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APPENDIX A. Search Strategy

Database: Ovid MEDLINE(R) <1950 to April Week 3 2009>

Search Strategy:

--------------------------------------------------------------------------------

1 (remote: adj2 consult:).tw. (158)

2 exp electronic mail/ (1025)

3 exp Telecommunications/ (36778)

4 exp remote consultation/ (2661)

5 telemed$.mp. or exp Telemedicine/ (10571)

6 exp telepathology/ (504)

7 or/1-6 (37311)

8 derm$.mp. or exp dermatology/ (180688)

9 7 and 8 (534)

10 telederm$.mp. (269)

11 9 or 10 (576)

12 limit 11 to yr=”1990 -Current” (559)

PubMed search (06-03-09):

(((remote* AND consult*[tw]) OR (electronic mail[mh]) OR (telecommunications[mh]) OR 

(remote consultation[mh]) OR (telemed* OR telemedicine[mh]) OR (telepathology[mh])) AND 

(dermatol* OR dermatology[mh])) OR (telederm*) [587]

Search results from OVID MEDLINE (556 references) and PubMed (587 references) were 

combined, resulting in a total of 657 unique references
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Teledermatology for Diagnosis and Management of Skin Conditions: 

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APPENDIX B. Data Extraction Form

First author: _____________________________________

Year published: ___________

Country where study performed (country of first author or multicenter): ______________________

Source of funding for study: _______________________________ 

Extractor: ______________________________________

DESIGN (circle):

Systematic review Cross-sectional study

Randomized controlled clinical trial Case series

Non-randomized controlled clinical trial Case report

Cohort study Qualitative

Case-control study Editorial/opinion piece/letter

Other evaluation of diagnostic test

KEY QUESTION(S) (circle):

KQ1: Diagnostic accuracy/reliability

KQ2: Clinical management accuracy/reliability

KQ3: Clinical outcomes (clinical course, satisfaction, quality of life, visits avoided, etc.)

KQ4: Costs

KQ5: Implementation 

Background

NOTES:

□ Study contains/may contain same data as another study (specify study: ___________________

____________________________________________________________________________ )
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Teledermatology for Diagnosis and Management of Skin Conditions: 

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STUDY SETTING/EQUIPMENT:

Single- or Multi-center trial? (circle one) 

a. # of sites where photos obtained _________ 

setting for each site (e.g., patient home, physician office, hospital, nursing home, etc.)

 1.

 2.

 3.

 4.

b. # of sites where photos interpreted _________

setting for each site (e.g., dermatology clinic [or other type of clinic], hospital, VA or nonVA, academic or community-based, etc.)

1.

 2.

 3.

 4.

Technology used: Store & Forward Live Interactive

Purpose of examination: Diagnosis Therapy Follow-up Other ___________

Camera type: ___________________ Pixels: ___________

Special imaging technique(s) (describe): ___________________________________________

____________________________________________________________________________

Image interpretation technique(s): ________________________________________________

____________________________________________________________________________

PROVIDERS (e.g., family practice dermatologist, specialist dermatologist, dermatopathologist):

A. Gold Standard Test Provider

1. Clinical dermatologist (in-person evaluation)

Level of training

Experience with teledermatology (volume of cases, if reported)

2. Histodermatologist 

Level of training

Experience with teledermatology (volume of cases, if reported)

B. Index Test Provider

Level of training

Experience with teledermatology (volume of cases, if reported)

C. Photographer/History Taker (if different from Index Test Provider)

Level of training

Experience with teledermatology (volume of cases, if reported)
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STUDY PARTICIPANTS:

Number enrolled: ____________

How were patients recruited? _____________________________________________________

Inclusion Criteria: ______________________________________________________________

Exclusion Criteria: _____________________________________________________________

Age Mean _______ yrs Range ________________ yrs

Gender Female ________% Male _________%

Veterans ________%

Race (describe) ________________________________________________________________

Other population characteristics (describe): __________________________________________

_____________________________________________________________________________

Number of lesions/conditions evaluated: ______________

Dermatologic condition(s): Rash __________ Lesion __________ Mixed __________

 Other details about condition(s), if provided _____________________________________

Gold standard: In-person Dermatology ________ Histopathology _______

 Other (specify) _____________________________________________

STUDY FEATURES/QUALITY:

FOR DIAGNOSTIC ACCURACY TESTS (Yes, No, Unclear):

(NOTE: index test is new, unproven test; gold standard is established reference test)

1. Study patients representative of actual patient population to be tested Y N U

2. Inclusion/exclusion criteria clearly described Y N U

3. Appropriate (accurate) gold standard Y N U

4. Time between index and gold standard assessments appropriate Y N U

(i.e., insufficient time for disease progression or recovery)

5. All (or random sample) of patients received both tests Y N U

6. Same gold standard used for all patients Y N U

7. Gold standard independent of index test Y N U

8. Sufficient detail provided to replicate index test Y N U

9. Sufficient detail provided to replicate gold standard test Y N U

10. Index test interpreted without knowledge of gold standard results Y N U

11. Gold standard interpreted without knowledge of index results Y N U

12. Similar clinical data available during test interpretation as in practice Y N U

13. Uninterpretable/indeterminate test results reported Y N U

(i.e., all test results reported)

