Teledermatology has drawn interest in the dermatologic community, because it allows for earlier detection of skin cancer in patients with poor access to health care. Using a combination of dermoscopy and digital photography, teledermatology has demonstrated acceptable concordance with face-to-face clinical diagnoses in multiple settings for pigmented skin lesions. Additional studies on using teledermatology to assess nonpigmented skin lesions are needed. Future advances in mobile teledermatology may help make this technology more widespread and affordable. Although teledermatology is not a replacement for regular total body skin examinations, it is a useful tool to significantly reduce the burden of dermatologic malignancies.
Key points
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Access to dermatologists for skin cancer screening is a growing problem.
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Teledermatology offers immediate skin cancer screening by transmitting medical information to a dermatologist for remote evaluation.
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Teledermatology has acceptable accuracy compared with a face-to-face clinical examination in diagnosing skin cancer and is a useful alternative for patients with poor access to health care.
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Addition of dermoscopy and/or reflectance confocal microscopy to a teledermatology consultation can help improve the diagnostic accuracy.
Skin cancer accounts for significant morbidity and mortality, and it is estimated that the value of life lost to society from melanoma ranges from $8 billion per year to $15 billion per year. Early detection and treatment of these skin cancers could reduce the morbidity and mortality. The average wait time to see a dermatologist is 33.9 days. This problem of access to a specialist could be partially resolved by using teledermatology. Teledermatology uses telecommunications to transmit medical information to a dermatologist for remote evaluation. Medical information may consist of clinical history, macroscopic photos, and/or dermoscopic images of skin lesions for remote evaluation. Teledermatology has drawn interest in the dermatologic community, because it allows for immediate and near comprehensive skin cancer screening for patients with poor access to health care.
The primary types of consultation using teledermatology include (1) synchronous, live interactive or (2) asynchronous, store-and-forward ( Table 1 ). Live interactive consultation means that the patient and physician are able to interact with each other in real time. Store-and-forward consultation occurs when the patient’s medical information is stored and then reviewed at a later time by a medical provider at a remote location ( Box 1 ). Combining both live interactive and store-and-forward is called a hybrid consultation. The most common and successful type of consultation in teledermatology is store-and-forward. Consultations are generated either by a patient (direct to patient) or by another health care provider (consultative model). The latter is the most common and successful model, but consultations generated by patients are gaining popularity.
| Category | Live Interactive | Store-and-Forward |
|---|---|---|
| Description | Videoconferencing technology used for realtime interaction between patient and physician | Images and histories forwarded on to a consulting dermatologist |
| Physician-Patient Interaction | Allows for immediate advice and for the patient to ask questions | No interaction between patient and physician |
| Cost | Can be expensive due to videoconferencing technology | Relatively inexpensive |
| Convenience | Requires patient and physician to be available at same time | No need for coordinating scheduled visits; useful for patients with poor access to health care |
| Reimbursement | Yes | No |
| Internet speed | Highly dependent | Not dependent |
| Image quality | Lesser than still images | Superior images |
Step 1: obtain a forest view, a close up view followed by a macroscopic image of the lesion a
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Step 2: wipe the lesion with an alcohol pad prior to taking dermoscopy images
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Step 3 b : for cameras with only polarized dermoscope attachments (most commonly used): 2 modes
Noncontact mode – microscopic images taken less than 2 inches from the skin.
Contact mode – images taken while touching the skin.
For cameras with nonpolarized dermoscopy attachments: ultrasound gel or alcohol gel should be applied to reduce reflection from the skin surface; image should be taken while touching the skin.
a Please refer to ATA guidelines for instructions for taking these images: .
b Newer photo-dermoscopy kits have both polarized and nonpolarized modes, which can be switched back and forth at the press of a button.
Digital photography is often used in a teledermatology consultation to replace visualization and touch. The addition of dermoscopic images enhances the quality of the consultation. It also renders a high degree of confidence and accuracy in making a diagnosis, especially for a skin lesion. Dermoscopy, also known as dermatoscopy or epiluminescence microscopy, allows for noninvasive microscopic evaluation of skin lesions with a magnifying lens-like device. The images can then be digitized and transmitted electronically, which is known as teledermoscopy. This combination of digital photography and dermoscopy has the potential to improve skin cancer outcomes through early detection and management.
How to perform a store-and-forward consultation for a skin lesion with dermoscopy
Standard guidelines for performing a teledermatology store-and-forward consultation from the American Telemedicine Association are detailed by McKoy and colleagues and can be obtained on the American Telemedicine Association Web site. Although there are no established standard practice guidelines for obtaining dermoscopy images, the authors recommend that a forest view followed by a close-up view and a macroscopic image of the lesion should be obtained in that order. The lesion is then to be wiped with an alcohol pad prior to taking dermoscopy images. For cameras with only polarized dermoscope attachments (most commonly used), microscopic images must be taken less than 2 inches from the skin (noncontact), followed by images taken while touching the skin (contact). For nonpolarized images, ultrasound gel or alcohol gel should be applied prior to contact with the lesion; this liquid interface reduces the reflection from the skin surface. Newer photo-dermoscopy kits have both polarized and nonpolarized modes that can be switched back and forth at the press of a button.
How to perform a store-and-forward consultation for a skin lesion with dermoscopy
Standard guidelines for performing a teledermatology store-and-forward consultation from the American Telemedicine Association are detailed by McKoy and colleagues and can be obtained on the American Telemedicine Association Web site. Although there are no established standard practice guidelines for obtaining dermoscopy images, the authors recommend that a forest view followed by a close-up view and a macroscopic image of the lesion should be obtained in that order. The lesion is then to be wiped with an alcohol pad prior to taking dermoscopy images. For cameras with only polarized dermoscope attachments (most commonly used), microscopic images must be taken less than 2 inches from the skin (noncontact), followed by images taken while touching the skin (contact). For nonpolarized images, ultrasound gel or alcohol gel should be applied prior to contact with the lesion; this liquid interface reduces the reflection from the skin surface. Newer photo-dermoscopy kits have both polarized and nonpolarized modes that can be switched back and forth at the press of a button.
Related posts:
Clinical Diagnosis of Skin Cancer
Enhancing Skin Cancer Diagnosis with Dermoscopy
Electrical Impedance Spectroscopy in Skin Cancer Diagnosis
Using Raman Spectroscopy to Detect and Diagnose Skin Cancer In Vivo
Assessing Genetic Expression Profiles in Melanoma Prognosis
Smartphone-Based Applications for Skin Monitoring and Melanoma Detection
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