1. J Dermatolog Treat. 2020 May 4:1-9. doi: 10.1080/09546634.2020.1762843. [Epub
ahead of print]
Inpatient Teledermatology During the COVID-19 Pandemic.
Rismiller K(1), Cartron AM(2), Trinidad JCL(1).
(1)Division of Dermatology, Department of Internal Medicine, The Ohio State
University Wexner Medical Center, Columbus, Ohio, USA.
(2)Department of Dermatology, University of Maryland School of Medicine,
Baltimore, MD, USA.
2. J Am Acad Dermatol. 2020 May 4. pii: S0190-9622(20)30776-3. doi:
10.1016/j.jaad.2020.04.154. [Epub ahead of print]
The COVID-19 crisis: A unique opportunity to expand dermatology to underserved
Ashrafzadeh S(1), Nambudiri VE(2).
(1)Harvard Medical School, Boston, Massachusetts, USA; Department of Dermatology,
Brigham and Women's Hospital, Boston, Massachusetts, USA.
(2)Department of Dermatology, Brigham and Women's Hospital, Boston,
Massachusetts, USA. Electronic address: firstname.lastname@example.org.
3. Australas J Dermatol. 2020 May 3. doi: 10.1111/ajd.13301. [Epub ahead of print]
Practice guidelines for teledermatology in Australia.
Abbott LM(1)(2), Miller R(1), Janda M(3), Bennett H(1), Taylor M(4), Arnold C(1),
Shumack S(1), Soyer HP(5), Caffery LJ(5).
(1)The Australasian College of Dermatologists, Sydney, New South Wales,
(2)Sydney Law School, University of Sydney, Sydney, New South Wales, Australia.
(3)Centre for Health Services Research, The University of Queensland, St Lucia,
(4)Centre for Online Health, Centre for Health Services Research, The University
of Queensland, St Lucia, Queensland, Australia.
(5)The University of Queensland Diamantina Institute, Woolloongabba, Queensland,
Despite the potential of teledermatology to increase access to dermatology
services and improve patient care, it is not widely practised in Australia. In an
effort to increase uptake of teledermatology by Australian dermatologists and
support best practice, guidelines for teledermatology for the Australian context
have been developed by The University of Queensland's Centre for Online Health in
collaboration with The Australasian College of Dermatologists' E-Health
Committee. The guidelines are presented in two sections: 1. Guidelines and 2.
Notes to support their application in practice, when feasible and appropriate.
Content was last updated March 2020 and includes modalities of teledermatology;
patient selection and consent; imaging; quality and safety; privacy and security;
communication; and documentation and retention of clinical images. The guidelines
educate dermatologists about the benefits and limitations of telehealth while
articulating how to enhance patient care and reduce risk when practicing
© 2020 The Authors. Australasian Journal of Dermatology published by John Wiley &
Sons Australia, Ltd on behalf of Australasian College of Dermatologists.
4. Int J Med Inform. 2020 Mar 13;139:104118. doi: 10.1016/j.ijmedinf.2020.104118.
[Epub ahead of print]
Teleoncology for children with cancer: A scoping review on applications and
Kermani F(1), Orooji A(2), Sheikhtaheri A(3).
(1)Department of Health Information Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
(2)School of Medicine, North Khorasan University of Medical Science (NKUMS),
North Khorasan, Iran.
(3)Health Management and Economics Research Center, Department of Health
Information Management, School of Health Management and Information Sciences,
Iran University of Medical Sciences, Tehran, Iran. Electronic address:
BACKGROUND AND OBJECTIVES: Teleoncology can be used to reduce the limitations due
to the lack of access to specialists, inadequate resources and training, and
reducing unnecessary travels and arising of the costs. The purpose of this study
was to review the literatures to identify and classify the areas of application
and outcomes of using teleoncology in diagnosis, management, and treatment of
children with cancer.
