Teledermatology-based presurgical management for nonmelanoma skin cancer: a pilot study

Abstract

Background: To date, no previous experiences of teledermatology (TD) as a preoperative management facility have been published.

Objective: The objective was to evaluate a store-and-forward TD (SFTD) system aimed at the presurgical management of nonmelanoma skin cancer patients.

Methods and materials: This was a multicenter, longitudinal, descriptive, and evaluative pilot study. Patients included in the TD-based surgical referral system presented with a nonmelanoma skin cancer or a fast-growth vascular tumor suitable for surgery under local anesthesia. Waiting intervals and on-the-day cancellation rates were evaluated and compared with a sample of patients managed through the conventional system. The accuracy of the diagnoses yielded and of the surgical techniques planned through teleconsultation was also calculated.

Results: A total of 134 patients were enrolled in the study. The mean waiting interval was 26.10 days [95% confidence interval (CI), 24.51-27.70] in patients managed through TD and 60.57 days (95% CI, 56.20-64.93 days; n=92; p < .001) in the conventional system. On-the-day surgery cancellation was 2.99% (95% CI, 1.52%-4.46%) for the TD series and 8.85% (95% CI, 5.62%-11.81%; p<.005) in the conventional system. The accuracy of the telediagnoses was kappa=0.86 (95% CI, 0.83-0.89). The agreement rate between the surgical technique planned through teleconsultation and the technique finally performed was kappa=0.75 (95% CI, 0.04-0.79).

Conclusion: SFTD has been demonstrated to be effective and accurate as a preoperative tool for nonmelanoma skin cancer, avoiding unnecessary visits to the hospital and shortening the waiting intervals to the surgical treatment.