Great cases in teledermatology

San Francisco - Telemedicine works well in a field like dermatology and likely catches skin conditions which might not otherwise be caught early enough, says Thomas P. Long, M.D., a clinical associate professor of dermatology at Brown Medical School and director of the dermatology residency training program at Rhode Island Hospital.

Real time dermatology

One disadvantage of real-time teledermatology is that it requires more technological bandwidth to transmit images whereas the storage of images through the store and forward method does not.

The VAMC in Togus, Maine, is the only medical center that serves veterans in the state, which is home to 154,500 vets. VAMC is the referral hospital for five community clinics in Maine. There are no dermatologists on staff at the hospital, making it under-served.

Nurse practitioners take patient histories at the hospital, record images and store all the data in the hospital's computerized medical record system. Dermatologists in Providence, R.I., can review the electronic records and images captured by the nurse practitioner. Dermatologists can then make an assessment and recommend diagnostic studies or a treatment plan.

"When I was first asked to engage in telemedicine, I was concerned that I would miss a skin cancer," Dr. Long says. "I thought it would be difficult to translate a three-dimensional skin lesion into a two-dimensional image. I thought it would be too difficult to diagnose. However, the quality of the images is excellent, and I feel comfortable in offering my opinion."

He notes that the dermatologists in Rhode Island are able to diagnose rashes and skin infections as well as potentially life-threatening conditions like melanoma. Because images are stored and can be retrieved at any time, other dermatologists can offer their opinions on a particular case that may be of wider interest, Dr. Long explains.

A unique, useful teaching tool

"It's a teaching tool," he says. "Medical students and residents can learn quite a bit from teledermatology.

"We diagnose many melanomas in an early and curable stage," Dr. Long says. "We look at both the clinical image and use electronic light microscopy to enhance the image. We are then able to select the lesions that look suspicious. We could catch melanoma in an early and curable state. If we didn't use teledermatology, they might advance in two, three or five years, and not be treatable."

Competence with challenging cases

More challenging dermatological cases can also be diagnosed and treated using telemedicine, Dr. Long notes.

Challenging cases such as changing pigmented lesions, amelanotic melanoma, angiosarcoma, cutaneous T-cell lymphoma, cutaneous infections and unusual rashes have been diagnosed and treated using teledermatology, according to Dr. Long.

"We can have a sub-specialist on our staff look at the images that are stored," Dr. Long says.

Telemedicine as a whole and teledermatology in particular will expand in the future, especially if there is wider adaptation of computerized medical records, Dr. Long predicts.

"It works extremely well when there are computerized medical records," Dr. Long says. "When more physicians move to electronic medical records, it will facilitate image storing and teledermatology."