METHODS: This scoping review of the published literatures was conducted by
searching the Web of Science, PubMed/Medline, Scopus, and Cochrane Library
databases in October 2019. Studies investigated telemedicine in diagnosis,
management, and treatment of cancer in children were also included. We identified
and classified different applications and the reported outcomes of this
RESULTS: In this study, 1834 articles were retrieved, and after removing the
unrelated and duplicated articles, 20 articles were reviewed ultimately. We found
that, teleoncology services were provided to the patients with cancer, their
parents, and nurses in various clinical fields such as telepathology, telemental
care (telepsychology), teleneurology, teledermatology, telehematology, and
teleophthalmology. The findings also showed that, the outcomes of using
telemedicine in children with cancer can be classified into six general
categories (five primary and 14 secondary outcomes). Primary outcomes including
diagnosis accuracy, reduced costs as well as mortality and secondary outcomes
consist of improved relationship and training, better care management,
satisfaction, and workload.
CONCLUSION: The use of telemedicine for children with cancer is growing, and
there is a tendency for using this technology for families and clinical staff.
Providing teleoncology services to children with cancer may improve diagnosis
accuracy and reduce the cost and mortality rate. Also, better care management,
appropriate relationships and training, increased satisfaction, and decreased
workload may be achieved.
Copyright © 2020 Elsevier B.V. All rights reserved.
5. Telemed J E Health. 2020 Apr 27. doi: 10.1089/tmj.2020.0013. [Epub ahead of
Implementing Teledermatology for Rural Veterans: An Evaluation Using the RE-AIM
Peracca SB(1), Jackson GL(2)(3), Lamkin RP(4), Mohr DC(4)(5), Zhao M(4), Lachica
O(1), Prentice JC(4)(6), Grenga AM(7), Gifford A(4), Chapman JG(2), Weinstock
MA(7)(8)(9), Oh DH(1)(8)(10).
(1)Dermatology Service, San Francisco Veterans Affairs Health Care System, San
Francisco, California, USA.
(2)Center of Innovation to Accelerate Discovery and Practice Transformation
(ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
(3)Department of Population Health Sciences and Division of General Internal
Medicine, Department of Medicine, Duke University, North Carolina, USA.
(4)Center for Healthcare Organization and Implementation Research (CHOIR),
Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.
(5)Department of Health Law, Policy and Management, School of Public Health,
Boston University, Boston, Massachusetts, USA.
(6)Department of Psychiatry, School of Medicine, Boston University,
(7)Providence VA Medical Center, Providence, Rhode Island.
(8)Office of Connected Care, Veterans Health Administration, Washington, District
of Columbia, USA.
(9)Dermatoepidemiology Unit, Departments of Dermatology and Epidemiology, Brown
University, Providence, Rhode Island, USA.
(10)Department of Dermatology, University of California at San Francisco, San
Francisco, California, USA.
Introduction: Few systematic evaluations of implementing teledermatology programs
in large health care systems exist. We conducted a longitudinal evaluation of a
U.S. Department of Veterans Affairs (VA) initiative to expand asynchronous
consultative teledermatology services for rural veterans. Methods: The reach,
effectiveness, adoption, implementation, and maintenance framework guided the
evaluation, which included analysis of quantitative VA administrative data as
well as an online survey completed by participating facilities. The first 2 years
of the program were compared with the year before the start of funding. Results:
Sixteen hub facilities expanded teledermatology's reach over the 2-year period,
increasing the number of referral spoke sites, unique patients served, and
teledermatology encounters. Effectiveness was reflected as teledermatology
constituted an increasing fraction of dermatology activity and served more
remotely located patients. Adoption through defined stages of implementation
progressed as facilities engaged in a variety of strategies to enhance
teledermatology implementation, and facilitators and barriers were identified.
Program maintenance was assessed by Program Sustainability Index scores, which
reflected the importance of executive support, and ongoing concerns about
staffing and longitudinal funding. Discussion: Enabling hubs to create solutions
that best fit their needs and culture likely increased reach and effectiveness.
Important facilitators included organizational leadership and encouraging
communication between stakeholders before and during the intervention.
Conclusions: A systematic analysis of teledermatology implementation to serve
rural sites in VA documented a high degree of implementation and sustainability
as well as areas for improvement.
6. PLoS One. 2020 Apr 27;15(4):e0232131. doi: 10.1371/journal.pone.0232131.
Teledermatology in Norway using a mobile phone app.
Rizvi SMH(1)(2), Schopf T(3), Sangha A(2), Ulvin K(2), Gjersvik P(4).
(1)Department of Dermatology, Oslo University Hospital, Oslo, Norway.
(2)Askin AS, Oslo, Norway.