14. All patients accounted for at end of study Y N U
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FOR CONTROLLED TRIALS (Yes, No, Unclear, Not Applicable) (adapted from USPSTF approach):

1. Initial assembly of comparable groups

a. Randomized trials

True randomization Y N U NA

Concealment Y N U NA

b. Other studies

Inclusion/exclusion criteria defined and applied to Y N U NA

 all groups

Potential confounders considered Y N U NA

2. Groups similar at baseline Y N U NA

 If not, describe significant differences ________________________________________________________

3. Comparable groups maintained (attrition, cross-overs, Y N U NA

 adherence, etc.)

Loss to follow-up (%): ________

If not comparable for all groups, explain: __________________

4. Blinding (masking)

a. Participants Y N U NA

b. Outcome Assessment Y N U NA

5. All important outcomes considered Y N U NA

6. Outcome measures reliable and valid Y N U NA

7. Analysis 

a. RCT – Intention-to-treat Y N U NA

b. Other – confounders adjusted for, if needed Y N U NA

RESULTS:

Number of patients with complete data: _________

Reasons for incomplete data: _____________________________________________________________________

Significant differences between patients enrolled and patients who completed study? _________________________

_____________________________________________________________________________________________

Time between photograph and gold-standard interpretation of condition (mean and/or range): _________________

Length of follow-up (for follow-up studies only): _____________________________________________________

Study duration: ________________________________________________________________________________

FOR STUDIES THAT REPORT SENSITIVITY AND SPECIFICITY:

Complete the following table if possible (see definitions at end of form):

Reference (Gold Standard) Test 

Findings

Positive Negative

Index Test 

Findings

Positive PPV=

Negative NPV=

Sens.= Spec.=
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OTHER AGREEMENT OUTCOMES:

Kappa Coefficient: _______________

Percent Agreement: ______________

Other Outcomes (describe): ______________________________________________________________________

_____________________________________________________________________________________________

CLINICAL MANAGEMENT OUTCOMES:

Clinical course (describe outcomes):

Patient satisfaction with teledermatology (assessment tool, outcomes):

Quality of life (assessment tool, outcomes):

Clinic visits avoided? Yes (# if provided ________) No

Did test results influence treatment selected for patients?

Describe: ____________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Did test results influence management strategy for patients?

Describe: ____________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

OTHER RELEVANT FINDINGS:

AUTHORS’ CONCLUSIONS:
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eer Review Comments and Author Responses

RESPONSE

d methods for this review clearly described? 

NANA

as in our synthesis of the evidence? 

NANA

published studies on the use of teledermatology for the 

in conditions (including studies of clinical outcomes, pa

osts) that we may have overlooked?

NANA

mprehensive review of the status of the literature. Thank you 

is the quality of the test itself ensured? We assume the reviewer is asking about the quality of the picture image. We 

did not specifically look at image techniques but we only included studies published after 1990 to insure technical relevance.

he statement “The long duration to achieve definitive derma

th current VA practice ...” We have clarified this statement.

 prefer to see the Key Question stated followed by the 

could be the brief discussion of the results from the literature 

Thank you for the suggestion. We have placed the conclusions immediately following the questions.

c studies were excluded To shorten the Executive Summary, we have deleted the inclusion/exclusion 

details. We have clarified the inclusion/exclusion criteria for studies in the full report.

mes of interest” We have specified the outcomes of interest.
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lusion may be misinterpreted as overly negative; the true 

lations is between telederm and primary care diagnosis and 

We agree that this type of study is needed and have clarified the conclusion statements to reflect that.

s – I’m not sure what it means that ‘weighted mean absolute 

than teledermatology’ (page v) – perhaps include some con

rs more meaningful or at least place them in some context 

gnostic tests)

These comparisons have been reworded to clarify that these differences are differences in accuracy rates.

them We have made this change.

d to randomized trials for questions 1-2; does this mean that 

consults were not included? (page iii)

Inclusion was for controlled trials (not randomized); most were repeated measure design. Retrospective reviews were included if a control group was utilized. This has been clarified in the inclusion/exclusion criteria.

racy of teledermatology to better than UC, or at least much 

This statement has been revised to clarify that accuracy improved, but still was not better than usual care.

de the information that the accuracy and concordance for 

le (page xlvii)

This information has been added.

UND:

atement “SAF is the more widely used form of teledermatol

An informal survey of dermatology chiefs is included in the introduction.

rify the “other” and “not eligible study setting” exclusion 

We have modified the study exclusion criteria, eliminating these two criteria.

iteria for studies (bulleted format) These have been reformatted into bullet structure.

d have used more explanation These are now described.

esults (657 references) The explanation was inadvertently deleted from the draft sent for review; 

please see updated flow diagram.

he start date for the review This has been clarified in the text.

the QUADAS scores – how do these compare with, say, the 

n other systematic reviews?

