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Telemedicine in dermatology: a randomised controlled trial
I R Bowns1, K Collins, S J Walters
1School of Health and Related Research (ScHARR), University of Sheffield, UK.
Health Technology Assessment (Winchester, England)
|October 20, 2006
Summary
Store-and-forward (SF) teledermatology showed potential biases and recruitment issues, preventing firm conclusions on its clinical performance. Digital photography for skin cancer assessment is unlikely to replace face-to-face consultations while ensuring patient safety.
Area of Science:
- Dermatology
- Digital Health
- Health Services Research
Background:
- Store-and-forward (SF) teledermatology and digital photography are emerging tools in dermatology.
- Conventional face-to-face consultations remain the standard for diagnosing skin conditions and cancers.
Purpose of the Study:
- To compare the clinical equivalence of SF teledermatology with traditional consultations for new adult referrals.
- To assess the equivalence of digital photography and dermoscopy versus face-to-face consultations for suspected skin cancers.
Main Methods:
- A prospective randomized controlled trial was conducted for SF teledermatology.
- Digital photography with and without dermoscopy was used for suspected skin cancer cases prior to face-to-face consultation.
Main Results:
- SF teledermatology faced recruitment challenges and potential biases, hindering definitive conclusions on its performance.
- Digital photography showed high sensitivity (98%) but low specificity (43%) for skin cancer detection, with a number-needed-to-harm of 153 for squamous cell carcinoma.
- Approximately 30% of skin cancer cases could potentially avoid face-to-face consultation with digital imaging, but missed diagnoses remain a concern.
Conclusions:
- No valid conclusions could be drawn on the clinical performance of SF teledermatology due to study limitations.
- Digital photography is unlikely to significantly reduce the need for conventional consultations in suspected skin cancer cases without compromising safety.
- Further research on inter-clinician agreement in diagnosis and management is recommended.