(3)National Centre for e-Health Research, University Hospital Northern Norway,
(4)Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Rashes, ulcers and skin lesions are well suited for telemedicine. We have
developed a smartphone app, the first of its kind in Norway, where a referring
physician can write a short medical history and take clinical and dermatoscopic
photographs with a smartphone, which is then sent to and evaluated by a
dermatologist. In the period from June 1st, 2017, to September 1st, 2019,
clinical information and photographs of rash and skin lesions from 171 patients
were sent by 40 primary care and nursing home physicians via the smartphone app
to four dermatologists for diagnosis and therapeutic advice. A wide range of
dermatological conditions were diagnosed, most commonly chronic ulcers (17%),
eczema (15%) and pigmented lesions (13%). Assessed later by a dermatologist,
referral for regular consultations with a specialist was avoided in 119 patients
(70%). Sixteen patients (9%) were recommended a regular consultation with a
dermatologist; information for prioritization in the specialist healthcare
service was then provided. In 36 patients (21%), further measures by the
referring physician were recommended. Our experience indicates that many ordinary
consultations on rash, ulcers and skin lesions in the specialist healthcare
services can be avoided when using the smartphone app.
Conflict of interest statement: SMHR, AS and KU founded and are shareholders in
Askin AS (www.askin.no) of which TS is a partner. PG has no conflict of interest.
The commercial affiliation does not alter our adherence to PLOS ONE policies on
sharing data and materials.
7. J Am Acad Dermatol. 2020 Apr 22. pii: S0190-9622(20)30696-4. doi:
10.1016/j.jaad.2020.04.080. [Epub ahead of print]
Teledermatology in the Wake of COVID-19: Advantages and Challenges to Continued
Care in a Time of Disarray.
Gupta R(1), Ibraheim MK(2), Doan HQ(3).
(1)School of Medicine, Baylor College of Medicine, Houston, TX, USA. Electronic
(2)The University of Texas McGovern Medical School, Houston, TX, USA.
(3)Department of Dermatology, Division of Internal Medicine, The University of
Texas MD Anderson Cancer Center, Houston, TX, USA.
8. J Med Internet Res. 2020 Apr 21;22(4):e16700. doi: 10.2196/16700.
Benefits of Teledermatology for Geriatric Patients: Population-Based
G Bianchi M(#)(1), Santos A(#)(1), Cordioli E(#)(1).
(1)Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
BACKGROUND: Teledermatology is a health care tool that has been increasingly used
around the world, mostly because dermatology has an emphasis on visual diagnosis.
Many studies have shown that access to specialized care improves using
teledermatology, which provides accurate diagnosis and reduces the time taken for
treatment, with high patient satisfaction. As the population around the world
grows old, there will be even more demand for dermatologists in years to come. It
is essential to know which are the most prevalent skin conditions in the primary
care population and if they can be addressed through teledermatology.
OBJECTIVE: Our main goal was to evaluate the proportion of lesions in individuals
aged 60 years and older that could be managed using teledermatology in
conjunction with primary care physicians. Second, we aimed to assess the most
frequent skin lesions, the most common treatments provided to patients, and the
distribution and causes of referrals made by the teledermatologists.
METHODS: This was a retrospective cohort study from July 2017 to July 2018 in São
Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented
with 12,770 skin lesions. Teledermatologists had three options to refer patients:
(1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3)
back to the primary care physician with the most probable diagnosis and
RESULTS: Teledermatology managed 66.66% (8408/12614) of dermatoses with the
primary care physician without the need for an in-presence visit; 27.10%
(3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to
biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo,
onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid
cyst, xerosis, leucoderma, and wart, with significant differences between sexes.
Malignant tumors increased with age and were the leading cause for biopsies,
while infectious skin conditions and pigmentary disorders decreased. Emollient
was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases.
CONCLUSIONS: Teledermatology helped to treat 67% of the dermatoses of older
individuals, addressing cases of minor complexity quickly and conveniently
together with the primary care physician, thus optimizing dermatological
appointments for the most severe, surgical, or complex diseases. Teledermatology
does not aim to replace a face-to-face visit with the dermatologist; however, it
might help to democratize dermatological treatment access for patients and
decrease health care expenses.
