{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:32:39Z","timestamp":1792798359003,"version":"4.5.0"},"reference-count":52,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T00:00:00Z","timestamp":1728518400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Herlev and Gentofte Hospital Research Foundation"},{"DOI":"10.13039\/100008363","name":"Kr\u00e6ftens Bek\u00e6mpelse","doi-asserted-by":"publisher","award":["R277-A16675"],"award-info":[{"award-number":["R277-A16675"]}],"id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012774","name":"Innovationsfonden","doi-asserted-by":"publisher","award":["9093-00005B"],"award-info":[{"award-number":["9093-00005B"]}],"id":[{"id":"10.13039\/100012774","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Telemed Telecare"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Five dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies,\n                      <jats:italic>Caution Protocol<\/jats:italic>\n                      and\n                      <jats:italic>Majority Vote<\/jats:italic>\n                      , and the sensitivity and specificity of the patient triages were calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Triage by a single teledermatologist showed a sensitivity of 92.3% and a specificity of 58.7%. Sensitivity improved with the number of assessors, particularly when using the\n                      <jats:italic>Caution Protocol<\/jats:italic>\n                      , though with a considerable drop in specificity. The\n                      <jats:italic>Majority Vote<\/jats:italic>\n                      showed a more balanced improvement in sensitivity and specificity. Safety analyses indicated that diagnostic accuracy decreased with poor image quality and increased case difficulty.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>\n                      Expert teledermoscopic triage of melanocytic skin lesions is highly sensitive and lowers the need for unnecessary excision procedures by half while dismissing as few as 0.4% (95% confidence interval 0\u20130.6%) of melanomas, even when applied to a high-prevalence pre-triaged subpopulation. Implementation of safety procedures increases accuracy. Using multiple teledermatologists increases sensitivity but at the cost of specificity unless a\n                      <jats:italic>Majority Vote<\/jats:italic>\n                      consensus strategy is applied. Future teledermoscopy guidelines should encompass safety procedures and protocols for disagreement between assessors.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1357633x241286003","type":"journal-article","created":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T09:26:35Z","timestamp":1728552395000},"page":"1296-1307","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Teledermoscopic triage of melanoma-suspicious skin lesions is safe: A retrospective comparative diagnostic accuracy study with multiple assessors"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6440-9962","authenticated-orcid":false,"given":"Gustav Gede","family":"Nervil","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, Copenhagen University Hospital \u2013 Herlev and Gentofte, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels Kvorning","family":"Ternov","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Copenhagen University Hospital \u2013 Herlev and Gentofte, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Lorentzen","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Kromann","sequence":"additional","affiliation":[{"name":"Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5876-0190","authenticated-orcid":false,"given":"\u00c5sa","family":"Ingvar","sequence":"additional","affiliation":[{"name":"Department of Dermatology Lund, Sk\u00e5ne University Hospital, Sk\u00e5ne, Sweden"},{"name":"Lund University Skin Cancer Research Group, Lund University, Lund, Sweden"},{"name":"Department of Clinical Sciences, Dermatology, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7363-0455","authenticated-orcid":false,"given":"Kari","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Dermatology Lund, Sk\u00e5ne University Hospital, Sk\u00e5ne, Sweden"},{"name":"Lund University Skin Cancer Research Group, Lund University, Lund, Sweden"},{"name":"Department of Clinical Sciences, Dermatology, Lund University, Lund, Sweden"},{"name":"Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Tolsgaard","sequence":"additional","affiliation":[{"name":"Copenhagen Academy for Medical Education and Simulation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7210-8884","authenticated-orcid":false,"given":"Tine","family":"Vestergaard","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisbet Rosenkrantz","family":"H\u00f6lmich","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Copenhagen University Hospital \u2013 Herlev and Gentofte, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,10,10]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2016.01.035"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2022.0160"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.61409\/A07230435"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2019.12.063"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38516.649537.E0"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsb2019760"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/ddg.14233"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X16663328"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16275"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.2196\/43395"},{"key":"e_1_3_3_12_2","first-page":"1","article-title":"Dermoscopy, with and without visual inspection, for diagnosingmelanoma in adults (review)","volume":"12","author":"Dinnes J","year":"2018","unstructured":"Dinnes J, Jj D, Chuchu N, et al. Dermoscopy, with and without visual inspection, for diagnosingmelanoma in adults (review). Cochrane Libr 2018; 12: 1\u2013661.","journal-title":"Cochrane Libr"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X20987423"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X221122113"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.14147"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.2340\/00015555-1906"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.2196\/40888"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X221147074"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.144.4.502"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.137.12.1583"},{"key":"e_1_3_3_21_2","unstructured":"The Danish Health Authority. Danish Cancer Patient Pathway for melanoma patients (Danish: Pakkeforl\u00f8b for moderm\u00e6rkekr\u00e6ft i huden) [Internet]. 