Reliability of store and forward teledermatology for skin neoplasms

Erin M. Warshaw, Amy A. Gravely, David B. Nelson

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Background Teledermatology may be less optimal for skin neoplasms than for rashes. Objectives We sought to determine agreement for skin neoplasms. Methods This was a repeated measures study. Each lesion was examined by a clinic dermatologist and a teledermatologist; both generated a primary diagnosis, up to 2 differential diagnoses, and management. Macro images and polarized light dermoscopy images were obtained; for pigmented lesions only, contact immersion dermoscopy image was obtained. Results There were 3021 lesions in 2152 patients. Of 1685 biopsied lesions, there were 410 basal cell carcinomas (24%), 240 squamous cell carcinomas (14%), and 41 melanomas (2.4%). Agreement was fair to substantial for primary diagnosis (45.7%-80.1%; kappa 0.32-0.62), substantial to almost perfect for aggregated diagnoses (primary plus differential; 78.6%-93.9%; kappa 0.77-0.90), and fair for management (66.7%-86.1%; kappa 0.28-0.41). Diagnostic agreement rates were higher for pigmented lesions (52.8%-93.9%; kappa 0.44-0.90) than nonpigmented lesions (47.7%-87.3%; kappa 0.32-0.86), whereas the reverse was found for management agreement (pigmented: 66.7%-79.8%, kappa 0.19-0.35 vs nonpigmented: 72.0%-86.1%, kappa 0.38-0.41). Agreement rates using macro images were similar to polarized light dermoscopy; contact immersion dermoscopy, however, significantly improved rates for pigmented lesions. Limitations We studied a homogeneous population. Conclusions Diagnostic agreement was moderate to almost perfect whereas management agreement was fair. Polarized light dermoscopy increased rates modestly whereas contact immersion dermoscopy significantly increased rates for pigmented lesions.

Original languageEnglish (US)
Pages (from-to)426-435
Number of pages10
JournalJournal of the American Academy of Dermatology
Issue number3
StatePublished - Mar 1 2015

Bibliographical note

Funding Information:
This research was supported by the Department of Veterans Affairs (VA), Veterans Health Administration, Health Services Research and Development Service IIR 01-072-2 . During this study, Dr Warshaw was supported by a VA Cooperative Studies Clinical Research Career Development Award.


  • dermoscopy
  • diagnosis
  • management
  • reliability
  • skin cancer
  • teledermatology


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