The Remote Assessment of Melanocytic Skin Lesions: A Viable Alternative to Face-to-Face Consultation

Abstract

Background: The incidence of melanoma continues to rise in the Western world, prompting health care professionals to search for novel tools that may increase rates of early detection. Here we focus on one such tool: remote specialist diagnosis of melanocytic lesions utilising mobile-phone camera patient-generated clinical images. Objective: We aim to test the hypothesis that patient-generated clinical images utilising mobile phones are of acceptable quality, and that digital image diagnostic outcomes are comparable with face-to-face (FTF) diagnostic outcomes. Methods: Study participants were asked to photograph, using their mobile-phone camera any number of their own melanocytic naevi, and then upload these clinical images to a central server. Diagnostic accuracy of the management decision based on assessing these digital images was tested by comparing results from digital image assessment with results from FTF assessments. Results: We provide evidence that suggests potential patients are capable of uploading good quality clinical images of melanocytic lesions for diagnostic purposes, and we show that good concordance rates can be achieved with respect to digital image and FTF diagnostic outcomes. With respect to the latter, exact agreement was found in 116 of 167 assessable lesions (69%). Conclusions: This work suggests that specialist remote diagnosis of patient-generated clinical images of melanocytic lesions utilising mobile-phone cameras may be a viable alternative to traditional FTF assessments.

Engagement, Empowerment and Patient Generated Health Data

“…After taking images of the condition on a mobile phone when the rash appeared on a shopping trip, the patient presented the evidence to her physician and she was diagnosed as having a typical urticarial rash (Armstrong, 2004). Photographs taken on smart phones have helped the diagnosis of medication-related skin conditions (Hartgers & Jatoi, 2010), the management of psoriasis (Frühauf, et al, 2012) and the surveillance of skin lesions for melanoma (Boyce, Gilmore, Xu, & Soyer, 2011). These results show that the data does indeed improve physiological health outcomes, yet the inclusion of this data is not healthcare process and is not automatic in healthcare services.…”

“…Collection and use of patient generated health data in clinical care is a theme demonstrated in the literature with patients willing to collect the data in some circumstances (Boyce, et al, 2011). However, there are also inhibitors to data collection and use which are heterogeneous to individual healthcare consumers.…”

“…Hence this research will address that gap utilising healthcare consumer photographs taken over time for use in both treatment modalities. In an era where shrinking health budgets are promoting the radical rethinking of medicine to emphasise wellness promotion over disease management, the ancillary finding by Boyce et al (2011) that patient generated health data could lead to improved awareness of a health condition and recognition of health related behaviours is important. Increases in quality of life and empowerment, coupled with real evidence that patient generated health data saves patients' time and money (Frühauf, et al, 2012) is a strong motivator for the research of patient generated health data and its effects on patient engagement.…”

“…Whilst these situational influences are important in shopping experiences where self-service technology are used to replace the service interaction, they are not relevant in the case of the collection of patient generated health data. In the study by Boyce, et al (2011) 52% of patients asked a member of their peer network to take images of melanocytic lesions.…”

“…More specifically, the literature highlights that clinicians use the data for diagnosis and management (Boyce, et al, 2011), enhanced clinician-patient collaboration (Pourdanesh, et al, 2012) unintended consequences like agenda setting (Nundy, et al, 2014a) and this impacts on service delivery time and costs (Frühauf, et al, 2012). The services marketing literature discusses patient data sharing outside clinical care in self-diagnosis (Robertson, et al, 2014) and co-creating service design (Elg, Engström, Witell, & Poksinska, 2012) …”