Remote telemedicine tool found highly accurate in diagnosing melanoma

According to the study authors, the findings add to evidence that such technology could help to reliably address diagnostic and treatment disparities for lower-income populations with limited access to dermatologists. It may also help dermatologists quickly catch cases of melanoma, a serious form of skin cancer that kills more than 8,000 Americans a year.

Their new system, which the researchers call SpotCheck, enables skin cancer specialists to remotely examine skin lesions using an established technique called dermoscopy, in which experts use a camera connected to a specialized magnifying lens to peer beneath the skin's surface.

While previous research has explored telemedicine options for speeding diagnoses of melanoma and compared in-person and remote evaluation of dermoscopy images, the authors say their work is among the first to target skin growths identified first by concerned patients rather than by primary care physicians. This is important, the research team says, because most cases of melanoma are initially spotted by patients or their friends and family.

Led by a team at NYU Langone Health and its Perlmutter Cancer Center, the new analysis used SpotCheck to evaluate dermoscopic images of 375 skin lesions from volunteers who were concerned that their skin blemishes might be cancerous. According to the results, which published online Nov. 9 in the Journal of the American Academy of Dermatology, dermoscopy experts who remotely reviewed all of the samples were 91% accurate in their diagnoses, based on later biopsies. Dermatologists who instead performed an evaluation of all of the volunteers in a doctor's office had an accuracy of 93%.

"Our findings suggest that this method of teledermoscopy may not only help healthcare providers catch potentially dangerous skin cancers early, it may also reduce expensive, anxiety-causing referrals to specialists for benign lesions," said study senior author David Polsky, MD, PhD.

According to the United States Centers for Disease Control and Prevention, melanoma is the most common form of cancer in the country and is notoriously difficult to treat after tumors spread throughout the body. Past studies have shown that the disease often goes undetected in people from lower-income neighborhoods, who may have difficulty finding dermatologists in their area or may struggle to take time off work to attend appointments.

For the research, the team administered questionnaires to 147 men and women who had responded to newspaper ads after identifying suspicious lesions on their skin. The surveys assessed personal and family history of skin cancer, melanoma risk factors, and the history of each worrisome skin spot, among other factors. Then, a general dermatologist performed a physical exam using the visual appearance of the blemishes and a dermatoscope to make a diagnosis, and if needed, performed a biopsy.

Next, the study coordinator captured clinical and dermoscopic images, which were sent to a central server for remote review by a separate team of skin cancer specialists with expertise using dermoscopy. They reviewed the questionnaires and images in order to make their own diagnoses. This group of dermatologists was not made aware of the results of the in-person evaluation. The researchers also conducted a phone survey one week after the patients' appointments to assess their satisfaction.

Among the findings, the study showed that overall, 97% of the evaluated lesions were later determined by biopsy to be benign. Notably, both the dermatologists who examined the participants in-person and those who instead relied on clinical photos and dermoscopy alone detected 11 out of the 13 cases of skin cancer, including two melanomas.

The results further revealed that nearly 90% of the patients were satisfied with the telemedicine experience, with one-fifth reporting that they preferred this method of exam over an in-person appointment with a specialist.

"A key advantage of teledermoscopy platforms is that community health workers can be trained to collect images and send them out for expert review," said Polsky, the Alfred W. Kopf, MD, Professor of Dermatologic Oncology at NYU Grossman School of Medicine. "As a result, this technology could be used in the future to offer virtual triage services in walk-in clinics, pharmacies, and community centers."

Polsky, also a professor in the Department of Pathology at NYU Grossman School of Medicine, adds that next, the research team plans to identify neighborhoods with higher rates of late-stage melanoma for possible SpotCheck deployment.

He cautions that the tool is meant to assess specific skin concerns and is not a substitute for a full-body check in a doctor's office. The participants in the study had to limit their lesions of concern to three.

Funding for the study was provided by the Melanoma Research Alliance, the Sergei S. Zlinkoff Fund for Medical Research and Education, and the Orbuch Brand Pilot Program for Diseases of the Skin.

In addition to Polsky, other NYU Langone investigators involved in the study are Shirin Bajaj, MD; Avani Kolla, MD; Vivienne Li, BA; Payal Shah, MD; Nicholas Gulati, MD, PhD; Maressa Criscito, MD; Yiping Xing, MD; Adriana Lopez, MD; Duy Tran, MD; Vignesh Ramachandran, MD; Efe Kakpovbia, MD; Shane Meehan, MD; Yongzhao Shao, PhD; Kristen Lo Sicco, MD; Emily Milam, MD; Amy Bieber, MD; Amanda Levine, MD; Tracey Liebman, MD; and Jennifer Stein, MD, PhD. Study lead author Jenne Ingrassia, BA, is now a physician resident at New York Medical College in Valhalla.