Teledermatopathology: Current status and perspectives

Teledermatopathology allows remote diagnosis of skin specimens at remote locations by using computer and communications technology, and it can be performed with real-time (dynamic) transmission of images or the store-and-forward (SAF; static) option [3,16,23]. The first method provides remote consultation via a robotic microscope, which can be controlled by the consulting pathologist [3,16,23]. On the contrary, using the SAF system, each image is captured and transmitted as a single file. The fields to be examined are selected by the referring pathologist and then transmitted by an e-mail or a file transfer protocol (FTP) connection or using a specific web application [3,16,23]. In the last several years, virtual slide systems (VSSs) have been introduced in telepathology. With these systems, the whole slide can be digitized at high resolutions, which allows the user to view any part of the specimen at any magnification [8]. In this way, the limitations imposed by capturing small preselected areas can be overcome. Moreover, the acquired images can be stored on a virtual slide (VS) server that makes them available on the web, and an integrated VS client enables the users to browse the VS [8,23]. Recently, new ultrarapid VS processors have been developed [24]. In dermatopathology, the knowledge of skin physiology and semiotics should always be integrated with a clinical background to arrive at a correct diagnosis. The study of histopathologic specimens from inflammatory skin diseases and equivocal melanocytic lesions can be particularly difficult, and a strict correlation with clinical parameters becomes mandatory. Two examples of der-matopathologic entities that might be problematic in routine dermatopathology are inflammatory dermatoses, characterized by subtle pattern arrangements of inflammatory cells and dysplastic nevi, where subtle changes in architectural and cytologic appearance can lead astray to a more malignant behavior.This issue is of major concern for achieving correct diagnoses in teledermatopathology [2, 16, 18]. The feasibility of both SAF and real-time teledermatopathology has already been proved in few studies, mainly on nonmelanoma skin cancer or melanocytic lesions, with less emphasis on inflammatory skin diseases [1, 2, 4, 6, 7, 16-19, 22]. These studies suggest that diagnostic efficacy and accuracy in teledermatopathology may be particularly weak when examining entities that require the identification of subtle architectural arrangements or delicate cytologic features, as in inflammatory skin diseases [1, 2, 4, 6, 7, 16-19, 22]. Recent applications of VSS in teledermatopathology both on melanocytic lesions and on inflammatory skin diseases confirmed the intrinsic difficulty of dermatopathology and teledermatopathology [11, 15]. Further development of the VSS and new studies using the new VS processor, as well as training with the virtual microscope, might improve the diagnostic performance of teleconsultants