The British Journal of Dermatology recently released a paper¹ and editorial column² demonstrating the effectiveness of the MoleMap program ("MoleSafe” here in the US originated in New Zealand and Australia as "MoleMap”) compared to a face to face dermatology visit.

Note: This blog post may be a little more formal and "scholarly” than my usual posts. I thought it was important to convey this compelling information accurately and as objectively as possible, so I’ll be including longer sections of quotes from the BJD paper.

The study, hoped to determine if patients could be screened for melanomas and other skin cancers effectively with the use of a teledermatology system (which includes the use of epiluminescence microscopy and macrophotograhy and forwards results to dermatologists) as triage (screening and prioritization) by general practitioners and lesion diagnosis clinics when using proper screening equipment, compared to face-to-face examinations by dermatology specialists.

Conducted in New Zealand, this was particularly valuable to that location since NZ suffers from one of the "highest reported incidence of melanoma and nonmelanoma skin cancers in the world” ¹ while at the same time being challenged by an undersupply of dermatologists. In addition, some 15% of the population there lives more than an hour’s drive from a dermatologist. It’s not just essential to confirm the value of teledermatology in that country, but also in all places where "the technology could be used as a triage tool to reduce waiting lists and thus improve access to the public hospital lesion diagnosis clinic.”

As a matter of fact, this was reported in the British Journal of Dermatology because of the interest in determining if this would be a good solution in Great Britain where current U.K. National Institute for Health and Clinical Excellence (NICE) guidelines dictate that all suspected skin malignancy should be seen face to face, and the use of teledermatology for pigmented lesions remains controversial.

"However, the incorporation of high-quality teledermoscopic images in addition to macroscopic images may challenge this view.”²

Indeed, the researchers comment in their conclusion that:

Teledermoscopy offers considerable potential to reduce patient travel costs and waiting time, and thus to increase access to specialist care. …We hope to integrate this technology into the public health service as it is already in use in NZ and Australia within the private sector (MoleMap programme).¹

We read the results of this clinical study with great interest, and some pride, since our sister [parent?] company, MoleMap New Zealand, was selected to supply the quality equipment and trained technicians. That is significant is because lesser quality methods and equipment used in earlier studies to compare diagnoses done via face-to-face exams vs preliminary screenings with teledermoscopy led to lesser consensus:

The use of a melanographer skilled in digital and dermoscopic imaging ensured consistently high image quality. Earlier trials have been hampered by inconsistent digital images and often required the general practitioner to obtain the image. Image quality depends on training, experience and time, which may not be practical for a busy general practitioner.¹

This also supported of the value of including Dermoscopy, which is an essential component of any MoleSafe exam, over just macro-photography, as used by some physicians:

"Concordance of teledermoscopy to face-to-face diagnosis in this study was much higher than that reported in earlier trials. This in part reflected the greater specificity that Dermoscopy has over simple macro photography in the triage of lesions.”¹

How It Was Conducted:

First, the study set out to "assess the accuracy and reproducibility of teledermatology including dermoscopic images (teledermoscopy) compared with face-to-face assessments by dermatologists.” Some two hundred patients with a total of 491 lesions were seen by a dermatologist, and also screened with same methods used by the MoleMap/MoleSafe program with the results sent to the doctors for review.

All patients were seen face to face by two out of three dermatologists, and after a period of 4 weeks the same lesions were reviewed anonymously by two using a standardized history, macro digital images and corresponding dermoscopic images.²

The results were that there was excellent agreement between teledermoscopy and face-to-face diagnosis.

We have shown that 136 of 200 patients (constituting 74% of lesions) could have been spared a face-to-face consultation through using teledermoscopy as the preliminary assessment.¹

The agreement in assessment of more significant lesions was an even better 83% for both face-to-face and teledermoscopy. But what was particularly interesting is that the type of scanning and review done by MoleSafe — including histological examination of suspected malignant lesions — showed the teledermoscopic diagnosis to be more accurate than face-to-face diagnosis.

"This seemingly unlikely observation may relate to the ability to enlarge and contemplate images on a computer screen which is simply not possible during examination of the patient with a hand-held dermatoscope.”²

It’s also important to note that reproducing the study’s results are contingent on the training and experience of the dermatologist, both of whom in the trial were experienced in tele-dermatology and dermoscopy. And when done in conjunction with a whole-body exam, again, as we do at MoleSafe, and as done in a naked eye exam by your dermatologist, results should be even more significant:

"…this store-and-forward form of teledermoscopy provided only images of the lesions of concern and did not permit a whole-body examination. The use of a whole-body teledermoscopy service may overcome this limitation, and a recent analysis of 100 consecutive melanomas diagnosed by MoleMap NZ showed that 37% of patients were unaware of their melanoma.”¹

Here’s the takeaway…

In the future, general practitioners may be able to refer a patient with suspicious skin lesions to a ‘virtual lesion clinic’ for triage. Perhaps there will soon be mobile clinics since "the technology is portable, easy to operate and images can be transmitted via a virtual private network to the teledermoscopists – overcoming geographical barriers and delivering service to remote areas.”

What does this study add?

• Teledermoscopy approximated 100% sensitivity and 90% specificity for detecting melanoma and nonmelanoma skin cancers.

• Importantly, 74% of all lesions were determined to be manageable by the general practitioner without needing to be seen face-to-face by a dermatologist.

• This use of teledermoscopy as a triage tool offers the potential to shorten waiting lists and thus improve healthcare access and delivery.¹

Simply put, this is a clarion call for the value and effectiveness of the kinds of screenings that are conducted by MoleSafe and MoleMap and we are proud to be at the leading edge of skin cancer detection and awareness.

¹Source: British Journal of Dermatology, 12/09: "Successful triage of patients referred to a skin lesion clinic using teledermoscopy (IMAGE IT trial)” by E. Tan, A. Yung, M. Jameson,* A. Oakley and M. Rademaker  Journal Compilation ©2010 British Association of Dermatologists • British Journal of Dermatology 2010 162, pp803–811

²Commentary: British Journal of Dermatology – "Does teledermoscopy validate teledermatology for triage of skin lesions?” S. M. Halper 2010