Eye vs iPhone: no added value from digital teledermoscopy

Skin cancers

By Mardi Chapman

27 Feb 2020

A Queensland study has shown the use of mobile digital teledermoscopy does not increase the sensitivity of skin self-examination (SSE) compared to the naked-eye.

While advocates for the technology may be a little disappointed, the RCT of more than 200 adults with risk factors for skin cancer showed the sensitivity and specificity of skin cancer detection in both groups was still high.

The intervention group used a dermatoscope attachment for their iPhone to view and enlarge, photograph, store and forward images of suspicious lesions to a dermatologist for review.

The control group received web-based instructions for whole-body skin self-examination.

Both groups performed the skin self-examination at 1 and 2 months and were reviewed by a dermatologist at 3 months.

At a lesion-level analysis, the study found the sensitivity was 75% for the intervention group and 88% for the control group. Specificity was 87% and 89% respectively.

At an individual participant level analysis, the sensitivity was 87% versus 97% and specificity was 95% versus 96% respectively.

At the study end, dermatologists found 44 missed lesions on 36 participants with similar proportions in each patient group.

Participants in the intervention group more commonly missed basal cell carcinomas (44%) than did participants in the control group (21%).

“In contrast, one case of melanoma was missed by a participant in the control group, whereas no melanomas were missed by participants in the intervention group indicating that the provision of the asymmetry and colour rule via a mobile dermoscopy app was useful to guide intervention group participants towards photographing lesions suspicious of melanoma.”

The study concluded that current public health recommendations for regular skin self-examinations should be maintained.

Lead investigator Professor Monika Janda, from the Centre for Health Services Research at the University of Queensland, told the limbic they had expected that the sensitivity would be much better in people using the devices.

“Participants who used the device did a little less whole-body SSE so we think that maybe using the devices might have taken a bit more time,” she said.

“We were thinking if we had given them a bit longer to get used to it, that difference might have disappeared.”

“The other issue was we didn’t specifically train the partners [of participants] …and partners were more frequently used by the participants in the intervention group because obviously the photo-taking especially on the back requires a partner.”

Professor Janda said the study suggested that people in rural and regional areas would not be disadvantaged by mobile teledermoscopy if there was no other convenient option for them

“What we now know is that the technology works perfectly so people can take beautiful pictures and the dermatologists can feel very confident in looking at those pictures and deciding whether they [patients] need to come in or not.”

A Comment article in The Lancet Dermatology said the study was a welcome addition to the literature since little rigorous evidence exists to support claims for new technological approaches.

“Digital diagnostic aids represent a rapidly advancing research field that is of great interest to clinicians, patients, and the public.”

However, “…the results from this trial suggest that a cautious approach continues to be required when evaluating new technological approaches that aim to promote timely skin cancer detection, while improving patient safety and quality of care.”

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