Mobile Teledermatology for Skin Tumour Screening
Mobile Teledermatology for Skin Tumour Screening
Background The ability to diagnose malignant skin tumours accurately and to distinguish them from benign lesions is vital in ensuring appropriate patient management. Little is known about the effects of mobile teledermatology services on diagnostic accuracy and their appropriateness for skin tumour surveillance.
Objectives To evaluate the diagnostic accuracy of clinical and dermoscopic image tele-evaluation for mobile skin tumour screening.
Methods Over a 3-month period up to three clinical and dermoscopic images were obtained of 113 skin tumours from 88 patients using a mobile phone camera. Dermoscopic images were taken with a dermatoscope applied to the camera lens. Clinical and dermoscopic images of each lesion together with clinical information were separately teletransmitted for decision-making. Results were compared with those obtained by face-to-face examination and histopathology as the gold standard.
Results A total of 322 clinical and 278 dermoscopic images were acquired; two (1%) clinical and 18 (6%) dermoscopic pictures were inadequate for decision-making. After excluding inadequate images, the majority of which were dermoscopic pictures, only 104 of the 113 skin tumours from 80 of 88 patients could be tele-evaluated. Among these 104 lesions, 25 (24%) benign nonmelanocytic, 15 (14%) benign melanocytic, 58 (56%) malignant nonmelanocytic and six (6%) malignant melanocytic lesions were identified. Clinical and dermoscopic tele-evaluations demonstrated strong concordance with the gold standard (κ = 0·84 for each) and similar high sensitivity and specificity for all diagnostic categories. With regard to the detailed diagnoses, clinical image tele-evaluation was superior to teledermoscopy resulting in 16 vs. 22 discordant cases.
Conclusions Clinical image tele-evaluation might be the method of choice for mobile tumour screening.
The incidence of skin cancer, of which nonmelanoma skin cancer (NMSC) is the most frequent, has reached epidemic proportions in white populations and the trend is still rising. Early detection and treatment are essential in reducing mortality in melanoma and preventing major disfigurement, and to a lesser extent also mortality, in NMSC. Currently, dermoscopy or epiluminescence microscopy is the most widely accepted and most frequently used screening tool in dermatology as it allows better visualization of deeper structures of the skin. It has the potential to improve the diagnostic accuracy of melanoma by up to 49% if used by experts and, moreover, it has been shown to be beneficial in identifying malignancies in general. As it is based on two-dimensional pictures it is considered ideal for telemedicine purposes, namely for triage systems or self-skin examination tools. The technical equipment commonly used in this context has previously comprised expensive stereomicroscopes and digital dermoscopy systems, combined with high-end digital cameras. Besides the fact that these expensive and complex techniques may not significantly improve management plans, they are also not yet readily accessible to primary care physicians and even less so to patients. Therefore, from a practical approach it seems reasonable to use technical equipment that is widely distributed in the general population and more easily available and affordable for all, such as mobile camera phones and standard pocket dermoscopy devices. The feasibility of mobile teledermatology and teledermoscopy particularly in the diagnosis of melanocytic skin lesions has previously been demonstrated. In the present study, we aimed to assess the diagnostic accuracy of clinical image tele-evaluation and teledermoscopy for mobile skin tumour screening.
Abstract and Introduction
Abstract
Background The ability to diagnose malignant skin tumours accurately and to distinguish them from benign lesions is vital in ensuring appropriate patient management. Little is known about the effects of mobile teledermatology services on diagnostic accuracy and their appropriateness for skin tumour surveillance.
Objectives To evaluate the diagnostic accuracy of clinical and dermoscopic image tele-evaluation for mobile skin tumour screening.
Methods Over a 3-month period up to three clinical and dermoscopic images were obtained of 113 skin tumours from 88 patients using a mobile phone camera. Dermoscopic images were taken with a dermatoscope applied to the camera lens. Clinical and dermoscopic images of each lesion together with clinical information were separately teletransmitted for decision-making. Results were compared with those obtained by face-to-face examination and histopathology as the gold standard.
Results A total of 322 clinical and 278 dermoscopic images were acquired; two (1%) clinical and 18 (6%) dermoscopic pictures were inadequate for decision-making. After excluding inadequate images, the majority of which were dermoscopic pictures, only 104 of the 113 skin tumours from 80 of 88 patients could be tele-evaluated. Among these 104 lesions, 25 (24%) benign nonmelanocytic, 15 (14%) benign melanocytic, 58 (56%) malignant nonmelanocytic and six (6%) malignant melanocytic lesions were identified. Clinical and dermoscopic tele-evaluations demonstrated strong concordance with the gold standard (κ = 0·84 for each) and similar high sensitivity and specificity for all diagnostic categories. With regard to the detailed diagnoses, clinical image tele-evaluation was superior to teledermoscopy resulting in 16 vs. 22 discordant cases.
Conclusions Clinical image tele-evaluation might be the method of choice for mobile tumour screening.
Introduction
The incidence of skin cancer, of which nonmelanoma skin cancer (NMSC) is the most frequent, has reached epidemic proportions in white populations and the trend is still rising. Early detection and treatment are essential in reducing mortality in melanoma and preventing major disfigurement, and to a lesser extent also mortality, in NMSC. Currently, dermoscopy or epiluminescence microscopy is the most widely accepted and most frequently used screening tool in dermatology as it allows better visualization of deeper structures of the skin. It has the potential to improve the diagnostic accuracy of melanoma by up to 49% if used by experts and, moreover, it has been shown to be beneficial in identifying malignancies in general. As it is based on two-dimensional pictures it is considered ideal for telemedicine purposes, namely for triage systems or self-skin examination tools. The technical equipment commonly used in this context has previously comprised expensive stereomicroscopes and digital dermoscopy systems, combined with high-end digital cameras. Besides the fact that these expensive and complex techniques may not significantly improve management plans, they are also not yet readily accessible to primary care physicians and even less so to patients. Therefore, from a practical approach it seems reasonable to use technical equipment that is widely distributed in the general population and more easily available and affordable for all, such as mobile camera phones and standard pocket dermoscopy devices. The feasibility of mobile teledermatology and teledermoscopy particularly in the diagnosis of melanocytic skin lesions has previously been demonstrated. In the present study, we aimed to assess the diagnostic accuracy of clinical image tele-evaluation and teledermoscopy for mobile skin tumour screening.