Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial
Summary: Background: Skin self-examinations supplemented with mobile teledermoscopy might improve early detection of skin cancers compared with naked-eye skin self-examinations. We aimed to assess whether mobile teledermoscopy-enhanced skin self-examination can improve sensitivity and specificity o...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-03-01
|
| Series: | The Lancet: Digital Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589750020300017 |
| _version_ | 1819113809897324544 |
|---|---|
| author | Monika Janda, ProfPhD Caitlin Horsham, MSc Dimitrios Vagenas, PhD Lois J Loescher, PhD Nicole Gillespie, ProfPhD Uyen Koh, PhD Clara Curiel-Lewandrowski, MD Rainer Hofmann-Wellenhof, ProfMD Allan Halpern, ProfMD David C Whiteman, ProfPhD Jennifer A Whitty, ProfPhD B Mark Smithers, ProfMD H Peter Soyer, ProfFACD |
| author_facet | Monika Janda, ProfPhD Caitlin Horsham, MSc Dimitrios Vagenas, PhD Lois J Loescher, PhD Nicole Gillespie, ProfPhD Uyen Koh, PhD Clara Curiel-Lewandrowski, MD Rainer Hofmann-Wellenhof, ProfMD Allan Halpern, ProfMD David C Whiteman, ProfPhD Jennifer A Whitty, ProfPhD B Mark Smithers, ProfMD H Peter Soyer, ProfFACD |
| author_sort | Monika Janda, ProfPhD |
| collection | DOAJ |
| description | Summary: Background: Skin self-examinations supplemented with mobile teledermoscopy might improve early detection of skin cancers compared with naked-eye skin self-examinations. We aimed to assess whether mobile teledermoscopy-enhanced skin self-examination can improve sensitivity and specificity of self-detection of skin cancers when compared with naked-eye skin self-examination. Methods: This randomised, controlled trial was done in Brisbane (QLD, Australia). Eligible participants (aged ≥18 years) had at least two skin cancer risk factors as self-reported in the eligibility survey and had to own or have access to an iPhone compatible with a dermatoscope attachment (iPhone versions 5–8). Participants were randomly assigned (1:1), via a computer-generated randomisation procedure, to the intervention group (mobile dermoscopy-enhanced self-skin examination) or the control group (naked-eye skin self-examination). Control group and intervention group participants received web-based instructions on how to complete a whole body skin self-examination. All participants completed skin examinations at baseline, 1 month, and 2 months; intervention group participants submitted photographs of suspicious lesions to a dermatologist for telediagnosis after each skin examination and control group participants noted lesions on a body chart that was sent to the research team after each skin examination. All participants had an in-person whole-body clinical skin examination within 3 months of their last skin self-examination. Primary outcomes were sensitivity and specificity of skin self-examination, patient selection of clinically atypical lesions suspicious for melanoma or keratinocyte skin cancers (body sites examined, number of lesions photographed, types of lesions, and lesions missed), and diagnostic concordance of telediagnosis versus in-person whole-body clinical skin examination diagnosis. All primary outcomes were analysed in the modified intention-to-treat population, which included all patients who had a clinical skin examination within 3 months of their last skin self-examination. This trial was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12616000989448. Findings: Between March 6, 2017, and June 7, 2018, 234 participants consented to enrol in the study, of whom 116 (50%) were assigned to the intervention group and 118 (50%) were assigned to the control group. 199 participants (98 participants in the intervention group and 101 participants in the control group) attended the clinical skin examination and thus were eligible for analyses. Participants in the intervention group submitted 615 lesions (median 6·0 per person; range 1–24) for telediagnosis and participants in the control group identified and recorded 673 lesions (median 6·0 per person; range 1–16). At the lesion level, sensitivity for lesions clinically suspicious for skin cancer was 75% (95% CI 63–84) in the intervention group and 88% (95% CI 80–91) in the control group (p=0·04). Specificity was 87% (95% CI 85–90) in the intervention group and 89% (95% CI 87–91) in the control group (p=0·42). At the individual level, the intervention group had a sensitivity of 87% (95% CI 76–99) compared with 97% (95% CI 91–100) in the control group (p=0·26), and a specificity of 95% (95% CI 90–100) compared with 96% (95% CI 91–100) in the control group. The overall diagnostic concordance between the telediagnosis and in-person clinical skin examination was 88%. Interpretation: The use of mobile teledermoscopy did not increase sensitivity for the detection of skin cancers compared with naked-eye skin self-examination; thus, further evidence is necessary for inclusion of skin self-examination technology for public health benefit. Funding: National Health and Medical Research Council (Australia). |
| first_indexed | 2024-12-22T04:35:19Z |
| format | Article |
| id | doaj.art-f63bdcd6d4aa4dceb5a957dcb8dc5c0e |
| institution | Directory Open Access Journal |
| issn | 2589-7500 |
| language | English |
| last_indexed | 2024-12-22T04:35:19Z |
| publishDate | 2020-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet: Digital Health |
| spelling | doaj.art-f63bdcd6d4aa4dceb5a957dcb8dc5c0e2022-12-21T18:38:55ZengElsevierThe Lancet: Digital Health2589-75002020-03-0123e129e137Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trialMonika Janda, ProfPhD0Caitlin Horsham, MSc1Dimitrios Vagenas, PhD2Lois J Loescher, PhD3Nicole Gillespie, ProfPhD4Uyen Koh, PhD5Clara Curiel-Lewandrowski, MD6Rainer Hofmann-Wellenhof, ProfMD7Allan Halpern, ProfMD8David C Whiteman, ProfPhD9Jennifer A Whitty, ProfPhD10B Mark Smithers, ProfMD11H Peter Soyer, ProfFACD12Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Correspondence to: Prof Monika Janda, Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4102, AustraliaCentre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, AustraliaSchool of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, AustraliaMel and Enid Zuckerman College of Public Health, Colleges of Nursing and Public Health, The University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, The University of Arizona, Tucson, AZ, USAUQ Business School, The University of Queensland, Brisbane, QLD, AustraliaCentre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, AustraliaUniversity