Skin cancer is one of the most prevalent forms of cancer in the world, with 16,221 cases being diagnosed annually in Australia alone. The highest risk factor for skin cancer is chronic exposure to UV rays that can cause mutations in DNA and mitochondrial genes. It is further divided into three types; Basal cell, Squamous cell, and melanoma. Of the three, melanoma is the deadliest, as it is responsible for a large proportion of skin cancer-related deaths despite accounting for only 2% of all cancers.
According to the Cancer Council, approximately 2 out of 3 Australians are diagnosed with skin cancer before they turn 70. Recent developments made in the field of skin cancer research have made early diagnosis much easier. Diagnosis of Skin Cancer for any skin pathology involves an initial suspicion for skin cancer due to positive family history and physical examination, after which, definitive diagnosis is made via skin biopsy and histopathological examination.
When a new patient visits a dermatologist for a skin lesion, the dermatologist’s initial step is to examine the lesion with his naked eye. To this end, a device called a dermoscope was designed that facilitates the diagnosis of skin lesions via usage of a magnifying glass and a light source to enhance the visualization of skin lesions in an outpatient setting.
More recently, there has been growing interest in the efficacy of mobile applications that combine the photographic and telecommunication features of a mobile with a magnifying glass to examine skin lesions.
Because it involves the use of telecommunication devices, the device could enable doctors’ to provide consultations to patients living in rural areas eliminating the need for patients living in remote areas to travel long distances for dermatological consultation. But as applications such as these tend to often result in incorrect self-diagnosis by patients, doctors are not quite convinced regarding the benefits of this tool.
Some researchers who were quite intrigued about the potential clinical applications of teledermatology have recently conducted a study that examines the accuracy of mobile digital teledermoscopy for skin self-examinations.
A randomized, controlled trial done in Brisbane, Australia studied 234 participants who were divided into two groups, the control group, and the interventional group. The participants of the interventional group were provided with iPhone compatible dermatoscopes for conducting self-examinations. Both groups were then asked to perform self-examinations, the controlled group with the naked eye and interventional group with their provided dermatoscopes. Researchers found no significant benefit of either methodology over the other. In fact, the differences in the number of diagnoses between the groups were almost negligible.
The findings of the study revealed no added benefit with the use of teledermoscopy devices for self-examination by patients. The applications were instead found to have both lower sensitivity and specificity in diagnosing skin cancer when compared to naked eye examinations by a dermatologist.
In an online survey performed amongst dermatologists in Australia, researchers found that most medical personnel were open to using dermatoscopy in their practices. They even found it helpful, especially for lesion monitoring. However, they were not very keen on the concept of patients diagnosing themselves with self-assessment tools such as teledermoscopy. The reason for their concern was mainly due to the high risk of a patient discarding malignant skin lesions as being simply benign after self-examination. This can lead to cancer progression and untimely diagnosis of skin cancer when it is at an advanced stage, during which treatment efficacy can be extremely poor.
Although self-examination of skin lesions is still highly recommended by dermatologists, they do not recommend the use of teledermoscopy by patients for diagnosing skin lesions. The scope of self-examination using either a patient’s naked eye or tools such as teledermoscopy should be limited only to the identification of any suspicious skin lesions. Once a suspicious lesion is identified, it should always be followed by a consultation with a dermatologist to rule out skin cancer.
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Monika Janda, Caitlin Horsham, Dimitrios Vagenas, Lois J Loescher, Nicole Gillespie, Uyen Koh, Clara Curiel-Lewandrowski, Rainer Hofmann-Wellenhof, Allan Halpern, David C Whiteman, Jennifer A Whitty, B Mark Smithers, H Peter Soyer, Accuracy of mobile digital teledermoscopy for skin self examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial, The Lancet Digital Health, Volume 2, Issue 3, 2020, Pages e129-e137, ISSN 2589-7500.