Moreno-Ramirez 2007 — Store-and-forward teledermatology in skin-cancer triage (Seville, 2,009 teleconsultations)
Citation
Moreno-Ramirez D, Ferrándiz L, Nieto-García A, Carrasco R, Moreno-Alvarez P, Galdeano R, et al. Store-and-forward teledermatology in skin cancer triage: experience and evaluation of 2,009 teleconsultations. Arch Dermatol. 2007 Apr;143(4):479–484. DOI: 10.1001/archderm.143.4.479.
Study design and population
Multicentre, longitudinal, four-phase descriptive / evaluation study across 12 primary-care centres in Seville, Spain. 2,009 teleconsultations (March 2004 – July 2005). Gold-standard reference: clinical plus dermoscopic plus histopathology.
Reported metrics
- Filtering rate (avoided face-to-face visit): 51.20 % (95 % CI 49.00–53.40)
- Waiting interval teledermatology: 12.31 days (95 % CI 8.22–16.40)
- Waiting interval conventional letter referral: 88.62 days (95 % CI 38.42–138.82)
- Difference ~ 76 days; ~ 7× faster access (p < 0.001)
- Preserved melanoma detection sensitivity
Surrogate-to-outcome linkage
Classic pre-AI exemplar — demonstrates that referral appropriateness and waiting-time reduction co-move with preserved melanoma detection sensitivity in an EU primary-care setting. The 76-day waiting-time reduction feeds directly into the Conic 2018 surgical-delay → mortality-hazard anchor.
CRIT1–7 appraisal
| Criterion | Score | Justification |
|---|---|---|
| CRIT1 Relevance | 3 | Direct — primary-care teledermatology skin-cancer triage, EU setting. |
| CRIT2 Methodology | 2 | Multicentre prospective longitudinal evaluation; four-phase design; histopathology reference. |
| CRIT3 Reporting | 3 | Filtering rate, waiting intervals with 95 % CIs reported. |
| CRIT4 Applicability | 3 | EU primary-care setting, directly applicable. |
| CRIT5 Evidence weight | 1 | Prospective multi-centre descriptive evaluation (no control arm). |
| CRIT6 Risk of bias | 2 | No randomised control; historical comparison for waiting times. |
| CRIT7 Contribution | 3 | Core directional anchor — filtering rate and waiting-time reduction with preserved sensitivity. |
Aggregate: strong.
Limitations and notes
No randomised control (compared to historical letter-referral baseline); single Spanish region; pre-AI era.
Strength as anchor
Strong — the foundational EU multicentre study for the wait-time-reduction surrogate. Complements Giavina-Bianchi 2020 (contemporary, larger scale, Brazil public system) and Vidal-Alaball 2018 (Catalonia cost-savings) to span pre-AI to contemporary EU evidence.