Abstract
Recent studies demonstrating accuracy of teledermatology and teledermoscopy in the evaluation of pigmented skin lesions (PSL) have been performed only on PSL previously selected by face-to-face examination. The objective was to investigate the feasibility of teledermatology for the management of individuals exhibiting multiple PSL with a two-step procedure. In the first step, remote consultants selected clinically equivocal lesions evaluating a teletransmitted clinical image of patients' backs. In the second step, dermoscopic images of selected lesions were evaluated. Management recommendations of both steps were compared with face-to-face. For a total of 465 PSL in 18 patients, the agreement between the face-to-face and the two remote experts resulted moderate (kappa value, 0.530-0.565) in the first step and substantial (kappa value, 0.681-0.703) in the second step. Although there are limitations of this pilot experience (population and technical restrictions), our results provide preliminary evidence that a two-step teledermatologic approach may be feasible in managing individuals with multiple PSL.
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