There is no direct comparison. The QUADAS scale is, however, the most relevant for assessing the quality of studies of diagnostic tests. 

udies? Do the results vary? The results of the US vs. non-US studies were similar. We have revised the 

results section putting more emphasis on VA/DoD studies.

 two studies from one center; it may be worth noting that the 

 other health care setting/populations in active programs

This information has been added.

described ...” - please make sure you include the VA Teled

The references for this statement have been clarified – the Ops Manual is cited.
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d is the method used ... “ – I don’t think this is true based on 

An e-mail survey of chiefs of VA dermatology services was conducted to confirm that SAF is more commonly used than LI in the VA setting.

VA dermatology – readily usable by policy makers and clini

The conclusion section has been revised to focus on VA relevance.

tions with no available in-person dermatology? Is it possible 

ng (very rural and urban)?

The conclusion section has been revised to address this.

arch – be specific, prioritize The future research section has been revised to address specific needed study 

outcomes and settings.

cate that report is focused on adult population Twenty of the included studies enrolled a mixed (adult/pediatric) population; 

it would not be possible to report only the results from the adults included in those trials.

 is the overall framework that examines the diagnostic test(s) 

measurement characteristics, effects on patient care processes 

features related to successful implementation

Thank you.

that it is clear, accurate, completed, and clinically relevant ... the 

nd important, the literature search appeared comprehensive, the 

te, judgments of methodological quality were included, the pool

onservative, and the conclusions were reasonable.

Thank you.

AHRQ Telemedicine review that covered teledermatology. This reference has been added to the Summary and Discussion section.

re is a lack of concordance between face-to-face derma

ence between face-to-face and teledermatology is usually 

A statement has been added to the Future Research Recommendations section. 

 issues with pigmented lesions and expedite referral for these 

n which pigmented lesions and suspected malignancies are 

We have noted the inferior management accuracy rates for malignant and premalignant lesions in our conclusion statements for Key Question 2 and in the Conclusions Section.

ces noted in the studies result in altered clinical outcomes for 

We agree. As noted in the results for Key Question 3, there are few studies that directly address clinical outcomes.

h providing dermatology, especially in rural areas, issue of 

ology versus a general practitioner – this was alluded to but 

 the issues with providing face-to-face dermatology nation

We have added the need for research of this nature to the Conclusion section.

y is that of using a dermatology trained nurse practitioner. None of the studies identified for the review evaluated this model. The need 

to include dermatology trained nurse practitioners was added to the Future Research section.
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APPENDIX D. Abbreviations

CD = Clinic dermatology/clinic dermatologist; in-person dermatology care/in-person 

dermatologist

CID = Contact immersion dermatoscopy

DoD = Department of Defense

DSC = Dermatoscopy

Hrs = Hours

k = Kappa coefficient 

KC= Keratinocyte Carcinoma (BCC, SCC, Keratoacanthoma, SCC-in-situ)

KQ= Key question

LI = Live interactive teledermatology

95%CI = 95 percent confidence intervals

NPSL= Non-pigmented skin lesions

NA= Not applicable

NR = Not reported

PLD = Polarized light dermatoscopy

PSL = Pigmented skin lesions

Pt = Patient

RCT = Randomized controlled trial

QUADAS = Quality Assessment of Diagnostic Accuracy Studies 

SAF = Store and forward teledermatology

SD = Standard deviation

SL = Skin lesions 

TD = Teledermatology/teledermatologist

TDSC = Teledermatoscopy

UC = Usual care (in-person dermatology)

VA = Veterans Affairs

vs. = Versus
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vidence Table

tudies for Key Questions 1 and 2

ostic Concordance, Management Accuracy, Management Concordance 

Population and StudyCharacteristics

TeledermatologyCharacteristics

Outcomes Evaluated Quality Rating

udies (n=41)

Mean age (range): 66 years (23-94)Gender: female 4%, male 96% Race/ethnicity: white 97%Condition characteristics:Benign Neoplasm:267Keratinocyte Carcinoma:84Dysplastic Nevus: 155Melanoma:36Inclusion criteria: PSLExclusion criteria: Skin tags, previously biopsied lesionsStudy duration (months): 3

Nikon Coolpix 4500, 3Gen Dermlite, Minolta X370 with Heine dermphot (TDSC)Photographer: Support staffTime between photograph and gold standard (days): 0

Diagnostic Accuracy: YesDiagnostic Concordance: NoManagement Accuracy: YesManagement Concordance: No

Overall QUADAS score: 12/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 1/2
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Mean age (range): 71 years (21-94)Gender: female 2%, male 98%Race/ethnicity: white 99%Condition Characteristics:Keratinocyte Carcinoma - 385Actinic Keratosis - 81Benign Neoplasm - 258Other - 4Inclusion criteria: Non-pigmented neoplasmsExclusion criteria: Skin tags, previously biopsied lesionsStudy duration (months): 34

Nikon Coolpix 4500 3Gen Dermlite (TDSC)Photographer: Support staffTime between photograph and gold standard (days): 0

Diagnostic Accuracy: YesDiagnostic Concordance: NoManagement Accuracy: YesManagement Concordance: No 

Overall QUADAS score: 12/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 1/2

