Comparative effectiveness study of face-to-face and teledermatology workflows for diagnosing skin cancer.


Division of Research, Kaiser Permanente, Oakland, California. Electronic address: [Email]


BACKGROUND : The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood.
OBJECTIVE : We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows.
METHODS : Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017.
RESULTS : One teledermatology workflow achieved high-resolution images with use of a dermatoscope-fitted digital camera, a picture archiving and communication system, and image retrieval to a large computer monitor (in contrast to a smartphone screen). Compared with direct referral, this workflow was associated with a 9% greater probability of cancer detection (95% confidence interval [CI], 2%-16%), a 4% lower probability of biopsy (relative risk, 0.96; 95% CI, 0.93-0.99), and 39% fewer face-to-face visits (relative risk, 0.61; 95% CI, 0.57-0.65). Other workflows were less effective.
CONCLUSIONS : Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias.
CONCLUSIONS : Implementation is critical to the effectiveness of teledermatology.


comparative effectiveness research,dermatology/diagnosis,dermatology/epidemiology,dermatology/organization and administration,skin cancer,telemedicine,

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