Dermoscopic Photographs Impact Confidence and Management of Remotely Triaged Skin Lesions

INTRODUCTION: Improving remote triage is crucial given expansions in tele-dermatology and with limited in-person care during COVID-19. In addition to clinical pictures, dermoscopic images may provide utility for triage. OBJECTIVES: To determine if dermoscopic images enhance confidence, triage accuracy, and triage prioritization for tele-dermatology. METHODS: In this preliminary parallel convergent mixed-methods study, a cohort of dermatologists and residents assessed skin lesions using clinical and dermoscopic images. For each case, participants viewed a clinical image and determined diagnostic category, management, urgency, and decision-making confidence. They subsequently viewed the associated dermoscopy and answered the same questions. A moderated focus group discussion followed to explore perceptions on the role of dermoscopy in tele-dermatology. RESULTS: Dermoscopy improved recognition of malignancies by 23% and significantly reduced triage urgency measures for non-malignant lesions. Participants endorsed specific utilities of tele-dermoscopy, such as for evaluating pigmented lesions, with limitations including poor image quality. CONCLUSIONS: Dermoscopic images may be useful when remotely triaging skin lesions. Standardized imaging protocols are needed.