Gerald Gabler

Melanoma screening with cellular phones.

Background Mobile teledermatology has recently been shown to be suitable for teledermatology despite limitations in image definition in preliminary studies. The unique aspect of mobile teledermatology is that this system represents a filtering or triage system, allowing a sensitive approach for the management of patients with emergent skin diseases. Methodology/Principal Findings In this study we investigated the feasibility of teleconsultation using a new generation of cellular phones in pigmented skin lesions. 18 patients were selected consecutively in the Pigmented Skin Lesions Clinic of the Department of Dermatology, Medical University of Graz, Graz (Austria). Clinical and dermoscopic images were acquired using a Sony Ericsson with a built-in two-megapixel camera. Two teleconsultants reviewed the images on a specific web application (http://www.dermahandy.net/default.asp) where images had been uploaded in JPEG format. Compared to the face-to-face diagnoses, the two teleconsultants obtained a score of correct telediagnoses of 89% and of 91.5% reporting the clinical and dermoscopic images, respectively. Conclusions/Significance The present work is the first study performing mobile teledermoscopy using cellular phones. Mobile teledermatology has the potential to become an easy applicable tool for everyone and a new approach for enhanced self-monitoring for skin cancer screening in the spirit of the eHealth program of the European Commission Information for Society and Media.

Mobile teledermatology: A feasibility study of 58 subjects using mobile phones

Summary We investigated the diagnostic agreement between teledermatology based on images from a mobile phone camera and face-to-face (FTF) dermatology. Diagnostic agreement was assessed for two teledermatologists (TD) in comparison with FTF consultations in 58 subjects. In almost three-quarters of the cases (TD1: 71%; TD2: 76%), the telediagnosis was fully concordant with the FTF diagnosis. Furthermore, the diagnosed diseases were almost all in the same diagnostic category (TD1: 97%; TD2: 90%). If mobile teledermatology had been used for remote triage, TD1 could have treated 53% subjects remotely and 47% subjects would have had to consult a dermatologist FTF. TD2 could have treated 59% subjects remotely, whereas 41% subjects would have had to consult a dermatologist FTF. Forty-eight subjects responded to a questionnaire, of whom only 10 had any concerns regarding teledermatology. Thirty-one subjects stated that they would be willing to pay to use a similar service in future and suggested an amount ranging from €5 to €50 per consultation (mean €22) (€ = £0.7, US

Teledermatopathology: a controlled study about diagnostic validity and technical requirements for digital transmission.

1.4). These results are encouraging as patient acceptance and reimbursement represent potential obstacles to the implementation of telemedicine services.

telederm.org: freely available online consultations in dermatology.

Telepathology is the practice of diagnostic histopathology performed on digital pictures. In this study, we focused on the technical requirements for achievement of a correct diagnosis on digital histopathologic images. A collection of 560 melanocytic lesions was selected from the files of the Department of Dermatology, Medical University of Graz, Austria. From each lesion one histologic slide was completely digitally scanned with a robotic microscope. Digital pictures were reviewed by 4 dermatopathologists using a presentation program, which recorded the number of image calls, applied magnifications, overall time needed, and amount of transmitted bits during the digital sign-out. One month later, the 4 microscopists had to review the corresponding slides and render a direct diagnosis on each case.Telepathologic diagnoses corresponded with the original diagnoses in a range from 90.4% to 96.4% of cases (κ 0.80 to 0.93; P < 0.001). The median time needed for achievement of a diagnosis was 22 seconds and was significantly higher for melanomas compared with nevi. The median transmission effort for each diagnosis was 510 kilobytes after JPEG compression. Using an ISDN line with a transmission capacity of 64 kilobits/ second, this correlates to a transmission time of about 1 minute.Our results demonstrate that correct reporting on digital histopathologic images is possible with only a little time exposure. For an adequately fast transmission ISDN lines are suffcient after JPEG compression.

