Alexander Börve*, Medical Doctor, Gothenburg, Sweden Track: Research Presentation Topic: other Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2012-09-10

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All skin cancer can be cured if discovered early. Nevertheless, skin cancer can be difficult to diagnose without a dermoscope and a trained dermatologist. In Sweden, 80% of doctors have a smartphone. Physicians have started to realize that these smartphones can be used as medical tools. Third party smartphone “add ons” and apps have made it possible to ask a specialist through smartphone communication. We looked at the possibility of using the built-in digital camera in a smartphone, a customized dermoscope and a smartphone application to carry out teledermoscopic evaluations of suspicious skin lesions. In this study, we included 69 skin lesions (melanocytic and non-melanocytic) that were going to be excised or biopsied in order to exclude malignancy. The lesions were first evaluated clinically and with dermoscopy by a dermatologist during a face-to-face visit. Before performing the biopsy or excision, clinical and dermoscopic digital photographs were taken with the smartphone’s built-in camera and a dermoscope that could be fitted directly onto the smartphone. The suspected diagnosis and a management decision was provided by this dermatologist and later compared to the histopathological report. Furthermore, the level of diagnostic difficulty and the image quality was assessed. Later, two experienced dermoscopists independently reviewed the clinical and dermoscopic photographs and were provided with relevant clinical information about the lesions, which was all sent through the smartphone app. They were asked to provide the same parameters as mentioned above. The diagnostic accuracy of the dermatologist meeting the patient face-to-face was comparable to that of the two teledermoscopists. Adequate management decisions were also provided by one teledermoscopist for all 69 lesions and for 68 out of 69 lesions (98.6%) by the other teledermoscopist. Interestingly, the level of diagnostic difficulty of the cases was deemed to be high by the teledermoscopists in 61% and 87% of the cases respectively as compared to 54% of the cases when scored by the dermatologist who saw the patients face-to-face. This could possibly be explained by a certain degree of diagnostic insecurity when not being able to meet the patient in real life. Similarly, the image quality was rated as excellent or sufficient in all cases by the dermatologist who took the photographs, but in 84% and 94% of the lesions by the respective teledermoscopists. Nevertheless, the use of photographs of skin lesions suspicious of skin cancer acquired with a smartphone camera and a customized dermoscope, and then sent to dermatologists through a smartphone app for teledermoscopic evaluation, seems feasible due to the comparable diagnostic accuracy provided despite the diagnostic difficulty of the cases. Nevertheless, one should always be aware of the possibility of incorrect management decisions.