Forum for Nordic Dermato-Venereology No 3, 2019 Telemedicine | Page 12

Luit Penninga, Anne Kathrine Lorentzen, Jørgen Serup and Carsten Sauer Mikkelsen – Teledermatology in Arctic Greenland
diagnostic testing or treatment options. The local physician
informed the patient and started diagnostic investigation or
treatment as indicated. The local doctor could store-and-send
follow-up pictures when required. All cases including the
photographs/dermoscopic images were stored in the patients’
electronical records.
Fig. 2. The telemedicine device Pipaluk.
the Queen Ingrid Hospital in Nuuk, or a University Hospital
in Copenhagen, Denmark.
T elemedicine
In addition to using telemedicine for the provision of gen-
eral health care in rural villages, various other telemedical
programs have been implemented in the last decade in
Greenland. These programs can either be store-and-send appli-
cations or live-video-transmissions (2). For ophthalmological
cases, there are store-and-forward programs using advanced
equipment including optical coherence tomography (OCT)
and retina imaging. There are also live-video-transmission
programs for psychiatry, including consultations for acute
psychiatric problems, as well as other programs for neurolo-
gy, cardiology, rheumatology, gastroenterology, and wound
treatment.
T eledermatology
The first specialty to apply telemedicine in Greenland was
dermatology. For this purpose the Pipaluk machine was used.
The Pipaluk machine, which is located in all health care fa-
cilities across Greenland, is equipped with a regular camera
and a camera with an integrated dermoscope. When local
doctor was consulted by a patient with a dermatological issue,
the local physician could easily seek specialist advice from a
dermatological consultant.
The local doctor took clinical photographs with the camera
and/or dermoscope, and sent the photos accompanied by a
case story via the Pipaluk system to the department of der-
matology at Copenhagen University Hospital, Bispebjerg,
Denmark. There, a consultant dermatologist reviewed the case
and photographs, and replied with advice regarding further
96
T heme I ssue : T eledermatology
In addition to the store-and-forward option, live-video trans-
mission with the dermatologist is also possible (2). This option
is usually applied when the store-and-forward option does not
provide the information needed, for example in cases with
diagnostic difficulties, or if the patient does not respond to
the initiated treatment. In rare cases, patients are transferred
to the department of dermatology at Bispebjerg Hospital. This
happens in cases with very severe dermatological disease, in
which highly specialized knowledge and intensive treatment
is required.
After implementation of a national electronic patient journal
Cosmic® in 2017, the procedure for the store-and-forward
option was slightly changed. The images are now stored in the
electronic patient journal, and the consultant dermatologist
has access to the electronic patient journal. This also means
that the consultant dermatologist has access to more infor-
mation, for example laboratory tests.
A dvantages
and limitations
Teledermatology offers the great advantage that specialized
dermatological consultations are available throughout the
year. Before teledermatology, patients waited up to one year
for the dermatologist visit at the local/regional hospital. A
further advantage is that photographs are stored and can be
reviewed when necessary.
The teledermatological approach has also limitations. Typical-
ly, the clinical information in the case story accompanying the
photographs was limited when the Pipaluk model was used,
and the dermatologist often lacked important information.
This was improved when images where stored-and forwarded
in the electronic patient journal, and the dermatologist got
access to the electronic patient journal. This could possibly
be improved further by using standard schemes containing
questions which the local doctor must fill out.
The diagnosis of melanoma skin cancer using teledermatology
is difficult, and often the diagnosis cannot be confirmed or
rejected based on one teledermatological image only. Hence,
the dermatologists at Bispebjerg Hospital are cautious when
evaluating teledermatological cases possibly representing mel-
anoma skin cancer. Fortunately, the incidence of melanoma
skin cancer is low among Greenlandic Inuits (3).
Forum for Nord Derm Ven 2019, Vol. 24, No. 3