Wound Teleconsultation in Patients with Chronic Leg Ulcers

Studies have shown that skin disorders can be reliably diagnosed by online consultations. These consultations are provided free of charge by a new nonprofit organization of skin doctors worldwide

Two years' experience with Web-based teleconsulting in dermatology

Background: The treatment of chronic leg ulcers requires frequent assessments of local wound status and adjustment of therapy. The availability of reasonably priced photographic equipment and quick electronic transfer of high-quality digital images should make it possible that the assessment of wound status can be made by remote experts. Objective: This study examines the feasibility of using teledermatology for wound assessment and therapeutic suggestions for patients with chronic leg ulcers. Methods: One hundred ten chronic leg ulcers of different origins were examined in face-to-face consultations. The examining doctor assessed the wound, made therapeutic recommendations and took 1–4 photographs of the wound using a digital camera. The digital images and relevant clinical information were then transmitted via a web application to an expert in wound care, who provided an independent teledermatological assessment of wound status and therapeutic recommendations. Results: In our study, a high accordance between direct consultations and electronic consultations was found in the assessment of chronic leg ulcers, especially for important features like slough (concordance: 84.6%), necrosis (concordance: 98.2%) and granulation tissue formation (concordance: 76.4%). Furthermore, the teledermatologist generally felt confident in recommending further treatment strategies and in planning further wound assessments via the internet. Conclusions: Our results suggest that teledermatology offers great potential for the future in chronic wound care. By reducing the need to travel long distances to the hospital or to consult a physician with expertise in wound care, wound teleconsultation might lower health care costs and improve the quality of life for patients with chronic wounds, while still maintaining a high quality of wound care.

Personal Digital Assistants in Teledermatology

A non-commercial teledermatology network based on store-and-forward operation was established in April 2002. The aim was to create an easy-to-use platform for teleconsultation services, where physicians could seek diagnostic advice in dermatology from a pool of expert consultants and where they could present and discuss challenging dermatology cases with special emphasis on diagnosis and therapy. An online moderated discussion forum was added in October 2003. During the first two years, 348 health-care professionals from 45 countries registered to use the Website. A total of 783 requests for consultations were answered; 285 requests concerned pigmented skin lesions, 440 requests were from the whole range of clinical dermatology and 58 requests were about non-melanoma skin cancer. Of a total of 133 requests analysed, 80 (60%) were answered within one day, 47 (35%) within one week, five (4%) within two weeks and one (1%) consultation was answered in more than two weeks. Our experience with a discretionary, non-commercial, multilingual Website for open-access teleconsulting in dermatology appears to be successful. The Website represents an example of user-generated content, together with active interaction between users, who can present and discuss cases with remote colleagues.

The user-generated web-based dermoscopy image archive of the international dermoscopy society: A contribution to E-learning and exchange of knowledge

1 Nakamura T. Toxicoderma caused by shiitake. (Lentinus edodes). Jpn J Clin Dermatol 1977; 31:65–8. 2 Nakamura T. Shiitake (Lentinus edodes) dermatitis. Contact Dermatitis 1992; 27:65–70. 3 Chihara G, Maeda Y, Hamuro J et al. Inhibition of mouse sarcoma 180 by polysaccharides from Lentinus edodes. Nature 1969; 222:687–8. 4 Nakamura T. Shiitake dermatitis. Jpn Med J 1986; 3237:48–50. 5 Shimizu R. A case of drug eruption caused by lentinan. Rinsho Derma (Tokyo) 1990; 32:1065–8. 6 Hanada K, Hashimoto I. Flagellate mushroom (shiitake) dermatitis and photosensitivity. Dermatology 1998; 197:255–7. 7 Mowad CM, Nguyen TV, Elenitsas R, Leyden JJ. Bleomycin-induced flagellate dermatitis: a clinical and histopathological review. Br J Dermatol 1994; 131:700–2.

Feasibility and diagnostic agreement in teledermatopathology using a virtual slide system.

4,000 members from over 110 countries who can take part in the online discussion forum on the website www. dermoscopy-ids.org. The members share cases of interest with each other by entering clinical data and images as well as dermoscopic images to an input mask and pose questions pertaining to diagnosis, treatment or dermoscopic features of the lesions. The consultants of the forum then respond to the queries, and in this way all members are able to profit from their knowledge and expertise. Figure 1 depicts a case which was posted on the discussion forum. Since the website’s establishment in 2006, a vast number of cases has been uploaded and discussed, and as such cases with finalized discussions are removed from the discussion forum for clearness of arrangement. Therefore we decided to create a dermoscopy image archive to enable members to locate previous cases based on both clinical and dermoscopic criteria which are entered into an input mask ( fig. 2 ). The arrangement was developed with the goal of offering an additional source of dermoscopic images and expanding the value of the forum as an educational tool in dermoscopy.