©Mara G Bianchi, Andre Santos, Eduardo Cordioli. Originally published in the
Journal of Medical Internet Research (http://www.jmir.org), 21.04.2020.
9. Mil Med. 2020 Apr 20. pii: usz479. doi: 10.1093/milmed/usz479. [Epub ahead of
Synchronous Teledermoscopy in Military Treatment Facilities.
Day WG(1), Shrivastava V(2), Roman JW(2).
(1)Internal Medicine Intern, Naval Medical Center Portsmouth, 620 John Paul Jones
Cir, Portsmouth, VA 23708.
(2)Department of Dermatology, Naval Medical Center Portsmouth, 620 John Paul
Jones Cir, Portsmouth, VA 23708.
Sustained demand for dermatologic care throughout military medicine, in
conjunction with increasing dermatologic provider shortages, has led to increase
use of teledermatology in military treatment facilities (MTFs). Initially used to
aid in the differentiation of suspicious melanocytic lesions, dermoscopy has
found increasing clinical utility in an expanding realm of general dermatologic
conditions. We demonstrate the use of synchronous teledermoscopy within a remote
MTF by repurposing webcam technology already available at most MTFs. Two patients
were seen in clinic at a remote naval primary care clinic with limited
subspecialties. Once written consent was retrieved, an on-site dermatologist
evaluated each patient and performed a history and skin exam with dermoscopy.
Synchronous consultations were conducted with the Global Med Cart (GlobalMed(R)
Clinical Access Station with TotalExam(R) 3 HDUSB camera), and Cisco webcam video
jabber (Cisco TelePresence PrecisionHD USB Camera part number TTC8-03). The
patients then underwent individual synchronous teledermatology consultations with
an off-site U.S. Navy dermatologist located in the continental United States. The
methodology for the consultation involved the use of a standard dermatoscope and
jabber webcam. Two synchronous teledermatology consultations were completed
successfully on patients in MTFs with limited subspecialty capabilities. Both
cases, with two lesions of concern per case, had 100% concordance between the
on-site and teleconsulted dermatologist. Through observing inter-rater agreements
between the on-site and remote dermatologists, this small study demonstrates a
novel application of technology readily available at most MTFs.
© The Author(s) 2020. Published by Oxford University Press on behalf of the
Association of Military Surgeons of the United States. All rights reserved. For
permissions, please e-mail: email@example.com.
10. J Am Acad Dermatol. 2020 Apr 16. pii: S0190-9622(20)30661-7. doi:
10.1016/j.jaad.2020.04.048. [Epub ahead of print]
Teledermatology in the Era of COVID-19: Experience of an Academic Department of
Perkins S(1), Cohen JM(2), Nelson CA(2), Bunick CG(2).
(1)Department of Dermatology, Yale University, New Haven, CT, 06520. Electronic
(2)Department of Dermatology, Yale University, New Haven, CT, 06520.
11. Clin Exp Dermatol. 2020 Apr 18. doi: 10.1111/ced.14245. [Epub ahead of print]
Telemedicine and support groups in order to improve the adherence to treatment
and health related quality of life in patients affected by inflammatory skin
conditions during COVID-19 emergency.
Marasca C(1), Ruggiero A(1), Fontanella G(1), Ferrillo M(1), Fabbrocini G(1),
(1)Section of Dermatology, Department of Clinical Medicine and Surgery,
University of Naples Federico II, Napoli, Italy.
We have read with great interest the article by Deepak et al. which reported the
measures applied during the COVID-19 emergency in order to answer to the request
of consultations. Particularly they described the growing importance that
telemedicine is having during this emergency, focusing on the use of mobile
technology (particularly the use of WhatsApp) as a method to communicate via text
messages, voice messages, photos and videos, which is rapidly expanding within
the field of telemedicine.
This article is protected by copyright. All rights reserved.
12. Clin Exp Dermatol. 2020 Apr 17. doi: 10.1111/ced.14244. [Epub ahead of print]
Secure communication conduits during COVID19 lockdown.
Black SM(1), Ali FR(2).
(1)Medical Sciences Division, University of Oxford, Oxford, UK.
(2)Vernova Healthcare Community Interest Company, Macclesfield, UK.
