Teledermoscopy

From dermoscopedia

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 Editor: H. Peter Soyer

 Author(s): H. Peter Soyer, Katie Lee
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Description This chapter covers the aspects of teledermoscopa and mobile teledermoscopy
Author(s) Katie Lee · H. Peter Soyer
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Status update July 13, 2017
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Teledermoscopy[edit]

Teledermatology is the provision of dermatology services at a distance, using technology; it improves the efficiency of high-quality care by moving patient information instead of the patient themselves. Teledermatology is now an accepted part of many public health systems [1][2][3]; it has also proven useful for medical staff on commercial ships [4]and military personnel on deployment [5].

Due to the highly visual nature of dermoscopy, teledermoscopy in particular is a valuable resource for doctors and their patients, particularly in rural and remote areas where it is difficult to arrange face-to-face consultations with specialists. A teleconsultant can reply with provisional and differential diagnoses and a course of action, typically within 24 hours and without time zone difference constraints. Patients report high satisfaction with teledermatology, citing improved privacy and comfort and reduced waiting times [6][6].

Another major use of teledermatology is allowing primary care providers to appropriately triage patients who may need a face-to-face appointment with a specialist dermatologist. Teledermatology and dermoscopy can be more effective than traditional paper referrals in getting high-priority patients seen quickly [7][6], while also reducing unnecessary referrals to dermatologists [8][9].

Some studies assessing skin cancer have shown that diagnostic accuracy using teledermatology is comparable to face-to-face consultations, while others put teledermatology’s accuracy somewhat lower [6][10]; however, as for face-to-face consultations, adding dermoscopic images to a telemedicine consultation improves diagnostic accuracy considerably [11]Diagnostic accuracy is also less dependent on the quality of the image than on the level of diagnostic difficulty of the lesion and the expertise of the observer [12][13].

Mobile Teledermoscopy[edit]

Mobile teledermoscopy involves using a magnifying lens with a polarised light that attaches to a mobile phone, allowing medical staff or patients to take dermoscopic-quality images with their smartphone. Images are then stored and forwarded to an expert dermatologist with an app. Mobile teledermoscopy may be particularly useful as an aid to skin self-examination for melanoma: such aids have been shown to improve the frequency and sensitivity of skin self-examinations [14][15].

Pilot study participants have reported that mobile teledermoscopy is easy to perform [16][17] and motivates them to monitor their skin more often [18]; however, barriers to effective use include having many pigmented lesions, not having a partner to assist in imaging lesions on hard-to-reach places, or inadequate education about which lesions require attention.



References

  1. Finnane et al.: The growth of a skin emergency teledermatology service from 2008 to 2014. Australas. J. Dermatol. 2016;57:14-8. PMID: 26559493. DOI.
  2. Vega et al.: Testing a top-down strategy for establishing a sustainable telemedicine program in a developing country: the Arizona telemedicine program-US Army-Republic of Panama Initiative. Telemed J E Health 2013;19:746-53. PMID: 23931731. DOI.
  3. Tensen et al.: Two Decades of Teledermatology: Current Status and Integration in National Healthcare Systems. Curr Dermatol Rep 2016;5:96-104. PMID: 27182461. DOI.
  4. Dahl: Briefing notes on maritime teledermatology. Int Marit Health 2014;65:61-4. PMID: 25231327. DOI.
  5. Hwang et al.: Utilization of telemedicine in the U.S. military in a deployed setting. Mil Med 2014;179:1347-53. PMID: 25373065. DOI.
  6. 6.06.16.26.3 Finnane et al.: Teledermatology for the Diagnosis and Management of Skin Cancer: A Systematic Review. JAMA Dermatol 2017;153:319-327. PMID: 27926766. DOI.
  7. Dahlén Gyllencreutz et al.: Diagnostic agreement and interobserver concordance with teledermoscopy referrals. J Eur Acad Dermatol Venereol 2017;31:898-903. PMID: 28150389. DOI.
  8. Eminović et al.: Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial. Arch Dermatol 2009;145:558-64. PMID: 19451500. DOI.
  9. van der Heijden et al.: Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. Br. J. Dermatol. 2011;165:1058-65. PMID: 21729026. DOI.
  10. Coates et al.: Teledermatology: from historical perspective to emerging techniques of the modern era: part II: Emerging technologies in teledermatology, limitations and future directions. J. Am. Acad. Dermatol. 2015;72:577-86; quiz 587-8. PMID: 25773408. DOI.
  11. Ferrándiz et al.: Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: A randomized teledermoscopy trial. J. Am. Acad. Dermatol. 2017;76:676-682. PMID: 28089728. DOI.
  12. Piccolo et al.: Teledermoscopy--results of a multicentre study on 43 pigmented skin lesions. J Telemed Telecare 2000;6:132-7. PMID: 10912329. DOI.
  13. Piccolo et al.: Face-to-face diagnosis vs telediagnosis of pigmented skin tumors: a teledermoscopic study. Arch Dermatol 1999;135:1467-71. PMID: 10606051.
  14. Aneja et al.: Improvement in Patient Performance of Skin Self-examinations After Intervention With Interactive Education and Telecommunication Reminders: A Randomized Controlled Study. Arch Dermatol 2012;148:1266-72. PMID: 22911048. DOI.
  15. Hamidi et al.: Efficacy of skin self-examination for the early detection of melanoma. Int. J. Dermatol. 2010;49:126-34. PMID: 20465635. DOI.
  16. Janda et al.: Enhanced skin self-examination: a novel approach to skin cancer monitoring and follow-up. JAMA Dermatol 2013;149:231-6. PMID: 23426490. DOI.
  17. Wu et al.: Feasibility and Efficacy of Patient-Initiated Mobile Teledermoscopy for Short-term Monitoring of Clinically Atypical Nevi. JAMA Dermatol 2015;151:489-96. PMID: 25629626. DOI.
  18. Horsham et al.: Consumer acceptance of patient-performed mobile teledermoscopy for the early detection of melanoma. Br. J. Dermatol. 2016;175:1301-1310. PMID: 27037999. DOI.