2020. Available from: https:\/\/www.sst.dk\/-\/media\/Udgivelser\/2020\/Modermaerkekraeft\/Pakkeforloeb-for-modermaerkekraeft-i-huden.ashx?la=da&hash=87D5DB0DE5A4D72EBF1CA278EE8802E16FCB581D."},{"key":"e_1_3_3_22_2","unstructured":"OpenAI. ChatGPT [Large Language Model] [Internet]. Available from: https:\/\/chat.openai.com\/chat."},{"key":"e_1_3_3_23_2","volume-title":"RStudio: Integrated Development for R [Internet]","author":"RStudio Team","year":"2020","unstructured":"RStudio Team. RStudio: Integrated Development for R [Internet]. Boston, MA: RStudio, PBC, 2020, Available from: http:\/\/www.rstudio.com\/."},{"key":"e_1_3_3_24_2","volume-title":"Diagnostic testing accuracy: Sensitivity, specificity, predictive values and likelihood ratios - StatPearls [Internet]","author":"Shreffler J","year":"2024","unstructured":"Shreffler J, Huecker MR. Diagnostic testing accuracy: Sensitivity, specificity, predictive values and likelihood ratios - StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2024 January 2023 [cited 2024 Mar 23], Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557491\/."},{"key":"e_1_3_3_25_2","unstructured":"R Foundation for Statistical Computing Vienna A. R: A language and environment for statistical computing. [Internet]. 2022. Available from: https:\/\/www.r-project.org\/."},{"key":"e_1_3_3_26_2","unstructured":"Posit Software PBC formerly RStudio P. RStudio 2023.09.0\u2009+\u2009463 \u201cDesert Sunflower\u201d [Internet]. Available from: https:\/\/posit.co\/downloads\/."},{"key":"e_1_3_3_27_2","article-title":"A review of literature supporting the development of practice guidelines for teledermatology in Australia","volume":"61","author":"Abbott LM","year":"2020","unstructured":"Abbott LM, Miller R, Janda M, et al. A review of literature supporting the development of practice guidelines for teledermatology in Australia. Australas J Dermatol 2020; 61: e174\u2013e183.","journal-title":"Australas J Dermatol"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.2340\/actadv.v104.15302"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/ajd.13777"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1080\/02841850600803842"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.2196\/15597"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0942-0"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/104649648501600405"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20190610"},{"key":"e_1_3_3_35_2","first-page":"67","article-title":"A structured approach to strategic decisions: Reducing errors in judgement requires a disciplined process [Internet]","volume":"60","author":"Kahneman D","year":"2019","unstructured":"Kahneman D, Lovallo D, Sibony O, et al. A structured approach to strategic decisions: Reducing errors in judgement requires a disciplined process [Internet]. MIT Sloan Manage Rev. 2019; 60: 67\u201373.","journal-title":"MIT Sloan Manage Rev"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1111\/1754-9485.12450"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2014.12.008"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.2196\/24820"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.14565"},{"key":"e_1_3_3_40_2","first-page":"802","article-title":"A comparative study of the image quality of dermoscopic images acquired in general practice versus at a dermatology department","volume":"2","author":"Niklasson L","year":"2023","unstructured":"Niklasson L, Prasad SC, Schuster A, et al. A comparative study of the image quality of dermoscopic images acquired in general practice versus at a dermatology department. J Am Acad Dermatol 2023; 2: 802\u2013809.","journal-title":"J Am Acad Dermatol"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2016.0525"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2020.01.065"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2020.4066"},{"key":"e_1_3_3_44_2","article-title":"Teledermatology for diagnosing skin cancer in adults","volume":"12","author":"Chuchu N","year":"2018","unstructured":"Chuchu N, Dinnes J, Takwoingi Y, et al. Teledermatology for diagnosing skin cancer in adults. Cochrane Database Syst Rev 2018; 12: CD013193.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1002\/jvc2.254"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmaa041"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2022.2932"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16144"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1258\/jtt.2008.080901"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X221077864"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1177\/096914139500200209"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13244-018-0599-0"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0159806"}],"container-title":["Journal of Telemedicine and Telecare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1357633X241286003","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1357633X241286003","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1357633X241286003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:17:50Z","timestamp":1777691870000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1357633X241286003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,10]]},"references-count":52,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/1357633X241286003"],"URL":"https:\/\/doi.org\/10.1177\/1357633x241286003","relation":{},"ISSN":["1357-633X","1758-1109"],"issn-type":[{"value":"1357-633X","type":"print"},{"value":"1758-1109","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,10]]}}}