We commend Deepak and colleagues in highlighting the virtues of instant messaging
tools such as WhatsApp during the COVID-19 crisis1 . Whilst WhatsApp's advantages
include being highly intuitive, widely used and accessible, there are concerns
among clinicians about its use, as well as that of other commercially available
communications apps. These include the loss of anonymity to patients, the need to
reveal their personal telephone number as well questions over privacy and data
This article is protected by copyright. All rights reserved.
13. Dermatol Online J. 2019 Nov 15;25(11). pii: 13030/qt6xh9p2nn.
Implementation of a patient-assisted teledermatology model in the Veteran Health
Fortugno AP, Dellavalle RP(1).
(1)Department of Dermatology, University of Colorado School of Medicine, Aurora,
CO Dermatology Service, U.S. Department of Veterans Affairs, Eastern Colorado
Health Care System, Aurora, CO Department of Epidemiology, Colorado School of
Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
Owing to the inherently visual nature of the field of dermatology, advances in
imaging and communication technology have resulted in wide-spread application of
teledermatology since its introduction in the mid-1990s. In the last 20 years,
studies have repetitively shown that teledermatology provides effective and
efficient quality care for patients. It also increases access to underserved
patients and reduces traveling costs, wait times, and unnecessary referrals. In
this letter the authors seek to analyze implementation of a direct patient to
dermatologist model in a Veteran Health Administration (VHA) patient population,
referred to as patient-assisted teledermatology. This population is largely over
the age of 65 and a significant portion are either without internet or have the
minimum technology necessary to participate in the studied model. Owing to these
observations and personal experiences, the authors found the implementation
process of a patient-assisted model to be challenging in this population.
PMID: 32045144 [Indexed for MEDLINE]
14. JAAD Case Rep. 2020 Jan 30;6(2):141-143. doi: 10.1016/j.jdcr.2019.11.006.
eCollection 2020 Feb.
A suspected hedgehog dermatosis diagnosed via store and forward teledermatology.
Said JT(1), Stavert R(2).
(1)Harvard Medical School, Boston, Massachusetts.
(2)Department of Dermatology, Cambridge Health Alliance, Harvard Medical School,
15. J Am Acad Dermatol. 2020 Feb 5. pii: S0190-9622(20)30151-1. doi:
10.1016/j.jaad.2020.01.065. [Epub ahead of print]
Clinical effectiveness and cost-effectiveness of teledermatology: Where are we
now, and what are the barriers to adoption?
Wang RH(1), Barbieri JS(2), Nguyen HP(3), Stavert R(4), Forman HP(5), Bolognia
JL(6), Kovarik CL(7); Group for Research of Policy Dynamics in Dermatology.
(1)University of Pennsylvania Perelman School of Medicine, Philadelphia,
(2)Department of Dermatology, University of Pennsylvania Perelman School of
Medicine, Philadelphia, Pennsylvania. Electronic address:
(3)Department of Dermatology, Emory University School of Medicine, Atlanta,
(4)Department of Dermatology, Beth Israel Deaconess Medical Center, Boston,
(5)Department of Public Health (Health Policy), Economics, and Management, Yale
University, New Haven, Connecticut.
(6)Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
(7)Department of Dermatology, University of Pennsylvania Perelman School of
Medicine, Philadelphia, Pennsylvania.
There has been rapid growth in teledermatology over the past decade, and
teledermatology services are increasingly being used to support patient care
across a variety of care settings. Teledermatology has the potential to increase
access to high-quality dermatologic care while maintaining clinical efficacy and
cost-effectiveness. Recent expansions in telemedicine reimbursement from the
Centers for Medicare & Medicaid Services (CMS) ensure that teledermatology will
play an increasingly prominent role in patient care. Therefore, it is important
that dermatologists be well informed of both the promises of teledermatology and
the potential practice challenges a continuously evolving mode of care delivery
brings. In this article, we will review the evidence on the clinical and
cost-effectiveness of teledermatology and we will discuss system-level and
practice-level barriers to successful teledermatology implementation as well as
potential implications for dermatologists.
Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc.
All rights reserved.
16. Clin Exp Dermatol. 2020 Feb 7. doi: 10.1111/ced.14191. [Epub ahead of print]
Patient satisfaction with a new skin cancer teledermatology service.
Nicholson P(1), Macedo C(1), Fuller C(1), Thomas L(1).
