Patient-led teledermatology for skin lesion triage: A service evaluation of the Dyplens Dermoscope.

Abstract

Despite the massive enhancement in smartphone-cameras, there has not been any real interest within the UK to pursue patient-facing teledermatology within the sphere of skin lesion triage. High-spec dermoscopic images can be generated with smart-phone attachments, but to date, no formal clinical trial has been performed to establish the efficacy and feasibility of these consumer-level dermoscopes in skin lesion triage. To assess the ability of patients to capture dermoscopic images using a smartphone-attachment To identify the safety and diagnostic accuracy of consumer-level dermoscopy in triaging-out benign skin lesions from the 2WW cancer pathway. We recruited 78 patients already attending a face-to-face clinic at two locations. They were provided with instruction leaflets and instructed to obtain a dermoscopic and macroscopic image of their lesion(s) using their own smartphones. The images (and a brief history) were distributed to 5 experienced blinded assessors (consultants), who were asked to state their working diagnosis and outcome (reassurance or routine review or 2WW pathway) as they would in teledermatology. We compared their outcomes to the gold standard in-person diagnosis and/or histological diagnosis where available. The device achieved 100% sensitivity in diagnosing melanomas and Squamous cell cancers (SCCs) The specificity for melanoma (89%) and SCC (83%) diagnosis were high The overall diagnostic accuracy was 76.6% for both benign and malignant lesions The diagnostic accuracy was high for seborrheic keratosis (91%) and simple naevi (81%). Patient-captured dermoscopic images (figure-3) using bespoke smartphone-attachments could be the future in triaging-out benign lesions safely.