Teledermoscopy feasible and efficacious in monitoring atypical nevi

1. Teledermatologists had high diagnostic concordance compared to in-office dermatologists on management decisions when evaluating short-term dermoscopic changes. 

Evidence Rating Level: 2 (Good)

Study Rundown: Dermoscopy is a handheld imaging technique that when compared to the naked eye alone, improves the diagnostic accuracy of skin lesions. Monitoring potential skin cancer via serial dermoscopic images overtime can help show changes that may warrant biopsy. While conventionally, this monitoring is done in the office setting, advancements in technology have opened the door for such monitoring to be done by a remote dermatologist, via what is known as “teledermoscopy.” Authors investigated the potential role that teledermoscopy may have in clinical practice. It was found that monitoring atypical moles was feasible, efficacious, and well-received by patients. The study’s findings were strengthened by the prospective cohort design, which was novel in demonstrating patient receptivity to teledermoscopy after taking self-acquired images. Limitations included the small cohort size.

Click to read the study in JAMA Dermatology

Relevant Reading: Short-term digital surface microscopic monitoring of atypical or changing melanocytic lesions

In-Depth [prospective cohort]: In this study, 34 patients from a high-risk skin cancer clinic were recruited for participation of which 29 completed follow-up. Of the 29 patients included, there were 33 lesions that were monitored. Each participant had dermoscopic images taken both by a clinic professional and by the patient themselves at a base-line visit and at one follow-up visit 3-4 months later. The image taken by the patient was sent to a teledermoscopist via help from research personnel. Patients also completed surveys at both visits that assessed their attitude towards teledermoscopy, their willingness to pay for a mobile dermatoscope, and barriers that would affect likelihood for its use. There was 97% agreement in management decisions between in-patient dermatologists and the teledermoscopist (κ=0.87; SE, 0.13). Of the 33 image pairs taken by patients, only 2 were not sufficient for evaluation due to poor image quality. Ninety-seven percent of participants took images that could be evaluated by the teledermatologist. Patients reported strong favorability to use the dermatoscope (on a scale of 1-5: 4.59 [0.86] and 4.46 [0.84]) and high confidence in using it (means [SDs], 4.57 [0.64] and 4.62 [0.49]) at baseline and follow-up visits, respectively.

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Image: PD

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