Diagnosis and Management of Malignant Melanoma in Store-and-Forward Teledermatology.

BACKGROUND: Published studies have led to concern that store-and-forward teledermatology (SFT) diagnosis and management of melanomas may be inferior to face-to-face (FTF) dermatology care. INTRODUCTION: To ascertain the frequency of correctly managed and diagnosed melanomas within a population of veterans in Veterans Integrated Service Network 20 SFT. MATERIALS AND METHODS: We conducted a retrospective chart review of 7,960 veterans seen by SFT between July 1, 2009 and December 31, 2011. RESULTS: Of the 61 veterans that met inclusion and exclusion criteria, 45 (74%) melanomas were correctly diagnosed and 57 (93%) were correctly managed. DISCUSSION: Diagnostic and management accuracy of SFT is comparable to FTF. Incorrect diagnosis or management of melanomas did not prove to have significant consequences for patient care. Cases subject to analysis of this study are not demographically representative of the general population. CONCLUSION: Diagnosis and management of melanoma in SFT is comparable to FTF care.

Unimaged Melanomas in Store-and-Forward Teledermatology.

BACKGROUND: Store-and-forward teledermatology (SFT) readers can only diagnose what is imaged. This limitation has caused concern regarding the ability of primary care to direct imaging of lesions suspicious for melanoma. Melanomas not imaged by primary care providers (PCPs) are termed unimaged melanomas. OBJECTIVE: To determine the frequency of unimaged melanomas among Veterans referred for care in a SFT program. MATERIALS AND METHODS: All SFT patients with melanoma diagnosis were ascertained by query of the VA corporate data warehouse, Veterans Integrated Service Network 20 store-and-forward program database, and the VA Computerized Patient Record System. RESULTS: Between July 1, 2009 and December 31, 2011, 12,863 SFT consultations were conducted on 7,960 Veterans. Sixty-nine melanomas met inclusion and exclusion criteria; 13 melanomas were unimaged. The frequency of unimaged melanoma was 10.1 per 10,000 consultations. DISCUSSION: Our calculated frequency of unimaged melanomas associates SFT with noninferiority to face-to-face care. This study was conducted on an exclusively Veteran population, precluding generalizability to the general population. CONCLUSIONS: PCPs referring to store-and-forward teledermatology may fail to image melanomas.