Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Maak, D.
Diagnostic Value of Teledermoscopy for Skin Cancer Prevention
[ Diplomarbeit ] Medical University of Graz; 2012. pp. 60
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Frühauf Julia
- Hofmann-Wellenhof Rainer
- Altmetrics:
- Abstract:
- Abstract Background: Teledermatology (TD), a discipline of telemedicine, supplies dermatological expertise at a distance. A specific application of TD that has been repeatedly tested is the use of dermatologist-directed store-and-forward triage systems. Even with regard to skin cancer, which incidence rate is continuously increasing worldwide, TD may be a valuable triage tool for providing early diagnosis of disease, facilitating patient management and improving therapeutic decisions. Objective: To evaluate the applicability of a second opinion teleconsultation service among patients attending centres for preventive health care in Austria. Design: In a routine setting, general practitioners performed teledermoscopy using a digital dermoscopic system and clinical images were taken with a high-resolution digital camera. Images of suspicious skin tumours were then transmitted via virtual private network for decision-making. In cases of suspected malignancy, results were compared with a reference standard derived from histopathologic or FTF findings following referral to a local specialist. In addition, the general practitioners´ acceptance of and confidence in the teleconsultation service was evaluated using a specifically developed questionnaire. Results: From 2008-2010, 962 dermoscopic and 123 clincial images were obtained from 693 patients. In 122 lesions of 112 patients an excision or FTF examination by a local specialist was recommended. Diagnoses from thirty-two of these 122 lesions could be verified by histopathology (n=19) or FTF examination (n=13). In these cases, remote desicions showed a strong concordance with the reference standard (detailed diagnoses: 91.7%; tumour category: 96.9%); all malignant lesions (n=8) and 23/24 bengin lesions were correctly identified (sensitivity: 100%; specificity: 95.8%). However, the GPs were only partly satisfied with the service. In particular, they expressed reservations about system usability and legal ambiguities. Conclusions: A remote second-opinion service seems suitable to triage out clearly benign skin tumours, thus allowing obvious malignancies and equivocal skin lesions to be appropriately managed also by non-experts, such as general practitioners. However, besides the removal of legal ambiguities, further technical advancements seem mandatory to make the service applicable also for routine usage.