JMIR Publications

ABSTRACT

Background:

Teledermoscopy has demonstrated benefits like decreased costs and enhanced access to dermatology care for skin cancer detection. However, the heterogeneity among teledermoscopy studies hinders the systematic reviews’ synopsis of diagnostic outcomes. This hampers trust and adoption of teledermoscopy in general practice and consequently impedes overall healthcare benefits.

Objective:

To improve understanding and standardization of teledermoscopy diagnostic study results this study aims to identify and categorize study characteristics reported for contributing to heterogeneity among teledermoscopy diagnostic outcome studies. Subsequently, the reported variability and consistency of these study characteristics in teledermoscopy diagnostic outcome studies was assessed.

Methods:

A review of systematic reviews regarding the diagnostic outcomes of teledermoscopy was performed to discern reported study characteristics contributing to heterogeneity. Identified study characteristics were thematically grouped into three overarching domains (population, index test, reference standard) for development of a data extraction framework. Next, a scoping review on teledermoscopy diagnostic outcomes studies was performed, guided by the PRISMA-ScR checklist. Data pertaining to study characteristics from included studies were extracted, and a descriptive content analysis was conducted for each data characteristic within the included studies. The systematic reviews’ reference lists validated the scoping review query.

Results:

The literature search yielded four systematic reviews, revealing 15 heterogeneous study characteristics grouped into population, index test, and reference standard domains. The scoping review identified 49 studies of which 27 studies were at least included in one of the four systematic reviews. Population characteristics included sample size reporting where one-third included less than 100 samples. Almost all studies reported on type of lesion which varied highly, and most teledermoscopy consultations took place in secondary care. One-fifth (22%) did not describe in- or exclusion criteria for patients, or criteria varied highly in the remaining studies. Index test characteristics showed large differences in the level of clinical expertise, profession, and training in dermatoscopic photography. Over 60% did not report on one or more index test characteristics. Image quality and additional clinical information reporting likewise varied. Reference standard characteristics showed that most studies reported the consultation being assessed by a teledermatologist, with one study mentioning that a training was followed. Sixteen studies did not report on the level of experience in assessing teledermoscopy consultations. Most studies applied at least histopathology as a gold standard.

Conclusions:

Clinical and methodological heterogeneity among teledermoscopy diagnostic outcome studies, in the population, index test and reference standard domains, indicates a lack of standardized reporting. This hinders the synopsis of teledermoscopy diagnostic outcomes in systematic reviews and in turn diminishes the ability to translate research results into routine practice. The use of the (tailored) STARD checklist in the reporting on teledermoscopy diagnostic outcome studies is recommended to facilitate consistent reporting and meaningful comparisons of study outcomes related to teledermoscopy in systematic reviews. We suggest to perform a Delphi study to gather consensus on the tailored STARD guideline.