{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:07:08Z","timestamp":1788930428744,"version":"build-2803163510"},"reference-count":12,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Smartphone-based store-and-forward teledermatology (SAF-TD) has emerged as a potential approach to improving access to dermatological care. Patient-initiated SAF-TD systems, which enable direct image submission to dermatology specialists, represent an increasingly relevant but insufficiently studied model. However, diagnostic agreement remains insufficiently characterized in real-world, patient-initiated, direct-to-specialist systems in which adult patients independently submit conventional smartphone photographs and assessments are performed by dermatologists with different levels of clinical experience. Methods: A prospective cross-sectional, single-center study was conducted between February 2022 and September 2024, which included 83 patients. Patients independently submitted conventional smartphone photographs through a hospital patient portal. Diagnoses established remotely by an experienced and a beginner dermatologist were compared with face-to-face (FTF) diagnoses as the reference standard. Melanocytic lesions were defined as the positive category and non-melanocytic conditions as the negative category. Diagnostic agreement was assessed using Cohen\u2019s kappa, and sensitivity and specificity were calculated with 95% confidence intervals (CIs). Results: Agreement between SAF-TD and FTF classification was 91.6% (95% CI, 83.6\u201395.9) for the experienced dermatologist (\u03ba = 0.781; 95% CI, 0.628\u20130.934) and 90.4% (95% CI, 82.1\u201395.0) for the beginner dermatologist (\u03ba = 0.760; 95% CI, 0.603\u20130.917), indicating substantial agreement. Sensitivity and specificity were 94.7% (95% CI, 75.4\u201399.1) and 90.6% (95% CI, 81.0\u201395.6), respectively, for the experienced dermatologist and 86.4% (95% CI, 66.7\u201395.3) and 91.8% (95% CI, 82.2\u201396.4), respectively, for the beginner dermatologist. Conclusions: Patient-initiated smartphone-based SAF-TD demonstrated substantial agreement with FTF binary classification by both dermatologists. These findings support its potential clinical use as a complementary method for initial remote dermatological assessment. However, the results require validation in larger, multicenter studies.<\/jats:p>","DOI":"10.3390\/diagnostics16172883","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:30:02Z","timestamp":1788798602000},"page":"2883","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Accuracy of Smartphone-Based Patient-Initiated Store-and-Forward Teledermatology: A Cross-Sectional Direct-to-Specialist Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Dominyka","family":"Stragyte","sequence":"first","affiliation":[{"name":"Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gvidas","family":"Mikalauskas","sequence":"additional","affiliation":[{"name":"Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugne","family":"Tiskeviciute","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina","family":"Gaidulevic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3827-0984","authenticated-orcid":false,"given":"Renata","family":"Paukstaitiene","sequence":"additional","affiliation":[{"name":"Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kestutis","family":"Stasaitis","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Skaidra","family":"Valiukevicien\u0117","sequence":"additional","affiliation":[{"name":"Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e068207","DOI":"10.1136\/bmjopen-2022-068207","article-title":"Diagnostic reliability in teledermatology: A systematic review and meta-analysis","volume":"13","author":"Bourkas","year":"2023","journal-title":"BMJ Open"},{"key":"ref_2","first-page":"75","article-title":"Implementation and evaluation of Stanford Health Care direct-care teledermatology program","volume":"22","author":"Pathipati","year":"2016","journal-title":"Telemed. 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Dermatol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/17\/2883\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:14:19Z","timestamp":1788927259000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/17\/2883"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":12,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16172883"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16172883","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]}}}