Mean age (range): 42 (7-92)Gender: female 69%, male 31%Race/ethnicity: white 85%, black 12%, Asian 2%, Hispanic 1%Condition Characteristics (Only reported for 70):Actinic Keratosis - 10Acneiform - 12Benign Neoplasm - 19Dysplastic nevus - 1Infectious - 7Eczematous - 8Other – 13Inclusion criteria: New pts on study daysExclusion criteria: NRStudy duration (months): 18

Camera: NRPhotographer: NRTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2 

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
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Age: NRGender: NRRace/Ethnicity: NR Condition characteristics: Melanoma - 22Benign Neoplasm - 15Dysplastic nevi - 7Inclusion criteria: Non-pigmented, absence of regular network, or diameter <5 mmExclusion criteria: NRStudy duration (months): NR

Nikon 4500 Coolpix, Wild M650 SteromicroscopePhotographer: DermatologistTime between photograph and gold standard (days): NR

Diagnostic Accuracy: YesDiagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 8/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 1/3 Data analysis: 1/2

Mean age (range): 28.4 years (10-55)Gender: female 39%, male 61%Race/ethnicity: NRCondition characteristics: PSLInclusion criteria: >3 clinically atypical nevi on back Exclusion criteria: NR

Nikon 990 (macro), Videocap digital videodermoscopy Photographer: NRTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
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Mean age: 70.3 yearsGender: female 39%, male 61% Race/ethnicity: NRCondition characteristics: Keratinocyte Carcinoma - 95Actinic keratosis - 14Melanoma - 1Other - 3Benign Neoplasm - 17Inclusion criteria: Non-melanoma skin cancer or fast-growing vascular tumorExclusion criteria: “Lesions expected to require major reconstruction”, melanomaStudy duration (months): 12

Nikon Coolpix 4300 Photographer: NRTime between photograph and gold standard (days): mean 26 days

Diagnostic Accuracy: YesDiagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: Yes 

Overall QUADAS score: 9/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 6/7 Reference test: 3/3 Data analysis: 0/2

Mean age: 41.5 yearsGender: female 59%, male 41%Race/ethnicity: NRCondition characteristics: Benign Neoplasm - 548Keratinocyte Carcinoma - 119Actinic keratosis - 102Melanoma - 18Infectious - 9Papulosquamous/Other - 15Other Malignant Neoplasm - 3Dysplastic nevus - 76 Inclusion criteria: Circumscribed lesionsExclusion criteria: NRStudy duration (months): 15

Nikon Coolpix 4300 Photographer: NRTime between photograph and gold standard (days): <31

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No 

Overall QUADAS score: 12/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 6/7 Reference test: 3/3 Data analysis: 2/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
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Mean age: intervention 43.6 years, Gender: female 63%, male 37% Race/ethnicity: NRCondition characteristics: Malignancy- 3Benign Neoplasm –5Infectious - 4Eczematous – 11Papulosquamous/Other - 62Acneiform - 7Inclusion criteria: ≥ 16 years old, had not seen dermatologist in last yearExclusion criteria: genital lesionsStudy duration (months): NR

Nikon Coolpix 900 Photographer: Primary care staff, often general practitionerTime between photograph and gold standard (days): mean 60 

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 2/2 Index test: 4/7 Reference test: 2/3 Data analysis: 2/2

Mean age: NRGender: female 53%, male 47%Race/ethnicity: NRCondition characteristics:Keratinocyte Carcinoma – 54Actinic keratosis-15Dysplastic nevus-3Melanoma-24Benign neoplasm-159Other-1Inclusion criteria: Suspected skin cancerExclusion criteria: NRStudy duration (months): NR

Camera: NRPhotographer: Medical Photography DepartmentTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 6/7 Reference test: 3/3 Data analysis: 2/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
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Mean age (range): 39 years (1-73)Gender: female 71%, male 29%, Race/ethnicity: NRCondition characteristics: Keratinocyte Carcinoma - 2Benign Neoplasm - 54Melanoma - 1Dysplastic Nevus - 1Inclusion criteria: PSLExclusion criteria: Pts who did not show to CDStudy duration (months): 2

Nikon Coolpix 4500 DermLite (TDSC)Photographer: General practitioner Time between photograph and gold standard (days): <30

Diagnostic Accuracy: YesDiagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 6/7 Reference test: 3/3 Data analysis: 1/2

Mean age (range): 59 years (16-93)Gender: female 64%, male 36% Race/ethnicity: NRCondition characteristics: Keratinocyte Carcinoma - 43Actinic keratoses - 17Melanoma - 8Benign neoplasms - 37Papulosquamous/Other - 4Inclusion criteria: New pts with skin growthExclusion criteria: Inflammatory dermatoses, infections, resolved lesions, poor quality images Study duration (months): NR

Nikon Coolpix 955 38 TD (6 were trainee dermatologists)Photographer: medical studentTime between photograph and gold standard (days): 0

