Forum for Nordic Dermato-Venereology No 3, 2019 Telemedicine | Page 27

John Paoli – Teledermatology and teledermoscopy: old technology just waiting to be exploited
Fig. 3. Most members of our teledermatology and teledermoscopy research group were present when we received Dagens Medicin’s “Gold Scalpel”
award for innovation of the year in Swedish health care for our smartphone app for mobile teledermoscopy referrals in 2013.
from 80 TDS referrals and 77 paper referrals from the previous
trial and asked 6 Swedish dermatologists to evaluate them
and provide a probable diagnosis, the priority of the case and
a management decision. TDS allowed for higher diagnostic
agreement, better triage decisions and more patients with skin
cancer booked directly to surgery when needed (especially in
the cases of invasive melanoma). Furthermore, TDS resulted in
significantly more patients with benign lesions being resent to
primary health care avoiding unnecessary visits. On the other
hand, 5 assessments made on feature-poor melanoma in situ
lesions were incorrectly prioritised by teledermoscopists in
this study. It is therefore essential to be generous in offering
face-to-face visits when assessing TDS referrals for melanocytic
lesions, even if they are just slightly atypical. Finally, the in-
terobserver concordance was found to be moderate with both
TDS and paper referrals (9).
Finally, we also studied the quality of clinical and dermoscopic
images acquired by primary care physicians with little or no
training using an iPhone ® 4 (Apple, Cupertino, California,
USA) and a compatible digital dermoscope (Handyscope®,
FotoFinder ® Systems GmbH, Bad Birnbach, Germany) to im-
ages of the same lesions taken by dermatologists and trained
nurses at a Dermatology department using a Canon EOS D550
camera (Canon Inc., Tokyo, Japan) together with a Heine D20
dermoscope (Heine Optotechnik GmbH & Co., Herrsching,
Germany). When assessing the image quality of the two image
Forum for Nord Derm Ven 2019, Vol. 24, No. 3
sets of the 172 included tumours, images taken by primary
health care physicians and those obtained at the Dermatology
department were of intermediate to high quality in the abso-
lute majority of cases (95.5–97.7% and 96.5–98.8%, respec-
tively). Moreover, no significant differences in the diagnoses
made based on the two image sets were seen and most image
pairs received the same main diagnosis by the two evaluators
(81.4% and 83.7%, respectively) (10).
Since our early publications and lectures promoting TDS,
many Dermatology departments in Sweden have started to
implement similar systems to improve their triaging of referrals
from primary care. The Regions of Västerbotten (Umeå) and
Gävleborg (Gävle) were two of the first regions to implement
similar digital, although not app-based, solutions for TD and
TDS, also making it mandatory for primary care physicians
to send digital images with their referrals to Dermatology de-
partments. In the region of Stockholm, a copy of our original
smartphone app has been used in pilot studies during the past
few years and has unsurprisingly shown the same benefits
demonstrated by our group initially. And, as the years go by,
an increasing number of regions in Sweden are catching on
to the idea. Sadly, in our own region of Västra Götaland, a
digital solution for TD and TDS was not implemented until
March of 2018 and is still only available for about 50% of the
region’s primary care centres. On a brighter note, discussions
are ongoing at a national level with the clear goal of imple-
T heme I ssue : T eledermatology
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