Short summary

This study aims to establish expert consensus on the essential components for teledermatological assessment of skin tumors using a Delphi process. The process involves three rounds of input and ranking by a panel of teledermatology experts. The variables are reviewed and prioritized based on their relevance, impact on patient outcomes, and feasibility. The final consensus will ensure a framework for better teledermatological management.

Rationale

Patients with suspicious skin lesions typically seek their general practitioners (GP) for an evaluation. In case the GP does not exclude malignancy, patients are referred for a consultation with a dermatologist. A subset of lesions is more aggressive and potentially deadly, which makes correct diagnosis and action crucial. Melanoma is the most common of these lesions. Dermoscopy is paramount for correct diagnosis of melanoma as found in a meta-analysis: Dermoscopy improves the diagnostic accuracy with a diagnostic odds ratio for melanoma of 9 (95% CI 1.5-54.6) as compared to unaided visual inspection (1). However, this is only the case if the investigator is sufficiently experienced in dermoscopy (2). The most important prognostic factor for melanoma is diagnosis in an early stage of disease (3). This is also a very important factor for reducing concern for the patient. As such, quick and valid action and diagnosis is of central importance to the patient. In a retrospective study with 11 years of data on teledermatological evaluations of skin lesions on Dutch patients, including teledermoscopy, response times for a teledermatological evaluation was a median of 2.4 hours. The same study found that teledermatological evaluation could reduce the number of patients who needed referral for a conventional dermatological consult by ~60 % and estimated a reduced cost of 144 € per patient (~19.000 patients/1 year) (4). Teledermatology with teledermoscopy therefore has the potential to reduce patient anxiety due to the fast response times, while at the same time reducing the referral pressure on dermatologists and reducing health care cost. This again can allow for earlier clinical evaluation and treatment of suspicious skin lesions. Currently there is no established consensus on which parameters are important for an optimal teledermatological assessment of skin lesions suspicious of being malignant. To establish an expert consensus through a Delphi process, on which data are important for a teledermatological evaluation.

Description of the cohort

Panel of dermatology experts from around the world

Data and biological material

Known teledermoscopy experts are contacted by members of the steering group and asked if they are interested in participating in the study as a KOLs. If so, they are asked to recommend one or two additional experts who are contacted in the same fashion. The panel is comprised of at least 15 international dermatologists with specific expertise in teledermatology and teledermoscopy (i.e. with a history of at least 200 teledermoscopic evaluations) as well as regular dermoscopy and skin tumor diagnostics. An expert is defined as having a minimum of 6-years of clinical experience with skin tumor diagnostics, including the regular use of dermoscopy in skin cancer diagnostics, and who is still clinically active. The panel of KOLs commits to the entirety of the Delphi process by accepting participation in the study. KOLs are accredited as a group-author "expert panel" with specification of panel members under Acknowledgements in the published paper.

Collaborating researchers and departments

Department of Dermatology and Allergy Centre, Odense University Hospital

• . Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Denmark
• Copenhagen Academy for Medical Education and Simulation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
• Department of Dermatology , Skåne University Hospital Lund and Department of Clinical Sciences Lund, Dermatology, Lund University, Sweden