Diagnostic Accuracy: YesDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
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Mean age (range): 35 years (2-82)Gender: female 63%, male 37% Race/ethnicity: NRCondition characteristics: Acneiform - 41Infectious - 54Pre-malignant/Malignant- 2Eczematous - 46Benign Neoplasms - 45Papulosquamous/Other - 54Inclusion criteria: New dermatology ptsExclusion criteria: NoneStudy duration (months): 2.3

Canon Powershot S10 Two dermatologists with 3 to 5 years experience.Photographer: NurseTime between photographing and gold standard test (days): NR

Diagnostic Accuracy: NoDiagnostic Concordance: Yes Management Accuracy: NoManagement Concordance: No

Overall QUADAS score: 9/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 6/7 Reference test: 2/3 Data analysis: 0/2

Age: NRGender: NRRace/ethnicity: NR Condition characteristics: Benign Neoplasm - 81Keratinocyte Carcinoma - 48Actinic keratoses - 10Melanoma - 5Infectious - 3Papulosquamous/Other - 10Dysplastic nevus - 6Inclusion criteria: Pts with suspected skin cancer, informed consent Exclusion criteria: Pts who did show to CD (number NR)Study duration (months): 18

Nikon Coolpix 9502 different dermatologists and a 3rd year trainee dermatologist viewed all the cases as wellPhotographer: General practitionerTime between photograph and gold standard (days): <14

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes 

Overall QUADAS score: 8/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 5/7 Reference test: 2/3 Data analysis: 1/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
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Mean age (range): 43 years (2 to 84Gender: female 65%, male 35%Race/ethnicity: NRCondition characteristics (for 57 biopsied PSL):Keratinocyte Carcinoma - 23Benign Neoplasm - 12Dysplastic Nevi -16Melanoma - 6Inclusion criteria: changing, new, symptomatic or concerning pigmented lesionsExclusion criteria: NRStudy duration (months): 3

Nikon Coolpix 4300 Photographer: General practitionerTime between photograph and gold standard (days): mean 8 days (range 5-14)

Diagnostic Accuracy: Yes Diagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 9/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 2/3 Data analysis: 0/2

Mean age: NRGender: female 64%, male 36%Race/ethnicity: NRCondition characteristics: NRInclusion criteria: NRExclusion criteria: NRStudy duration (months): 1

Fujifilm MX-1700 Photographer: dermatologistsTime between photograph and gold standard (days): 0

Diagnostic Accuracy : NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 2/2 

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
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Median age (range): 41 years (14-71)Gender: female 17%, male 83% Race/ethnicity: NRCondition characteristics: PSLBenign Neoplasm - 5Melanoma - 7Inclusion criteria: NRExclusion criteria: NRStudy duration (months): NR

TDSC: Heine Dermaphot Molemax Videocap Photographer: NRTime between photograph and gold standard (days): NR

Diagnostic Accuracy: Yes Diagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 9/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 6/7 Reference test: 3/3 Data analysis: 0/2 

Age: NRGender: NRRace/ethnicity: NRCondition characteristics: Infectious - 50Tumors (not further defined) -12Eczematous - 10Acneiform - 8Papulosquamous/ Other - 39Benign Neoplasm - 6Inclusion criteria: NRExclusion criteria: NRStudy duration (months): NR

Canon Powershot 70 Photographer: NRTime between photograph and gold standard (days): NR

Diagnostic Accuracy: NoDiagnostic Concordance: Yes Management Accuracy: NoManagement Concordance: No

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
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Mean age (range): 28 years (4-77)Gender: female 53%, male 47%Race/ethnicity: NRCondition characteristics:Acral PSLBenign - 71 Melanomas - 6Inclusion criteria: Acral melanocytic lesionsExclusion criteria: NRStudy duration (months): NR

TDSC: Molemax II, Heine Dermaphot Photographer: NRTime between photograph and gold standard (days): NR

Diagnostic Accuracy: Yes Diagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 9/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 2/3 Data analysis: 0/2

Mean age: NRGender: female 46%, male 54%Race/ethnicity: NRCondition characteristics: Skin growths Inclusion criteria: Skin growth referred by general practitioner Exclusion criteria: Previous dermatology evaluationStudy duration (months): NR

Olympus D-600L Photographer: General practitionerTime between photograph and gold standard (days): <16

Diagnostic Accuracy: NoDiagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 2/2 

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
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Age, gender, and race/ethnicity: NR Condition characteristics: PSLBenign Neoplasm - 24Dysplastic Nevus - 5Melanoma - 16Inclusion criteria: NRExclusion criteria: NRStudy duration (months): 16

Dermogenius ultra Photographer: Clinic dermatoscopic examinerTime between photograph and gold standard (days): 0

Diagnostic Accuracy: YesDiagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 1/2 

Mean age: 47 yearsGender: NRRace/ethnicity: NRCondition characteristics: Malignant/Premalignant - 6Benign Neoplasms - 12Eczematous 28Infectious- 15Acneiform - 13Papulosquamous/Other - 22Inclusion criteria: Pts referred from general practitionerExclusion criteria: Dermatologic referral clearly indicatedStudy Duration (months): 11

Ricoh 5000 Photographer: General practitionerTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 12/14Sources of bias identified by QUADAS  Selection: 2/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
84

