A pilot trial of mobile, patient-performed teledermoscopy

Abstract

Background Early detection by skin self-examination (SSE) could improve outcomes for melanoma. Mobile teledermoscopy may aid this process. Objectives To establish the clinical accuracy of SSE plus mobile teledermoscopy vs. clinical skin examination (CSE) and to test whether providing people with detailed SSE instructions improves accuracy. Methods Men and women aged 50-64 years (n = 58) performed SSE plus mobile teledermoscopy in their homes between May and November 2013 and were given technical instructions plus detailed SSE instructions (intervention) or technical instructions only (control). Within 3 months, they underwent a CSE. Outcome measures included (i) body sites examined, lesions photographed, and missed; (ii) sensitivity of SSE plus mobile teledermoscopy vs. in-person CSE using either patients or lesions as denominator; and (iii) concordance of telediagnosis with CSE. Results Overall 49 of 58 randomized participants completed the study, and submitted 309 lesions to the teledermatologist. Intervention-group participants were more likely to submit lesions from their legs compared with controls (P = 0·03), with no other differences. Eleven participants (22%) did not photograph 14 pigmented lesions that the dermatologist considered worthwhile photographing or monitoring. The sensitivity of SSE plus mobile teledermoscopy was 82% using the patient as denominator and 42% using the lesion as denominator. There was substantial agreement between telediagnosis and CSE (κ = 0·90), accounting for differential diagnoses. Conclusions SSE plus mobile teledermoscopy is promising for surveillance of particular lesions even without detailed SSE instructions. However, in the format tested in this study, consumers may overlook lesions and send many nonpigmented lesions. This investigation demonstrates that high-quality dermoscopic images can be taken by patients at home with high accuracy. What's already known about this topic? Cancer agencies recommend skin self-examination (SSE). Teledermoscopy (if done during clinic visits) has excellent concordance with face-to-face clinical examination, but the sensitivity and specificity of SSE plus mobile teledermoscopy done by people at home has not been studied. What does this study add? The sensitivity of SSE plus teledermoscopy ranges from 42% to 82%, and the specificity from 56·3% to 89·6% depending on the analytical method. SSE could complement melanoma screening and/or surveillance efforts.