Feasibility of a two-step teledermatologic approach for the management of patients with multiple pigmented skin lesions

Background Recent studies demonstrating accuracy of teledermatology and teledermoscopy in the evaluation of pigmented skin lesions (PSL) have been performed only on PSL previously selected by face-to-face examination. Objectives The objective was to investigate the feasibility of teledermatology for the management of individuals exhibiting multiple PSL with a two-step procedure. Materials and Methods In the first step, remote consultants selected clinically equivocal lesions evaluating a teletransmitted clinical image of patients' backs. In the second step, dermoscopic images of selected lesions were evaluated. Management recommendations of both steps were compared with face-to-face. Results For a total of 465 PSL in 18 patients, the agreement between the face-to-face and the two remote experts resulted moderate (kappa value, 0.530-0.565) in the first step and substantial (kappa value, 0.681-0.703) in the second step. Conclusions Although there are limitations of this pilot experience (population and technical restrictions), our results provide preliminary evidence that a two-step teledermatologic approach may be feasible in managing individuals with multiple PSL.