Development of a teledermatology system for the melanoma diagnosis. The pilot experience of the project Clicca il neo

Abstract

Cutaneous melanoma is a significant cause of mortality, and since the skin is easily accessible for inspection, it is amenable to interventions of education and promotion of early diagnosis through the use of telemedicine systems. Clicca il neo is a programme for the early diagnosis of skin cancer employing tools of teledermatology with a store-and-forward modality. The system uses a web form for data collection and upload of skin photographs taken by users. The target geographic area in which the pilot phase of the project was conduced has been the province of Bergamo (1,100,000 inhabitants according to data from ISTAT 2011) with an incidence of melanoma of approximately 14 cases per 100,000 inhabitants per year. Two main result indicators were adopted: 1) the proportion of assessable images over the total (expected threshold more than 75%); 2) the identification during the study period of at least one melanoma. Between July 1, 2015 and December 31, 2015, a total of 302 images of skin lesions were sent to the system -Clicca il neo, by people resident in the province of Bergamo. Of the images sent, 256 (84.7%) were of sufficient quality for evaluation, and of these, 11 (4.3%) were considered as images of highly suspicious lesions, 4 (1.6%) of a suspected squamous cell carcinoma and 6 (2.3%) of a suspected melanoma. Two of the 4 suspected squamous cell carcinomas and 3 of the 6 suspected melanomas received a diagnostic confirmation after surgical excision and histological examination. Remarkably, the excised melanomas were in 2 cases thin melanomas (thickness less than 1 mm) and, in 1 case, a melanoma in situ. This pilot project demonstrates the technical feasibility and potential utility of a teledermatology system to promote early detection of skin cancers. Several aspects remain to define including accessibility, reliability, and preventive effectiveness in reducing melanoma mortality and morbidity by early diagnosis.