Forum for Nordic Dermato-Venereology No 3, 2019 Telemedicine | Page 13

Luit Penninga, Anne Kathrine Lorentzen, Jørgen Serup and Carsten Sauer Mikkelsen – Teledermatology in Arctic Greenland
There are issues with compliance and follow-up with the
current teledermatological model in Greenland. Advice given
by the dermatologist is not always followed by the patients
and health care professionals. Many patients stop treatment
once they experience improvement or when they run out of
medication. This may lead to a high number of incomplete
treatment courses and early disease recurrence. Proper fol-
low-up is possible with teledermatology, and should be aimed
for in Greenland to improve (long-term) results.
After the implementation of telemedicine, the frequency of
consultations of medical specialists who travel through the
country visiting the regional hospitals and physician-staffed
clinics has significantly been reduced for some specialties.
Visits by psychiatrists have largely been replaced by telepsy-
chiatric consultations. Visits by neurologists have completely
been replaced by teleneurological consultations. Also, visits
by dermatologists have been reduced from annual visits to
all cities to visits every second year to the largest cities, and
might be further reduced in the future.
D iscussion
Teledermatology is also applied in other areas where geo-
graphical distances are large and population density is low
(4–6). An example is Australia, where a large teledermatology
program is successfully running (4). Other examples are rural
Brasil and Afghanistan (5, 6).
Telemedicine should not just be considered as a technological
advancement, but as a clinical intervention with potential
benefits and harms compared to conventional consultations.
A randomized trial showed that teledermatology was safe and
had similar clinical outcomes compared with conventional
treatment in an outpatient clinic (7). The study also showed
that teledermatology was not cost-effective in large cities due
to the extra time required for consultations, but when distanc-
es between the patients and dermatological clinics are large
and travel costs high, teledermatology is cost-effective (7).
This is certainly the case for Greenland. In addition, studies
have shown that teledermatology is reliable, as high levels
of agreement exist between diagnoses made using teleder-
matology and conventional consultations (8). In addition,
recommendations for biopsy in dermatological lesions were
comparable between cases seen teledermatologically and by
conventional consultations (8).
Studies have also shown that by using teledermatology, der-
matologists can supervise general practitioners in performing
safe surgery with appropriate margins for diseases like malig-
nant melanoma and other skin cancers (9). This approach of
telemedical-directed surgical care significantly reduces travel
costs (8). This can also be a useful tool in Greenland, although
Forum for Nord Derm Ven 2019, Vol. 24, No. 3
the incidence of melanoma and skin cancer is low (3).
In addition, store-and-forward teledermatology has been
shown to significantly improve the dermatological knowledge
of general practitioners using teledermatology (10).
As technological progress continues, new applications of
teledermatology have and will become available, for exam-
ple using mobile phones for teledermatology. These options
should be evaluated for the Greenlandic healthcare system,
and may be applied in the future (11).
C onclusion
Teledermatology can be a valuable tool for diagnosis and
treatment of dermatological patients in areas with large geo­
graphical distances, extreme weather conditions, and low
population density, like Greenland. Teledermatology ensures
the possibility of year-round access to expert dermatological
knowledge. Further improvement in compliance, follow-up,
and new applications for teledermatology in Greenland should
be explored.
R eferences
1. Lorentzen AK, Penninga L. Frostbite – A case series from arctic
Greenland. Wilderness Environ Med 2018; 29: 392–400.
2. Lee KJ, Finnane A, Soyer HP. Recent trends in teledermatology
and teledermoscopy. Dermatol Pract Concept 2018; 8: 214–223.
3. Boysen T, Friborg J, Andersen A, Poulsen GN, Wohlfahrt J, Melbye
M. The Inuit cancer pattern – the influence of migration. Int J
Cancer 2008; 122: 2568–2572.
4. Byrom L, Lucas L, Sheedy V, Madison K, McIver L, Castrisos G, et
al. Tele-Derm National: A decade of teledermatology in rural and
remote Australia. Aust J Rural Health 2016; 24: 193–199.
5. Ismail A, Stoff BK, McMichael JR. Store-and-forward telederma-
tology service for primary care providers in Afghanistan. Int J
Dermatol 2018; 57: e145–e147.
6. Assis TG, Palhares DM, Alkmim MB, Marcolino MS. Teledermato­
logy for primary care in remote areas in Brasil. J Telemed Telecare
2013; 19: 494–495.
7. Wootton R, Bloomer SE, Corbett R, Eedy DJ, Hicks N, Lotery HE,
et al. Multicentre randomised control trial comparing real time
teledermatology with conventional outpatient dermatological
care: societal cost-benefit analysis. BMJ 2000; 320: 1252–1256.
8. Campagna M, Naka F, Lu J. Teledermatology: An updated overview
of clinical applications and reimbursement policies. Int J Womens
Dermatol 2017; 3: 176–179.
9. Vedire K, Joselow AL, Markham CM, Raugi GJ. Teledermatology-di-
rected surgical care is safe and reduces travel. J Telemed Telecare
2016; 22: 121–126.
10. Mohan G, Molina G, Stavert R. Store and forward teledermatology
improves dermatology knowledge among referring primary care
providers: a survey-based cohort study. J Am Acad Dermatol 2018.
pii: S0190-9622(18)30662-5.
11. Clark AK, Bosanac S, Ho B, Sivamani RK. Systematic review of
mobile phone-based teledermatology. Arch Dermatol Res 2018;
310: 675–689.
T heme I ssue : T eledermatology
97