagnostic screening tool?

    Int J Dermatol

    (2005)
  • M.O. Oztas et al.

    Reliability of Web-based teledermatology consultations

    J Telemed Telecare

    (2004)
  • G. Ferrara et al.

    A pilot study of a combined dermoscopic-pathological approach to the telediagnosis of melanocytic skin neoplasms

    J Telemed Telecare

    (2004)
  • D. Piccolo et al.

    Diagnosis and categorization of acral melanocytic lesions using teledermoscopy

    J Telemed Telecare

    (2004)
  • M. Shapiro et al.

    Comparison of skin biopsy triage decisions in 49 patients with pigmented lesions and skin neoplasms: store-and-forward teledermatology vs face-to-face dermatology

    Arch Dermatol

    (2004)
  • B. Coras et al.

    Teledermatoscopy in daily routine–results of the first 100 cases

    Curr Probl Dermatol

    (2003)
  • M.F. Du Moulin et al.

    The reliability of diagnosis using store-and-forward teledermatology

    J Telemed Telecare

    (2003)
  • H.S. Pak et al.

    Teledermatology: an intraobserver diagnostic correlation study, part II

    Cutis

    (2003)
  • H.S. Pak et al.

    Teledermatology: an intraobserver diagnostic correlation study, part I

    Cutis

    (2003)
  • E. Rashid et al.

    Comparison of store and forward method of teledermatology with face-to-face consultation

    J Ayub Med Coll Abbottabad

    (2003)
  • M.R. Oliveira et al.

    Web site for training nonmedical health-care workers to identify potentially malignant skin lesions and for teledermatology

    Telemed J E Health

    (2002)
  • V.M. Jolliffe et al.

    Can we safely diagnose pigmented lesions from stored video images? A diagnostic comparison between clinical examination and stored video images of pigmented lesions removed for histology

    Clin Exp Dermatol

    (2001)
  • V.M. Jolliffe et al.

    Can we use video images to triage pigmented lesions?

    Br J Dermatol

    (2001)
  • A.C. Lim et al.

    Accuracy and reliability of store-and-forward teledermatology: preliminary results from the St George teledermatology project

    Australas J Dermatol

    (2001)
  • P. Taylor et al.

    Evaluating a telemedicine system to assist in the management of dermatology referrals

    Br J Dermatol

    (2001)
  • Cited by (231)

    • Patient satisfaction with the Veteran's Administration teledermatology service

      2023, Journal of the American Academy of Dermatology
    View all citing articles on Scopus

    This material is based on work supported, in part, by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Evidence Synthesis Program, Project #09-009. The full report is available at: http://www.hsrd.research.va.gov/publications/esp/.

    Conflicts of interest: None declared.

    The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the US government.

    Reprints not available from the authors.

    View full text