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Mean age (range): 59 years (18-92)Gender: female 43%, male 57%Race/ethnicity: white 82%, black 13%, Asian/Hispanic 5%Condition characteristics: Infectious - 31Premalignant/Malignant - 54Acneiform - 28Benign neoplasm - 115Eczematous - 44Papulosquamous/Other - 132Inclusion criteria: Adult new ptsExclusion criteria: Medical emergenciesStudy duration (months): 4

Olympus D-600L Nikon Coolpix 900 Photographer: NurseTime between photograph and gold standard (days): 0

Diagnostic Accuracy: YesDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes 

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 2/2 Index test: 6/7 Reference test: 2/3 Data analysis: 0/2 

Age, gender, and race/ethnicity: NR Condition characteristics: Keratinocyte Carcinoma - 1Infectious - 9Eczematous - 4Benign Neoplasm - 3Papulosquamous/Other - 16Inclusion criteria: NRExclusion criteria: Common conditions such as acne and melasmaStudy duration (months):NR

Kodak DC-210 Photographer: “Trainee doctor”Time between photographand gold standard (days): NR

Diagnostic Accuracy: NoDiagnostic Concordance: Yes Management Accuracy: NoManagement Concordance: No

Overall QUADAS score: 12/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 1/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
85

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Age: NRGender: NRRace/ethnicity: NR Condition characteristics: NRInclusion criteria: NRExclusion criteria: NRStudy duration (months): NR

Kodak DC265 Photographer: nurseTime between photograph and gold standard (days): <7

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 9/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 6/7 Reference test: 2/3 Data analysis: 1/2 

Age range: 15-94 yearsGender: female 66%, male 34%Race/ethnicity: NRCondition characteristics: PSLInclusion criteria: PSLExclusion criteria: NR Study duration (months): NR

Sanyo HiFi video Photographer: DermatologistTime between photograph and gold standard (days): NR

Diagnostic Accuracy: Yes Diagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 1/2 

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
86

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Age range: 8 to 94 yearsGender: female 76%, male 24% Race/ethnicity: NRCondition characteristics: PSLBenign Neoplasm - 635Keratinocyte Carcinoma - 20Dysplastic Nevi - 112Actinic keratoses - 13Melanoma - 9Infectious - 10Acneiform - 5Rash/Other - 13Eczematous - 2Inclusion criteria: PSLExclusion criteria: Genital lesions, mental impairment, fear of technical equipmentStudy duration (months): NR

Sanyo HiFi video Photographer: Dermatologist Time between photograph and gold standard (days): NR

Diagnostic Accuracy: NoDiagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 9/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 6/7 Reference test: 2/3 Data analysis: 1/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
87

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Age: NRGender: NRRace/ethnicity: NR Condition Characteristics: Eczematous - 18Benign Neoplasm - 9Infectious - 12 Keratinocyte Carcinoma - 3Acneiform - 6Paulosquamous/Other - 5Inclusion criteria: new skin conditionExclusion criteria: wart or acneStudy duration (months): 3

Kodak DC265 Photographer: DermatologistTime between photograph and gold standard (days): <7 

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 1/3 Data analysis: 0/2

Age: NRGender: NR Race/ethnicity: “42% of the conditions from pigmented pts”Condition characteristics (most common diagnoses in 127):Eczematous - 21Keratinocyte carcinoma - 9Papulosquamous/Other - 15Benign Neoplasm - 69Acneiform - 8Infectious - 5Inclusion criteria: New dermatology ptsExclusion criteria: NRStudy duration (months): 3

NRPhotographer: Nurse Time between photograph and gold standard test: NR

Diagnostic Accuracy: NoDiagnostic Concordance: Yes Management Accuracy: NoManagement Concordance: No

Overall QUADAS score: 13/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 2/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
88

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Age: NRGender: NRRace/ethnicity: NR Condition characteristics: 8 skin cancer cases Inclusion criteria: NRExclusion criteria: NRStudy duration (months): NR

Nikon Fujix DS505, Nikon SLR Photographer: NRTime between photograph and gold standard (days): NR

Diagnostic Accuracy: YesDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Age: NRGender: NRRace/ethnicity: NR Condition characteristics: PSLBenign Neoplasm - 37Dysplastic Nevus - 3Melanoma - 9Keratinocyte Carcinoma - 4Other -2Inclusion criteria: NRExclusion criteria: NRStudy duration (months): 6

TDSC: Mitsubishi CCD Photographer: 6 dermatologistsTime between photograph and gold standard (days): NR

Diagnostic Accuracy: YesDiagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 2/3 Data analysis: 1/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
89

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Mean age (range): 39.7 years (10 months - 81 years)Gender: female 48%, male 52% Race/ethnicity: NRCondition characteristics: Benign Neoplasm - 35Keratinocyte Carcinoma - 6Actinic keratoses -2Melanoma - 1Infectious - 12Acneiform - 8Papulosquamous/Other - 25Eczematous - 17Inclusion criteria: NRExclusion criteria: NoneStudy duration (months): 1.5

