77 THE VALUE OF TELEDERMOSCOPY TO THE EXPERTISE OF GPS DIAGNOSING SKIN DISORDERS The sensitivity for all the diagnoses categories together increased from 0.07 in year 1 to 0.10 in year 2 and 0.14 in year 3. The sensitivity for the diagnosis categories C43-C44 Melanoma and other malignant neoplasms of skin, D10-D36 Benign neoplasms, L20L30 Dermatitis and eczema (Figure 4.4) also increased. The sensitivity for melanoma (C43-C44) improved from 0 out of 12 cases confirmed (0.0%) in year 1, 3 out of 22 cases (13.6%) in year 2, and 4 out of 16 cases confirmed (25.0%) in year 3 (total 7 out of 50 cases diagnosed as melanoma). The sensitivity for Benign neoplasms (D10-D36) improved from 5 out of 65 cases confirmed (7.7%) in the first year to 13 out of 79 cases in the third year (16.5%). Added value of teledermoscopy Thirty-four diagnoses were scored by the TD to fourteen ICD-10 categories not chosen by the GPs (Table 4.3). In these cases the GP did not fill in a diagnosis. Five consultations were scored by the TD as no assessment possible and for these cases no diagnosis was filled in by the GP as well. Table 4.3: Diagnosis categories chosen by teledermatologist (TD) and not by general practitioner (GP). Category Description B00-B09 Viral infections characterized by skin and mucous membrane lesions B35-B49 Mycoses C81-C96 Malignant neoplasms, stated or presumed to be primary, of lymphoid, haematopoietic and related tissue D65-D69 Coagulation defects, purpura and other haemorrhagic conditions D70-D77 Other diseases of blood and blood-forming organs H60-H62 Diseases of external ear I80-I89 Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified L00-L08 Infections of the skin and subcutaneous tissue L40-L45 Papulosquamous disorders L60-L75 Disorders of skin appendages M30-M36 Systemic connective tissue disorders O94-O99 Other obstetric conditions, not elsewhere classified Q80-Q89 Other congenital malformations T08-T14 Injuries to unspecified part of trunk, limb or body region No abnormalities The number of diagnoses inserted by the GP increased over time from 13 (7.1%) to 27 (13.0%) and 34 (18.0%) in year 1, 2 and 3 respectively. Conversely, this indicates to the added value of teledermoscopy, which therefore starts out as relatively high as 92.9 percent of diagnoses are provided by the TD and were not filled in by GPs starting with teledermoscopy. This number then slightly decreases after GP’s continuing use of teledermoscopy to 82.0 percent of the patients diagnosed by TD in year 3. 4
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