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LK 120
Mobile teledermoscopy for faster and better prioritization of patients with suspected malignant skin tumours
LK 120
Mobile teledermoscopy for faster and better prioritization of patients with suspected malignant skin tumours
CEO & Founder iDoc24
BackgroundPatients with suspicious skin lesions usually see a general practitioner (GP) first. When the GP cannot exclude malignancy, the patient is generally referred to a dermatologist for evaluation... Read more

Description

Background
Patients with suspicious skin lesions usually see a general practitioner (GP) first. When the GP cannot exclude malignancy, the patient is generally referred to a dermatologist for evaluation with the naked eye and a special magnifying glass called a dermoscope to make a definitive diagnosis. During 2012 a study sponsored by the Swedish Association of Local Authorities and Regions using a teledermoscopy (TD) pathway between 20 primary healthcare centers and two Dermatology departments was carried out.

Methods
The GPs used the built-in camera in a regular smartphone (iPhone 4) coupled with a customized dermoscope (Handyscope, FotoFinder Systems GmbH), to send 900 digital referrals with clinical and dermoscopic images directly to the Dermatology department that the GPs were affiliated with, through a specially developed IT-application in the smartphone (iDoc24). Within 24 hours, an assessing dermatologist sent a response directly to the GP’s smartphone including a preliminary diagnosis, information on which priority the patient would be given to see a dermatologist and whether surgical treatment would be necessary or not. The outcome in terms of waiting time, number of visits and diagnostic feedback was compared with that of a control group of the same size referred via the traditional paper referral pathway.

Results
In total, 900 TD and 900 control patients have been included in the study. At the time of writing we have data on 344 patients referred by TD and 298 patients referred by traditional paper referral. A total of 122 GPs from 20 participating primary health care centres have used the TD solution. 98% of the referrals were assessed and responded to within 24 hours. By the end of July, we will have the final data ready for analysis, but preliminary results show that 80-90% of patients with melanoma or melanoma in situ and 65% of patients with squamous cell carcinoma could receive surgery on their first visit as compared to 25% and 10%, respectively, in the control group. This also saves valuable time since patients with these diagnoses receive necessary surgical care within approximately 9-14 days instead of 28-41 days. In addition, patients with benign lesions could receive reassurance within 24-48 hours instead of having to wait several months for their visit to a dermatologist.

Conclusion
Teledermoscopy can offer a preliminary diagnosis and information on the planned possible treatment within 24-48 hours to the GP and patient. It has the potential to substitute traditional paper referrals. The new pathway shortens waiting times for surgical treatment for patients with various forms of skin cancer.

Alexander Börve, MD is an orthopaedic spine surgeon from the Sahlgrenska University Hospital in Gothenburg, Sweden. He originally developed the iDoc24 platform in 2009 to allow paramedics to send images of accident-scene victims with their mobile phones directly to the ER doctors, and has since pivoted the platform into the dermatology space.“iDoc24 – Skin information in any device 24/7” has won numerous prizes as a tele-health service, as well as for the fundamental research Alexander has on-going in the field of digital health, which is part of his PhD thesis. Preliminary results from his latest research show a reduced “time-to-surgery” for malignant melanoma (deadly form of skin cancer) from 46 days to 14 days (on average). Alexander is also an advisor to Health 2.0 Europe and the chapter leader of Health 2.0 Stockholm. He is currently a visiting fellow in tele-medicine at UC Berkeley. And lastly he created the STD triage app!

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