(1)Dermatology Department, Chelsea and Westminster Hospital NHS Foundation Trust,
BACKGROUND: Rising numbers of two-week-wait (2WW) skin cancer referrals have
caused increasing pressure on UK dermatology departments. Initiatives to address
this include teledermatology. Previous studies have indicated good patient
acceptability but most have focused on general dermatology rather than skin
cancer referrals, and have taken place in rural settings, where teledermatology
may be preferable.
AIM: To evaluate patient satisfaction of teledermatology 2WW services in a
London-based tertiary National Health Service (NHS) setting.
METHODS: A literature search was performed and a patient satisfaction survey was
designed to evaluate: (i) ease of completing a questionnaire about the skin
lesion; (ii) lifestyle impact; (iii) preferences regarding electronic data
collection and communication of results; and (iv) confidence in the service. A
five-point Likert scale was used to assess responses. The study took place over a
RESULTS: Over half (51%; n = 31 of 60 patients) were female; 78% (47) were aged
≤ 55 years and 65% (39) were Caucasian. Over 80% (49) would recommend the
service, and the majority felt confident with the teledermatology model. Overall,
patients would be happy to complete electronic questionnaires and receive results
electronically, with younger patients being more amenable to this. Patients with
better health status, those of younger age and those with less frequent visits to
a dermatologist were more accepting of teledermatology.
CONCLUSION: To our knowledge, this is the first comprehensive study evaluating
patient satisfaction with teledermatology specifically for 2WW referrals in an
NHS setting. As skin cancer referrals increase, dermatology departments must
adjust. Patient involvement and feedback is paramount in implementing and
expanding teledermatology services.
© 2020 British Association of Dermatologists.
17. J Eur Acad Dermatol Venereol. 2020 Feb 7. doi: 10.1111/jdv.16275. [Epub ahead of
Diagnostic accuracy and interobserver concordance: teledermoscopy of 600
suspicious skin lesions in Southern Denmark.
Vestergaard T(1)(2), Prasad SC(1), Schuster A(1), Laurinaviciene R(1), Andersen
MK(3), Bygum A(1).
(1)Department of Dermatology and Allergy Centre, Odense University Hospital,
(2)OPEN, Odense Patient data Explorative Network, Odense University Hospital,
(3)Audit Project Odense, Research Unit of General Practice, University of
Southern Denmark, Odense, Denmark.
BACKGROUND: Skin cancer incidences are increasing and early diagnosis, especially
of malignant melanoma, is crucial. Teledermatology including teledermoscopy (TDS)
can be used to triage referrals of suspicious skin lesions, however, this is not
currently recommended in Denmark.
OBJECTIVES: To evaluate diagnostic accuracy, sensitivity, specificity and
interobserver concordance of TDS, and to evaluate the number of incidental
lesions potentially missed by TDS.
METHODS: Fifty general practices were invited to send images of suspicious skin
lesions for evaluation using smartphone TDS. Simultaneously, the patient was
referred for a face-to-face (FTF) consultation. Images for TDS were independently
evaluated by two dermatologists; a third dermatologist performed the FTF
consultation. Diagnosis, management plan and level of diagnostic confidence were
noted. For TDS photo quality was rated, and for FTF any incidental findings were
RESULTS: Six hundred lesions in 519 patients were included. The diagnostic
accuracy was significantly higher on FTF evaluation than on TDS (P < 0.01).
However, this was associated with a significant difference in specificity
(P ≤ 0.012) whereas no significant difference was found in sensitivity. The
concordance between FTF and TDS, and the interobserver concordance of two TDS
evaluations was moderate to substantial (AC1 = 0.57-0.71). Incidental melanomas
were found in 0.6% of patients on FTF evaluation, adding an extra 13% of
melanomas. However, on TDS these patients' photographed lesions all warranted FTF
follow-up, where these melanomas would have been identified.
CONCLUSION: In this large prospective study, no significant difference in
sensitivity was observed between FTF and TDS, but specificity was lower on TDS
than FTF. Taking management plans into account, we would, however, potentially
have dismissed 2 of 23 melanomas, if only TDS had been used for assessment. One
of these was a melanoma located on the scalp, an anatomic region less suitable
© 2020 European Academy of Dermatology and Venereology.