key: cord-0796283-izoomsc9
authors: Cheng, H. S.; Schurr, L.
title: Teledermatology for suspected skin cancer in New Zealand during the COVID-19 pandemic required in-person follow-up in 28% of cases
date: 2021-11-29
journal: JAAD Int
DOI: 10.1016/j.jdin.2021.11.003
sha: e84866e453a8fc6a616c880370fb697ce533d7cf
doc_id: 796283
cord_uid: izoomsc9

nan

The New Zealand (NZ) population has one of the highest incidences of non-melanoma skin cancer 30 (NMSC) in the world (1) . Standard face-to-face (FTF) assessment of skin cancer was abruptly 31 halted in early 2020, when the NZ government announced level 4 restrictions due to the COVID-32 19 pandemic. Educational facilities and businesses closed and people were instructed to stay 33 home unless accessing essential services. One hundred and thirty-six patients were included, 68 TH and 68 FTF. There were no significant 48 differences in age, gender or ethnicity between the groups. Clinic outcomes are shown in Table  49 1. There were no differences in referrals for biopsy or excision between the groups. TH 50 assessments were more likely to result in a request for follow-up (28% vs 3%, p<0.001). Histology 51 reports were available for 35 lesions in the FTF group and 37 lesions in the TH group. 52

Dermatologist diagnostic accuracy compared with histology, was 83% for FTF and 65% for TH 53 (p=0.111). The most frequent histological diagnosis was basal cell carcinoma (BCC) (60%). 54 55

With the occurrence of COVID-19 many dermatology units around the world have rapidly 56 adopted TH, improving our understanding of TH assessment for skin disease. Globally, this may 57 facilitate improved outcomes for patients without local access to dermatologists. The reported 58 accuracy of TH for assessment of skin lesions ranges widely. Some studies report similar 59 accuracy to FTF consultations, while others have found TH inferior to FTF for assessment of 60 non-pigmented lesions (2, 3). Dermatoscopy may improve accuracy (4). In 2018 a Cochrane 61 review concluded that a reliable estimate of the accuracy of teledermatology for diagnosis of 62 skin cancer could not be made, based on available literature (5). We found more than a quarter 63 of TH assessments required FTF follow-up, highlighting the limitations of these assessments. 64 65

Our study is limited by small numbers, particularly histological diagnoses, increasing the risk of 66 type 2 statistical error. A potential benefit of FTF assessment is detection of concurrent or 67 incidental skin lesions as this was not assessed in our study. While diagnostic accuracy was not 68 significantly different between the groups, more FTF follow-ups were requested after TH, 69

indicating TH consultation was not satisfactory for all lesions. Despite this, TH allowed patients 70

to access dermatology services during the strict level 4 lockdown period in NZ. 71 72 73 J o u r n a l P r e -p r o o f

The burden of non-melanoma skin cancers in 82

Store-and-forward teledermatology results in similar 84 clinical outcomes to conventional clinic-based care

Accuracy of teledermatology for nonpigmented neoplasms

The contribution of teledermatoscopy to the diagnosis and 89 management of non-melanocytic skin tumours

Teledermatology for diagnosing skin cancer in 91 adults

J o u r n a l P r e -p r o o f Capsule Summary

 There is insufficient evidence regarding the accuracy of teledermatology for diagnosis of nonmelanoma skin cancer  During the COVID-19 pandemic this study found more than a quarter of telehealth assessments for skin cancer required in-person follow-ups, however there were no differences in referrals for biopsies or excisions compared with face to face assessments