Store-and-forward teledermatology based on photographs taken with a smartphone by a general practitioner in case of suspicion of melanoma: evaluation of management concordance among dermatologists (Preprint)

BACKGROUND The incidence of melanoma is increasing worldwide. The effectiveness of treatment is associated with diagnostic and therapeutic delays. In this context, teledermatology (TD), especially store-and-forward TD, is a promising technology, as it can accelerate the care process. However, several studies indicate that the efficiency and reliability of this practice in cases of pigmented skin lesions is not proven and call for further work. OBJECTIVE The main objective of this study was to evaluate management concordance among teledermatologists concerning the appropriate consultation delay when reviewing photographs of suspicious pigmented skin lesions taken with a smartphone by a general practitioner (GP). METHODS Methods: We conducted management concordance analysis among different teledermatologists with experience in TD. The teledermatologists determined the consultation delay to propose to 110 patients with suspicious pigmented skin lesions viewed online based on 241 photographs taken by GPs in a real-life context. The practitioners had to decide among 4 possibilities for care management: 1. urgent need for consultation, 2. nonurgent need for consultation, 3. no need for consultation, and 4. impossible to assess: request for additional information or photographs from the GP. "Major" discordance was defined as follows: one teledermatologist decided that the patient had to receive a consultation within 15 days, while another teledermatologist decided that it was not necessary to see the patient ("simple letter to the attending physician"). RESULTS This study revealed poor agreement among dermatologists when they assessed photographs taken by a GP using a smartphone. The interrater agreement was poor regardless of the analysis modality used. The 2-to-2 interdermatologist management concordance revealed a low Cohen's kappa (between 0.11 and 0.43). Overall agreement was low (Fleiss’ kappa 0.24). We observed major discordance regarding care management for 42 clinical cases (38% of patients). CONCLUSIONS This study is in line with recent studies calling for postponement of the development of store-and-forward TD for the management of skin cancers until additional studies have been carried out.