A Comparison of the Concordance of Digital Images, Live Examinations, and Skin Biopsies for the Diagnosis of Hospitalized Dermatology Consultation Patients

Noah Scheinfeld, MD, JD, Jeremy Kurz, MD, Ellen Teplitz, MD


Skinmed. 2003;2(1) 

In This Article


The visual nature of dermatology lends itself to the utilization of digital images for medical record keeping and diagnosis. The provision of dermatologic care based on images alone is not yet an accepted method of practice. In order to be accepted, teledermatology must be proved to provide quality, efficient, cost effective, and reimbursable dermatologic care. Some studies[10] have shown that teledermatology is cost effective, especially for patients, while other studies,[11] especially those which have discounted patient travel costs, have not shown it to be cost effective. Current technology can provide information for accurate dermatologic diagnosis and treatment in the hospital and in the clinic. Variables involved in assessing a dermatologic image include color, topography and associated history, and other physical signs. Although there is data on the resolution of images needed for diagnosis of dermatologic disorders from digital images,[12] much work is needed to determine appropriate telediagnosis standards for image and history collection. Various adjunct technologies can aid telediagnosis including the durometer to measure degree of skin induration[13] and various methods of measuring skin texture.[14] In addition, the ideal number of images to be acquired still needs to be determined.

As our study shows, medical personnel with no formal dermatologic training can create images useful for dermatologic examinations. With the easy-to-learn imaging system described here, the quality of the images improved quickly as the month-long study progressed. Furthermore, the format used in our study, i.e., JPEG images on a USB-enabled Compactflash card, allowed us to quickly upload images onto a PC for immediate viewing, storage, or Internet transmission. The confidentiality and security of images transmitted is feasible and has been addressed.[15]

Dermatologists are more accurate than primary care physicians in diagnosing skin diseases.[16] Therefore, in situations where access to dermatologists is limited, teledermatology doesn't have to be better than having a dermatologist present in-person; it just has to be better than no dermatologist. As mentioned above, studies have shown high patient satisfaction with teledermatology. This study provides evidence that teledermatology consultation, even in suboptimal situations for photography, can be a clinically useful technique that can provide for relatively reliable diagnostic conclusions. Our findings provide justification for development of teledermatology systems that will maximize quality and efficiency, and minimize cost, while leading to better outcomes and easier accessibility to quality health care.


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