Introduction: Teledermatology, defined as the use of remote imaging technologies to provide dermatologic healthcare services to individuals in a distant setting, has grown considerably in popularity since its widespread implementation during the COVID-19 pandemic. Teledermoscopy employs a smartphone dermatoscope attachment paired with a smartphone camera to visualize colors and microstructures within the epidermis and superficial dermis that cannot be seen with the naked eye ABCD criteria alone. Methods: Our retrospective observational cohort and case–control study evaluated the utility of loaning a smartphone dermatoscope attachment to patients for remote triage of self-selected lesions of concern for skin cancer. The primary outcome was the number (percentage) of in-person follow-up visits required for patients who submitted lesion images, either with or without accompanying dermoscopic images. A medical record review was conducted on all Oregon Health & Science University Department of Dermatology spot check image submissions utilizing the smartphone dermatoscopes between August 2020 and August 2022. De-identified dermoscopic images of lesions that included corresponding non-dermoscopic clinical images in their submission (n = 70) were independently reviewed by a blinded expert dermoscopist. The expert used standard clinical algorithms (ABCD criteria for clinical images; dermoscopy three-point checklist for dermoscopic images) to determine whether the imaged lesion should be converted to an in-person visit for further evaluation and consideration for biopsy. Results: Of the 70 lesions submitted with corresponding clinical and dermoscopy images, 60 met the criteria for in-person evaluation from clinical (non-dermoscopic) image review compared to 28 meeting the criteria for in-person evaluation from dermoscopic images of the same lesion. Thus, a 53% reduction in conversion to an in-person consultation with the addition of smartphone dermatoscope images in virtual lesion triage was observed (p< 0.001, McNemar’s Test). Conclusion: Implementing patient-led teledermoscopy may reduce the frequency of in-person visits for benign lesions and consequently improve access to in-person dermatology consultations for patients with concerning and possibly malignant lesions.
引言：远程皮肤病学，即利用远程成像技术为身处异地的个体提供皮肤科医疗服务，自COVID-19大流行期间广泛实施以来，其普及度显著提升。远程皮肤镜技术通过智能手机皮肤镜附件与手机摄像头结合，可观察表皮及真皮浅层的颜色和微观结构，这些特征仅凭肉眼ABCD标准无法识别。方法：本研究通过回顾性观察队列与病例对照设计，评估向患者出借智能手机皮肤镜附件用于远程筛查自选可疑皮肤癌皮损的效用。主要结局指标为提交皮损图像（无论是否包含皮肤镜图像）的患者需要线下复诊的次数（百分比）。研究回顾了2020年8月至2022年8月期间俄勒冈健康与科学大学皮肤科通过智能手机皮肤镜接收的所有即时检查图像数据。对提交同时包含临床图像与皮肤镜图像的70例皮损的匿名皮肤镜图像，由一位不知情的皮肤镜专家进行独立评估。专家采用标准临床算法（临床图像采用ABCD标准；皮肤镜图像采用三点检查表）判断图像中的皮损是否需要转为线下就诊以进行进一步评估和活检考量。结果：在提交临床与皮肤镜配对图像的70例皮损中，通过临床（非皮肤镜）图像评估有60例符合线下就诊标准，而通过同一皮损的皮肤镜图像评估仅有28例符合该标准。因此，在虚拟皮损分诊中增加智能手机皮肤镜图像可使转为线下会诊的比例降低53%（p<0.001，McNemar检验）。结论：实施患者主导的远程皮肤镜检查可减少良性皮损的线下就诊频率，从而为具有可疑或潜在恶性皮损的患者提供更多线下皮肤科会诊机会。
Revolutionizing Skin Cancer Triage: The Role of Patient-Initiated Teledermoscopy in Remote Diagnosis
肿瘤(癌症)患者之家