
Bertil Persson
Consultant

When Are Single Reader Evaluations Insufficient in Teledermoscopic Assessments? : Analyses of a Retrospective Cohort Study
Author
Summary, in English
Background: Teledermoscopy (TDS) emerges as an efficient tool for diagnosing skin lesions. In Sweden, double reading is the standard of care, but risk factors for misdiagnosis or mismanagement using single reader evaluations (SRE) are not well-studied. This study aimed to assess the accuracy of SRE compared with the gold standard in TDS. Methods: This retrospective cohort study involved 1,997 TDS referrals sent from general practitioners to dermatologists in Stockholm, Sweden, selected based on dermoscopic diagnoses. All referrals underwent double reader evaluations (DRE). Each case was reassessed by a single external assessor, blinded to the DRE result. Based on predefined rules, a gold standard for the most correct diagnosis was established. Diagnostic accuracy and risk factors for misdiagnosis were evaluated. The trial was registered on ClinicalTrials.gov (ID NCT05033678). Results: Primary diagnosis by SRE agreed with the gold standard on benign-malignant classification in 84% of cases. Discordance was linked to lower diagnostic confidence and more frequent recommendations for further intervention. SRE achieved a benign-malignant sensitivity and specificity of 84% (95% confidence interval: 81-87% and 82-86%, respectively). The risk of overdiagnosis increased 96 times when assessors reported being "very unconfident." Out of a total of 311 melanomas, melanoma in situ, lentigo maligna, and severely dysplastic nevi, 62 were not recognized in the SRE primary diagnosis. However, 50 of these misdiagnosed lesions were still recommended for accurate management. Conclusions: The confidence level of TDS assessors heavily influences diagnostic accuracy. Therefore, when diagnostic confidence is perceived as moderate or low, additional interventions should be considered.
Department/s
- LUCC: Lund University Cancer Centre
- LUSCaR- Lund University Skin Cancer Research group
- Dermatology and Venereology (Lund)
- LU Profile Area: Light and Materials
- Lund Melanoma Study Group
- Teachers at the Medical Programme
- Clinical Sciences, Helsingborg
Publishing year
2025-01-27
Language
English
Pages
579-589
Publication/Series
Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Volume
31
Issue
5
Document type
Journal article
Publisher
Mary Ann Liebert, Inc.
Topic
- Dermatology and Venereal Diseases
- Cancer and Oncology
Status
Published
Research group
- LUSCaR- Lund University Skin Cancer Research group
- Lund Melanoma Study Group
ISBN/ISSN/Other
- ISSN: 1530-5627