Sony DCS-F1 Photographer: Medical studentTime between photograph and gold standard (days): NR

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Mean age (range): 39.5 years (3-91)Gender: female 47.5%, male 52.5%Race/ethnicity: NRCondition characteristics: PSLKeratinocyte carcinoma - 3Melanoma - 11Benign Neoplasm - 29Inclusion criteria: NRExclusion criteria: NRStudy duration (months): 3

TDSC: video camera and stereomicroscope Photographer: NRTime between photograph and gold standard (days): NR

Diagnostic Accuracy: YesDiagnostic Concordance: NoManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
90

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Age, gender, and race/ethnicity: NRCondition characteristics: Melanoma - 4Actinic keratoses - 20Keratinocyte Carcinoma - 49Dysplastic nevus - 16Benign Neoplasm - 106Infection - 20Eczematous - 36Papulosquamous/Other - 57Inclusion criteria: NRExclusion criteria: NRStudy duration (months): NR

Canon Powershot 600 Photographer: Medical studentsTime between photograph and gold standard (days): NR

Diagnostic Accuracy: Yes Diagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 2/3 Data analysis: 0/2

Age: NRGender: NRRace/ethnicity: NR Condition characteristics: NRInclusion criteria: NRExclusion criteria: NRStudy duration (months): 7

Kodak DC40 Photographer: NRTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 8/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 5/7 Reference test: 3/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
91

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Mean age (range): 41.2 years (8-82)Gender: female 52%, male 48% Race/ethnicity: NRCondition characteristics: PSLMelanocytic- 57Nonmelanocytic-9 Inclusion criteria: NRExclusion criteria: NRStudy duration (months): 0.75

TDSC: video camera and stereomicroscopePhotographer: NRTime between photograph and gold standard (days): NR

Diagnostic Accuracy: YesDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Age: NRGender: NRRace/ethnicity: NR Condition characteristics: NRInclusion criteria: Visible skin lesionExclusion criteria: NRStudy duration (months): NR

Ricoh RDC 300 Photographer: NRTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 2/2 Index test: 6/7 Reference test: 2/3 Data analysis: 0/2 

Mean age (range): 61 years (22 to 82)Gender: female 2%, male 98% Race/ethnicity: white 80%, black 20%Condition characteristics: NRInclusion criteria: Diagnostic uncertaintyExclusion criteria: Previous dermatology evaluationStudy duration (months): NR

Fujix DS-515Photographer: Research assistantTime between photograph and gold standard (days): 0

Diagnostic Accuracy: YesDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
92

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Age: NRGender: NRRace/ethnicity: NR Condition Characteristics:Benign neoplasm - 2Keratinocyte carcinoma - 7Actinic keratoses – 1Other – 1No biopsy - 1Inclusion criteria: Suspected skin cancerExclusion criteria: NRStudy duration (months): NR

Fujix DS-515 digital camera, 1280x1000 pixelsPhotographer: NRTime between photograph and gold standard test (days): 0

Diagnostic Accuracy: Yes Diagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Mean age (range): 40 years (18-84)Gender: NRRace/ethnicity: NRCondition characteristics: NRInclusion criteria: NRExclusion criteria: Acne or warts casesStudy duration (months): 2

Kodak DCS 420 Photographer: NondermatologistsTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 13/14Sources of bias identified by QUADAS  Selection: 2/2 Index test: 7/7 Reference test: 3/3 Data analysis: 1/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
93

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Age: NRGender: NRRace/ethnicity: NR Condition characteristics: Eczematous - 12Acneiform - 3Infectious - 5Other - 20Benign Neoplasm - 41Keratinocyte Carcinoma - 19Actinic keratoses - 5Inclusion criteria: Dermatology referral Exclusion criteria: NRStudy duration (months): NR

DC-40 Kodak Photographer: Dermatology residentTime between photograph and gold standard (days): NR

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 8/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 4/7 Reference test: 3/3 Data analysis: 0/2

Age: NRGender: NRRace/ethnicity: NR Condition characteristics: Rash-18Lesion-12Inclusion criteria: Nursing home resident with a skin conditionExclusion criteria: NRStudy duration (months): NR

Sony CCD-TR400 videoPhotographer: NurseTime between photograph and gold standard (days): <2

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
94

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

0)

Mean age (range): 42 (7-92)Gender: female 69%, male 31%Race/ethnicity: white 85%, black 12%, Asian 2%, Hispanic 1%Condition Characteristics for 70:Actinic Keratosis - 10Acneiform - 12Benign Neoplasm - 19Dysplastic nevus - 1Infectious - 7Eczematous - 8Other – 13Inclusion criteria: New pts on study daysExclusion criteria: NRStudy duration (months): 18

Camera: NRPhotographer: NRTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 12/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 1/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
95

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Mean age (range): 35 years (2-82)Gender: female 63%, male 37% Race/ethnicity: NRCondition characteristics: Acneiform - 41Infectious - 54Pre-malignant/Malignant- 2Eczematous - 46Benign Neoplasms - 45Papulosquamous/Other - 54Inclusion criteria: NoneExclusion criteria: NoneStudy duration (months): 2.3

