Successful triage of patients referred to a skin lesion clinic using teledermoscopy (IMAGE IT trial)


  • Conflicts of interest
    A.O. and M.R. receive an item of service payment for reading Molemaps for MoleMap NZ.

  • This study is registered with the Australian New Zealand Clinical Trials Registry (ACTR No. 12609000782235).

Eugene Tan.


Background  Teledermatology is a rapidly growing field with studies showing high diagnostic accuracy when compared with face-to-face diagnosis. Teledermoscopy involves the use of epiluminescence microscopy to increase diagnostic accuracy. The utility of teledermoscopy as a triage tool has not been established.

Objectives  To assess teledermoscopy as a triage tool for a hospital skin lesion clinic.

Methods  Patients referred to a dermatology skin lesion clinic were recruited. Digital and dermoscopic photographs were taken of skin lesions of concern and the patients were then seen independently face-to-face by two out of three dermatologists. The digital images were evaluated 4 weeks later, as a teledermoscopy consultation, by two of these dermatologists. The diagnosis and management from both types of consultation were compared.

Results  Two hundred patients with a total of 491 lesions were seen. There was excellent agreement between teledermoscopy and face-to-face diagnosis with only 12·3% of lesions having disparate diagnoses of clinical significance. Twelve of 491 (2·4%) lesions appeared to have been under-reported by teledermoscopy when compared with face-to-face diagnosis. However, when histopathology became available, only one malignant lesion had been missed (a basal cell carcinoma diagnosed as solar keratosis) by teledermoscopy. Teledermoscopy approximated 100% sensitivity and 90% specificity for detecting melanoma and nonmelanoma skin cancers. Importantly, 74% of all lesions were determined to be manageable by the general practitioner without needing to be seen face-to-face by a dermatologist.

Conclusions  This use of teledermoscopy as a triage tool offers the potential to shorten waiting lists and thus improve healthcare access and delivery.