Patient-Driven Teledermoscopy for Atypical Nevi Successful

Ricki Lewis, PhD

January 30, 2015

Mobile devices equipped with cameras can effectively enable patients to monitor atypical nevi and send images to their healthcare providers, according to an article published online January 28 in JAMA Dermatology.

Nevus monitoring typically spans 2.5 to 4.5 months. Approximately 19% of lesions change during that time, with 11% to 18% of them eventually becoming malignant. Clinically significant changes seen by comparing images side by side is evidence for excision of the lesion.

Patient-driven mobile teledermoscopy uses an application, DermScope, on an iPhone to transmit images from the patient to the healthcare provider. The technology may help alleviate the increased patient load in dermatology resulting from the aging US population and increased numbers of insured patients.

Xinyuan Wu, BA, from the Memorial Sloan Kettering Cancer Center in New York City, and coauthors conducted a pilot prospective cohort study to assess the practicality and effectiveness of teledermoscopy for short-term monitoring of one or more clinically atypical nevi. They followed 34 patients who see either of two dermatologists at Sloan-Kettering. Twenty-nine patients completed follow-up at 3 to 4 months; they had 33 lesions in total among them.

Questionnaires at baseline and follow-up asked each participant about attitudes toward teledermoscopy and about awareness of skin care issues. Family members completed the survey as well, because they would take the photos of hard-to-reach lesions.

The two dermatologists evaluated standard dermoscopic images, and a teledermatologist remotely evaluated the remotely acquired images for quality and clinically significant changes in the lesions. Such changes included any visual differences not attributed to tanning and change in number of milia-like cysts.

The approach proved both popular and accurate, and patients were enthusiastic about assisting in monitoring their condition.

Thirty of the resulting 33 image pairs were considered sharp enough for the teledermatologist to evaluate. "Compared with the clinical assessment of these nevi by a dermatologist (25 were deemed unchanged and 4 changed), the teledermatologist agreed with all of the clinical recommendations but opted for a more conservative diagnosis for 1 lesion, resulting in a kappa score of 0.87," write Monika Janda, PhD, from Queensland University of Technology, Brisbane, Australia, and coauthors in an accompanying editorial. The researchers hypothesize that the teledermatology employed a lower threshold for change to compensate for perceived diminished quality of the images compared with conventionally acquired images.

High-risk individuals and patients who have been successfully treated for melanoma need regular monitoring, Dr Janda and colleagues explain. “This places considerable burden on patients and strain on clinicians and the health care system.”

A previous study that attempted to integrate teledermoscopy into primary care was less successful, they write. “The family physicians reported many barriers including issues with the internet connectivity, lengthening of the consultation times, and the consultation covering several topics and not just nevi diagnoses.”

Effective integration of teledermoscopy into standard practice will need to consider technical specifications, user experience and workflow, and integration and scalability, Dr Janda and colleagues note. They conclude that "the findings from Wu and colleagues provide further support for the feasibility of consumer-driven mobile teledermoscopy."

Limitations of the study include the small sample size and the use of research assistants to save and transmit the cell phone images, which might not accurately reflect the ability of patients to do so on their own.

One editorialist provides teledermatological reports for GmbH and MoleMap. The other authors and editorialists have disclosed no relevant financial relationships.

JAMA Dermatology. Published online January 28, 2015. Article abstract, Editorial extract

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