Mobile teledermoscopy-there's an app for that!

Abstract

Background: The introduction of the smartphone with high-quality, built-in digital cameras and easy-to-install software may make it more convenient to perform teledermatology. In this study we looked at the feasibility of using a smartphone (iPhone 4(®)) with an installed application especially developed for teledermatology (iDoc24(®)) and a dermoscope (FotoFinder Handyscope(®)) that is customized to attach to the smartphone to be able to carry out mobile teledermoscopy.

Objectives: To study the diagnostic accuracy of this mobile teledermoscopy solution, to determine the interobserver concordance between teledermoscopists (TDs) and a dermatologist meeting the patient face-to-face (FTF), and to assess the adequacy of the TDs' management decisions and to evaluate the image quality obtained.

Patients/methods: During a 16-week period, patients with one or more suspicious skin lesions deemed to need a biopsy or excision were included. The smartphone app was used to send a clinical image, a dermoscopy image and relevant clinical information to a secure Internet platform (Tele-Dermis(®)). Two TDs assessed the incoming cases, providing a specific primary diagnosis and a management decision. They also graded the image quality. The histopathological diagnosis was used as the gold standard.

Results: Sixty-nine lesions were included. The FTF dermatologist's diagnostic accuracy was 66.7%, which was statistically higher than TD 1 (50.7%, P=0.04) but similar to TD 2 (60.9%, P=0.52). The interobserver concordances between the FTF dermatologist and the two TDs and between the respective TDs showed moderate to substantial agreement. The TDs provided adequate management decisions for 68 (98.6%) and 69 (100%) lesions, respectively. The image quality was rated as excellent or sufficient in 94% and 84% of the cases by the respective TDs.

Conclusion: This novel mobile teledermoscopy solution may be useful as a triage tool for patients referred to dermatologists for suspicious skin lesions.

Keywords: malignant melanoma; mobile teledermoscopy; non-melanoma skin cancer; smartphone application; teledermatology.

Figure 1.

Technologic equipment used in the mobile teledermoscopy solution: (A) the smartphone (iPhone 4^®) with the iDoc24^® app showing on the display; (B) the dermoscope (Fotofinder Handyscope^®) with its six light-emitting diodes lit; (C) the dermoscope attached to the smartphone displaying a dermoscopic image of a reticular nevus; and (D) a dermatologist viewing a case on the Internet platform (Tele-Dermis^®). [Copyright: ©2013 Börve et al.]

Figure 2.

Image quality of four different lesions included in the study. Clinical and dermoscopic images of: (A,B) a spitzoid nodular melanoma; (C,D) a seborrheic keratosis (note: this was the only case in which both teledermoscopists rated the images as having poor quality); (E,F)) a basal cell carcinoma; and (G,H) a dysplastic nevus. [Copyright: ©2013 Börve et al.]