Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Teledermoscopic triage of melanoma-suspicious skin lesions is safe : A retrospective comparative diagnostic accuracy study with multiple assessors

Nervil, Gustav Gede ; Ternov, Niels Kvorning ; Lorentzen, Henrik ; Kromann, Charles ; Ingvar, Åsa LU orcid ; Nielsen, Kari LU orcid ; Tolsgaard, Martin ; Vestergaard, Tine and Hölmich, Lisbet Rosenkrantz (2024) In Journal of Telemedicine and Telecare
Abstract

Background: The rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions. Methods: Five dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies, Caution Protocol and Majority Vote, and the sensitivity and specificity of the patient triages were calculated. Results: Triage by a single teledermatologist showed a sensitivity of 92.3% and a... (More)

Background: The rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions. Methods: Five dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies, Caution Protocol and Majority Vote, and the sensitivity and specificity of the patient triages were calculated. Results: Triage by a single teledermatologist showed a sensitivity of 92.3% and a specificity of 58.7%. Sensitivity improved with the number of assessors, particularly when using the Caution Protocol, though with a considerable drop in specificity. The Majority Vote showed a more balanced improvement in sensitivity and specificity. Safety analyses indicated that diagnostic accuracy decreased with poor image quality and increased case difficulty. Discussion: Expert teledermoscopic triage of melanocytic skin lesions is highly sensitive and lowers the need for unnecessary excision procedures by half while dismissing as few as 0.4% (95% confidence interval 0–0.6%) of melanomas, even when applied to a high-prevalence pre-triaged subpopulation. Implementation of safety procedures increases accuracy. Using multiple teledermatologists increases sensitivity but at the cost of specificity unless a Majority Vote consensus strategy is applied. Future teledermoscopy guidelines should encompass safety procedures and protocols for disagreement between assessors.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
accuracy‌, melanoma, skin cancer, teledermatology, Teledermoscopy, telemedicine
in
Journal of Telemedicine and Telecare
publisher
SAGE Publications
external identifiers
  • scopus:85205982808
  • pmid:39387164
ISSN
1357-633X
DOI
10.1177/1357633X241286003
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2024.
id
a730e881-bd5f-434f-beb7-f2bd50be6770
date added to LUP
2024-12-18 13:39:37
date last changed
2025-07-17 06:46:52
@article{a730e881-bd5f-434f-beb7-f2bd50be6770,
  abstract     = {{<p>Background: The rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions. Methods: Five dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies, Caution Protocol and Majority Vote, and the sensitivity and specificity of the patient triages were calculated. Results: Triage by a single teledermatologist showed a sensitivity of 92.3% and a specificity of 58.7%. Sensitivity improved with the number of assessors, particularly when using the Caution Protocol, though with a considerable drop in specificity. The Majority Vote showed a more balanced improvement in sensitivity and specificity. Safety analyses indicated that diagnostic accuracy decreased with poor image quality and increased case difficulty. Discussion: Expert teledermoscopic triage of melanocytic skin lesions is highly sensitive and lowers the need for unnecessary excision procedures by half while dismissing as few as 0.4% (95% confidence interval 0–0.6%) of melanomas, even when applied to a high-prevalence pre-triaged subpopulation. Implementation of safety procedures increases accuracy. Using multiple teledermatologists increases sensitivity but at the cost of specificity unless a Majority Vote consensus strategy is applied. Future teledermoscopy guidelines should encompass safety procedures and protocols for disagreement between assessors.</p>}},
  author       = {{Nervil, Gustav Gede and Ternov, Niels Kvorning and Lorentzen, Henrik and Kromann, Charles and Ingvar, Åsa and Nielsen, Kari and Tolsgaard, Martin and Vestergaard, Tine and Hölmich, Lisbet Rosenkrantz}},
  issn         = {{1357-633X}},
  keywords     = {{accuracy‌; melanoma; skin cancer; teledermatology; Teledermoscopy; telemedicine}},
  language     = {{eng}},
  publisher    = {{SAGE Publications}},
  series       = {{Journal of Telemedicine and Telecare}},
  title        = {{Teledermoscopic triage of melanoma-suspicious skin lesions is safe : A retrospective comparative diagnostic accuracy study with multiple assessors}},
  url          = {{http://dx.doi.org/10.1177/1357633X241286003}},
  doi          = {{10.1177/1357633X241286003}},
  year         = {{2024}},
}