Mustek cameraPhotographer: NurseTime between photograph and gold standard (days): NR

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Mean age (range): 40 years (17-82)Gender: female 51%, male 49%Race/ethnicity: NRCondition characteristics: Eczematous - 7Acneiform - 1Papulosquamous/Other - 6Benign neoplasm - 1Inclusion criteria: New dermatologic conditions Exclusion criteria: Surgical treatment, emergency cases and most neviStudy duration (months): NR

Sony CCD DXC 930P video Photographer: General practitionerTime between photograph and gold standard (days): NR

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 13/14Sources of bias identified by QUADAS  Selection: 2/2 Index test: 6/7 Reference test: 3/3 Data analysis: 2/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
96

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Age range: 3 month -83 yearsGender: female 51%, male 49%Race/ethnicity: NRCondition characteristics: Eczematous - 55Papulosquamous/Other - 37Infection - 23Acneiform - 12Tumor - 20Inclusion criteria: NRExclusion criteria: NRStudy duration (months): 12

Camera NRPhotographer: General practitioner or trained assistantTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 9/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 6/7 Reference test: 2/3 Data analysis: 0/2

Age: ≥ 18 years of ageGender: NRRace/ethnicity: NRCondition characteristics: Eczematous - 17 Benign Neoplasm -12Keratinocyte Carcinoma - 3 Actinic keratosis - 6Infectious - 4Acneiform - 11 Papulosquamous/Other -15Inclusion criteria: Adults with skin conditionExclusion criteria: NRStudy duration (months): NR

VC TK-1280U, Panasonic WV-E550Photographer: NRTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 11/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
97

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Mean age (range): 41 years (5 months-89 years) Gender: female 55%, male 45%Race/ethnicity: NRCondition characteristics (preliminary results): Tumor - 78Eczema - 54Infection - 28Benign Neoplasm - 21Acneiform - 13Papulosquamous/Other - 42Inclusion criteria: Dermatology referral Exclusion criteria: NRStudy duration (months): 18

VC7000 video, KY-F55B JVC video Photographer: General practitioner Time between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes

Overall QUADAS score: 9/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 6/7 Reference test: 2/3 Data analysis: 0/2

Median age (range): 65 (range 23 to 85)Gender: male 95%, female 5%Race/ethnicity: white 60%, black 40%Condition characteristics: Acneiform - 17Eczematous - 33Infectious - 9Papulosquamous/Other -17Benign Neoplasm - 36Premalignant Tumor - 16Malignant Neoplasm - 6Inclusion criteria: consecutive dermatology outptsExclusion criteria: Pts transported by stretcher Study duration (months): 2

3-CCS JVC video Photographer: Nurse escortTime between photograph and gold standard (days): 0

Diagnostic Accuracy: YesDiagnostic Concordance: Yes Management Accuracy: NoManagement Concordance: No

Overall QUADAS score: 12/14Sources of bias identified by QUADAS  Selection: 2/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2 

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
98

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Mean age: 47Gender: female 84%, male 16%Race/ethnicity: NRCondition characteristics: Benign Neoplasm - 81Keratinocyte Carcicnoma - 5Melanoma - 1Premalignant - 14Dysplastic Nevi - 5Inclusion criteria: NRExclusion criteria: NRStudy duration (months): NR

Panasonic video, Canon videoPhotographer: DermatologistTime between photograph and gold standard (days): NR

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: Yes 

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Age range: 2-86 years, Gender: female 60%, male 40%Race/ethnicity: NRCondition characteristics: Eczematous - 17Benign Neoplasm - 24Malignant Neoplasm - 25Actinic Keratosis - 15Infectious - 7Acneiform - 13Melanoma - 4 Papulosquamous/Other -30Inclusion criteria: New dermatology ptsExclusion criteria: NRStudy duration (months): NR

Canon VC-C1 video, Vtel systemPhotographer: DermatologistTime between photograph and gold standard (days): 0

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No 

Overall QUADAS score: 9/14Sources of bias identified by QUADAS  Selection: 1/2 Index test: 6/7 Reference test: 2/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating
99

nd Management of Skin Conditions: 

ence Evidence-based Synthesis Program

Mean age (range): 37 years (1-68)Gender: female, 60%, male 40% Race/ethnicity: white 73%, black 25% Condition characteristics: Eczematous - 14NMSC - 4Actinic keratosis - 5Acneiform - 9 Infection - 8Melanoma - 1Benign Neoplasm - 26Papulosquamous/Other -12Inclusion criteria: ReferralExclusion criteria: NRStudy duration (months): NR

Picture-Tel System 4000 video, Elmo model MN401X dcPhotographer: trained nurse Time between photograph and gold standard (days): NR

Diagnostic Accuracy: NoDiagnostic Concordance: YesManagement Accuracy: NoManagement Concordance: No

Overall QUADAS score: 10/14Sources of bias identified by QUADAS  Selection: 0/2 Index test: 7/7 Reference test: 3/3 Data analysis: 0/2

Population and StudyCharacteristics

Teledermatology Characteristics Outcomes Evaluated Quality Rating