of Arizona Cancer Center, The University of Arizona, Tucson, AZ, USADepartment of Dermatology, Medical University of Graz, Graz, AustriaMemorial Sloan Kettering Cancer Center, New York, NY, USAQIMR Berghofer Institute of Medical Research, Brisbane, QLD, AustraliaDepartment of Population Health, University of East Anglia, Norwich, UK; National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, Cambridge, UKQueensland Melanoma Project, The University of Queensland, Brisbane, QLD, AustraliaThe Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia; Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, AustraliaSummary: Background: Skin self-examinations supplemented with mobile teledermoscopy might improve early detection of skin cancers compared with naked-eye skin self-examinations. We aimed to assess whether mobile teledermoscopy-enhanced skin self-examination can improve sensitivity and specificity of self-detection of skin cancers when compared with naked-eye skin self-examination. Methods: This randomised, controlled trial was done in Brisbane (QLD, Australia). Eligible participants (aged ≥18 years) had at least two skin cancer risk factors as self-reported in the eligibility survey and had to own or have access to an iPhone compatible with a dermatoscope attachment (iPhone versions 5–8). Participants were randomly assigned (1:1), via a computer-generated randomisation procedure, to the intervention group (mobile dermoscopy-enhanced self-skin examination) or the control group (naked-eye skin self-examination). Control group and intervention group participants received web-based instructions on how to complete a whole body skin self-examination. All participants completed skin examinations at baseline, 1 month, and 2 months; intervention group participants submitted photographs of suspicious lesions to a dermatologist for telediagnosis after each skin examination and control group participants noted lesions on a body chart that was sent to the research team after each skin examination. All participants had an in-person whole-body clinical skin examination within 3 months of their last skin self-examination. Primary outcomes were sensitivity and specificity of skin self-examination, patient selection of clinically atypical lesions suspicious for melanoma or keratinocyte skin cancers (body sites examined, number of lesions photographed, types of lesions, and lesions missed), and diagnostic concordance of telediagnosis versus in-person whole-body clinical skin examination diagnosis. All primary outcomes were analysed in the modified intention-to-treat population, which included all patients who had a clinical skin examination within 3 months of their last skin self-examination. This trial was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12616000989448. Findings: Between March 6, 2017, and June 7, 2018, 234 participants consented to enrol in the study, of whom 116 (50%) were assigned to the intervention group and 118 (50%) were assigned to the control group. 199 participants (98 participants in the intervention group and 101 participants in the control group) attended the clinical skin examination and thus were eligible for analyses. Participants in the intervention group submitted 615 lesions (median 6·0 per person; range 1–24) for telediagnosis and participants in the control group identified and recorded 673 lesions (median 6·0 per person; range 1–16). At the lesion level, sensitivity for lesions clinically suspicious for skin cancer was 75% (95% CI 63–84) in the intervention group and 88% (95% CI 80–91) in the control group (p=0·04). Specificity was 87% (95% CI 85–90) in the intervention group and 89% (95% CI 87–91) in the control group (p=0·42). At the individual level, the intervention group had a sensitivity of 87% (95% CI 76–99) compared with 97% (95% CI 91–100) in the control group (p=0·26), and a specificity of 95% (95% CI 90–100) compared with 96% (95% CI 91–100) in the control group. The overall diagnostic concordance between the telediagnosis and in-person clinical skin examination was 88%. Interpretation: The use of mobile teledermoscopy did not increase sensitivity for the detection of skin cancers compared with naked-eye skin self-examination; thus, further evidence is necessary for inclusion of skin self-examination technology for public health benefit. Funding: National Health and Medical Research Council (Australia).http://www.sciencedirect.com/science/article/pii/S2589750020300017 |
| spellingShingle | Monika Janda, ProfPhD Caitlin Horsham, MSc Dimitrios Vagenas, PhD Lois J Loescher, PhD Nicole Gillespie, ProfPhD Uyen Koh, PhD Clara Curiel-Lewandrowski, MD Rainer Hofmann-Wellenhof, ProfMD Allan Halpern, ProfMD David C Whiteman, ProfPhD Jennifer A Whitty, ProfPhD B Mark Smithers, ProfMD H Peter Soyer, ProfFACD Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial The Lancet: Digital Health |
| title | Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial |
| title_full | Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial |
| title_fullStr | Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial |
| title_full_unstemmed | Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial |
| title_short | Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial |
| title_sort | accuracy of mobile digital teledermoscopy for skin self examinations in adults at high risk of skin cancer an open label randomised controlled trial |
| url | http://www.sciencedirect.com/science/article/pii/S2589750020300017 |
| work_keys_str_mv | AT monikajandaprofphd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT caitlinhorshammsc accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT dimitriosvagenasphd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT loisjloescherphd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT nicolegillespieprofphd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT uyenkohphd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT claracuriellewandrowskimd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT rainerhofmannwellenhofprofmd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT allanhalpernprofmd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT davidcwhitemanprofphd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT jenniferawhittyprofphd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT bmarksmithersprofmd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial AT hpetersoyerproffacd accuracyofmobiledigitalteledermoscopyforskinselfexaminationsinadultsathighriskofskincanceranopenlabelrandomisedcontrolledtrial |