78 CHAPTER 4 In three years’ time, TDs diagnosed the majority of the patients as benign neoplasm (year 1 35.5%, year 2 43.0%, year 3 41.8%) or other disorders of the skin and subcutaneous tissue (year 1 37.7%, year 2 23.2%, year 3 33.3%). In the first year, patients in teledermoscopy were not diagnosed by the GP with the ICD-10 code Melanoma and other malignant neoplasms of skin (C43-C44). In the second year GPs diagnosed two consultations as benign neoplasms, while the TD diagnosed these patient cases as melanoma or other malignant neoplasms of the skin (C43-C44). In the third year one consultation was diagnosed as radiation-related disorder (L55-L59) by the GP, that was diagnosed as melanoma by the TD. Overall, 12 (6.6%), 19 (9.2%) and 12 melanoma cases (6.3%) were diagnosed by the TD in three years’ time respectively and not or not correctly pre-diagnosed by the GP. This suggests that in 7.4 percent of the total teledermoscopy consultations performed in three years’ time melanoma was detected, which were not and/or not correctly pre-diagnosed by the GP. Also, 1 out of 3 (35.8%) teledermoscopy consultations were diagnosed as benign by the TD and not and/or not-correctly pre-diagnosed as such by the GP. DISCUSSION We conducted a retrospective study in the Netherlands to assess the potential value of teledermoscopy to GPs’ expertise in diagnosing skin disorders over three years’ time. Overall, of the total number of cases included in the study, the GPs provided more prediagnoses for each subsequent year from 7 percent in year 1 to 18 percent in year 3. Our study shows that the total percentage of correct pre-diagnosed cases of GPs is low, but during continual use of teledermoscopy it slightly increased over time from 6 percent to 13 percent. However, the number of incorrect pre-diagnosed cases also increased over time from 15.4 to 26.5 percent. This corresponds to a decrease in the overall PPV for all diagnosis categories. A possible explanation might be that after continual teledermoscopy use, GPs might select the more difficult cases for teledermoscopy consultation and handle the less complex cases themselves. GP’s PPV specifically increased over time for diagnosis category L20-L30 Dermatitis and eczema. This may indicate that GPs become more attune to correctly diagnosing patients with dermatitis and eczema over time. In general, GP sensitivity over all diagnosis categories showed a slight increase from 0.07 in year 1 to 0.14 in year 3. More importantly, GPs appear to become more sensitive in accurately pre-diagnosing skin disorders in the categories: C43-C44 Melanoma and other malignant neoplasms of skin and D10-D36 Benign neoplasms. As teledermoscopy is especially important in early diagnosis of melanoma, these results are promising. When GPs’ clinical expertise in recognizing melanoma improves, the sensitivity in melanoma
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