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Skin Cancer detection: Dermatologists “101” win against Teledermatology

Skin Cancer detection is made by performing regular skin checks in at risk population as well as in the general population:
-Not only does Total Body Skin Examination (TBSE) allow the dermatologist to diagnose skin cancer, but also other systemic conditions.
-TBSE is also necessary as it allows examination of difficult to see areas (such as the back, buttocks)

Unfortunately, this is not always possible because of lack of skin doctors, especially in poorer countries and rural areas.

This retrospective study from Boston sought to compare Teledermatology (store-and forward method, read more HERE) with “face-to-face” consultations. The proportion of lesions requiring biopsies and incidence of detected non-melanoma and melanoma skin cancers were compared between the two groups:
-The former group consisted of 623 patients
-This was compared with 637 patients at Veterans Affairs (VA) Boston Healthcare System
-Age and History of skin cancer was factored in the statistical calculation of results (indeed “face-to-face” patients had a higher rate of history of skin cancer (23% vs 8%, p=0.001)

Results show that “face-to-face” dermatology consultations had higher overall detection rate of skin cancers than teledermatology consultations, 11% vs. 4%, p=0.001, even when adjusted for age and prior history of skin cancer (adjusted p value <0.01):
-Melanoma Incidence of detected was 0.6% vs. 0%, not statistically significant
-incidence of detected keratinocytic carcinoma (basal cell carcinoma and squamous cell carcinoma combined) was 10% vs. 3.9%, p <0.05 respectively. There were also two cases of cutaneous T-lymphoma in the face-to-face consultation cohort, and one case of Merkel cell carcinoma in the teledermatology cohort.

Conclusion and Comments
-There is no alternative to doing teledermatology especially in isolated geographical regions
-However when there is an alternative, the classical “face-to-face” consultation is still the best:
1. once again as shown in this study for the detection of skin cancer
2…but also with regards to building a trusting relationship with the physician

Remarks
-It would be interesting to see the yield of physical examination (“face-to-face”) in rural areas, where dermatologists are few. Depending on the results, physicians could be trained on skin cancer detection.
-The differences were statistically significant as they took into account age and previous history of skin cancer. -However to begin with…there are differences between the 2 studied groups with regard to history of skin cancer (3 times higher in the “face-to-face group”. Even if the differences are statistically significant, a prospective study will need to provide a definite answer.

 

 

Reference: Poser 3037  – Nguyen BCM – Skin cancer detection through tele dermatology vs. face-to-face dermatology consultation. AAD Annual Meeting 2016, Washington DC, USA (United States of America)