Actinic keratosis (AK) and field cancerization are increasing health problems insufficiently
diagnosed by primary care physicians. The objective of this study was to assess the
validity and reliability of teledermatology (TD) and teledermoscopy in the diagnosis
of AK and field cancerization in a gatekeeper healthcare model. A prospective diagnostic
test evaluation was done to assess the diagnostic concordance, accuracy, and performance
parameters and the interobserver and intraobserver concordances of TD and teledermoscopy
compared with dermatologists’ face-to-face evaluation or histopathology. A total of
636 patients with 1,000 keratotic skin lesions were included. TD diagnostic concordance
for AK and field cancerization evaluation was very high and superior to primary care
physicians’ diagnosis (92.4% vs. 62.4% and 96.7% vs. 51.8%, P < 0.001). TD sensitivity,
specificity, and positive and negative predictive values for AK diagnosis and field
cancerization were high (range = 82.2–95.0) and better than primary care physicians’
diagnosis. Teledermoscopy yielded better results in diagnostic concordance, performance
parameters, and AK subtypes. Intraobserver and interobserver agreement was >0.83.
TD and, to a greater extent, teledermoscopy may be valid and reliable tools for the
diagnosis of AK and field cancerization and may improve diagnosis and correct allocation
and management in gatekeeper healthcare systems. It can be an alternative tool to
training primary care physicians in direct diagnosis of these lesions.
Abbreviations:
AK ( Actinic keratosis), FTF ( face-to-face), PCP ( primary care physician), PSL ( pigmented skin lesions), SCC ( squamous cell carcinoma), TD ( teledermatology), TDS ( teledermoscopy)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: March 03, 2020
Accepted:
February 17,
2020
Received in revised form:
January 25,
2020
Received:
November 27,
2019
Identification
Copyright
© 2020 The Authors. Published by Elsevier, Inc. on behalf of the Society for Investigative Dermatology.
