Can we safely diagnose pigmented lesions from stored video images? A diagnostic comparison between clinical examination and stored video images of pigmented lesions removed for histology

Rapid expansion of communication technology has permitted the clinician to perform a consultation with a patient located at a different site. Assuming adequate diagnostic accuracy it could theoretically be possible to use tel emedical techniques as a triage tool. Images of pigmented lesions sent by t he primary care physician could be viewed by the consultant dermatologist, and those with banal lesions spared from attending clinic. Previous studies assessing diagnostic accuracy of images of lesions have used 'face-to-face ' diagnoses as the 'gold standard'. We set out to compare diagnostic accura cy of image examination compared with that of clinical examination, using h istological examination as the diagnostic benchmark. We found that pigmente d lesions may be diagnosed as accurately by stored video image evaluation a s by conventional clinical examination. None of the malignant skin tumours was misdiagnosed as benign in either group. Whilst these results are encour aging in terms of the clinical safety of store-and-forward imaging, the ina bility to examine the whole patient or to palpate the lesions may limit the acceptability of the technique severely. Further evaluation of the cost : benefit ratio of such a system to the health care provider must be undertak en before considering this technique as a potential adjunct to managing out patient referrals.