Actinic keratosis (AK) and field cancerization are increasing health problems insufficiently diagnosed by primary care physicians. The objective of this study was to assess the validity and reliability of teledermatology (TD) and teledermoscopy in the diagnosis of AK and field cancerization in a gatekeeper healthcare model. A prospective diagnostic test evaluation was done to assess the diagnostic concordance, accuracy, and performance parameters and the interobserver and intraobserver concordances of TD and teledermoscopy compared with dermatologists’ face-to-face evaluation or histopathology. A total of 636 patients with 1,000 keratotic skin lesions were included. TD diagnostic concordance for AK and field cancerization evaluation was very high and superior to primary care physicians’ diagnosis (92.4% vs. 62.4% and 96.7% vs. 51.8%, P < 0.001). TD sensitivity, specificity, and positive and negative predictive values for AK diagnosis and field cancerization were high (range = 82.2–95.0) and better than primary care physicians’ diagnosis. Teledermoscopy yielded better results in diagnostic concordance, performance parameters, and AK subtypes. Intraobserver and interobserver agreement was >0.83. TD and, to a greater extent, teledermoscopy may be valid and reliable tools for the diagnosis of AK and field cancerization and may improve diagnosis and correct allocation and management in gatekeeper healthcare systems. It can be an alternative tool to training primary care physicians in direct diagnosis of these lesions.

光化性角化病（AK）和野外癌化正在加剧由初级保健医生未能充分诊断出的健康问题。这项研究的目的是评估在看门人医疗模型中，远距离皮肤病学（TD）和远距离皮肤镜在AK和野外癌的诊断中的有效性和可靠性。与皮肤科医生的面对面评估或组织病理学相比，进行了前瞻性诊断测试评估，以评估TD和远程皮肤镜检查的诊断一致性，准确性和性能参数以及观察者之间和观察者内部的一致性。总共包括636名1000例角化性皮肤病患者。TD对AK和田间癌变评估的诊断一致性很高，优于初级保健医师的诊断（92.4％比62.4％和96.7％比51.8％，P <0.001）。TD对AK诊断和野外癌变的敏感性，特异性以及阳性和阴性预测值均较高（范围= 82.2–95.0），并且优于初级保健医师的诊断。远程皮肤镜检查在诊断一致性，性能参数和AK亚型方面产生了更好的结果。观察者内部和观察者之间的协议大于0.83。TD和更广泛的远程皮肤镜检查可能是诊断AK和野外癌症的有效且可靠的工具，并且可以改善关守医疗系统的诊断以及正确的分配和管理。它可以作为培训初级保健医生直接诊断这些病变的替代工具。0）并优于初级保健医师的诊断。远程皮肤镜检查在诊断一致性，性能参数和AK亚型方面产生了更好的结果。观察者内部和观察者之间的协议大于0.83。TD和更广泛的远程皮肤镜检查可能是诊断AK和野外癌症的有效且可靠的工具，并且可以改善关守医疗系统的诊断以及正确的分配和管理。它可以作为培训初级保健医生直接诊断这些病变的替代工具。0）并优于初级保健医师的诊断。远程皮肤镜检查在诊断一致性，性能参数和AK亚型方面产生了更好的结果。观察者内部和观察者之间的协议大于0.83。TD和更广泛的远程皮肤镜检查可能是诊断AK和野外癌症的有效且可靠的工具，并且可以改善关守医疗系统的诊断以及正确的分配和管理。它可以作为培训初级保健医生直接诊断这些病变的替代工具。远程皮肤镜检查可能是诊断AK和野外癌变的有效且可靠的工具，并且可以改善关守医疗系统的诊断以及正确的分配和管理。它可以作为培训初级保健医生直接诊断这些病变的替代工具。远程皮肤镜检查可能是诊断AK和野外癌变的有效且可靠的工具，并且可以改善关守医疗系统的诊断以及正确的分配和管理。它可以作为培训初级保健医生直接诊断这些病变的替代工具。