A comparison of teledermatology using store-and-forward methodology alone, and in combination with Web camera videoconferencing.

We compared the diagnostic accuracy of conventional asynchronous teledermatology ('store-and-forward' [SAF]) with a combined technique, in which SAF methodology was used first, followed by a videoconference using low-cost Web cameras. The study involved 228 patients with 242 lesions. For each case, two independent teledermatologists (A and B) evaluated digital images and clinical information by the conventional SAF method and gave a single diagnosis. Then, each communicated with the patient via Web cameras and gave a single diagnosis (combined method). Finally, teledermatologist A performed a face-to-face examination of each patient and established the gold standard diagnosis. With the conventional SAF method, the diagnostic accuracy of teledermatologist A was 81%, while that for teledermatologist B was 75%. With the combined method, the corresponding values were 90% and 82% (P<0.001 for both). There was no significant difference in the interobserver agreement between the two methods. Use of Web camera videoconferencing improved patient satisfaction with teledermatology. This method of teledermatology may be a useful alternative to the SAF method alone.