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E-triage teledermatology may help ID skin cancer

Teledermatology might be a useful adjunct for patient care, according to Canadian dermatologist Dr. Joël Claveau, who is conducting a study aimed at assessing the impact of e-triage teledermatology for the early detection of skin cancer.

“Despite the warnings to consumers to protect their skin against sun damage and cancer, melanoma diagnoses are on the rise,” said Dr. Claveau, dermatologist at the Centre hospitalier universitaire de Québec, Hôtel-Dieu de Québec.

Even if there is concern about a suspicious mole and the patient is referred to a dermatologist, Dr. Claveau added that the wait time for an appointment with a dermatologist can be lengthy.

Role of e-triage teledermatology

“Our study is intended to show that by using teledermatology to evaluate and identify critical cases quickly, we can accelerate patient access to specialists,” said Dr. Claveau, who is also an associate professor at Laval University.

For the purpose of this study which got underway in Feb. 2016, Dr. Claveau said that about 20 family physicians were selected to participate. Each clinician involved in this investigation was asked to use an app on their iPhone or Android phone to submit photographs of suspicious lesions for evaluation prior to a scheduled appointment.

“So, instead of the physician sending in a fax referral, they are taking a photo of the lesion or lesions using a pocket-sized dermoscope that attaches to their smartphone. The photo of the lesion taken by the physician is then sent through the app to me to examine,” he said.

When Dr. Claveau receives a photo, he then evaluates it to determine the urgency of the appointment needed based on whether he thinks the mole is concerning.

“We refer to this process as e-triage, because it is like going to the emergency room. Not everyone has to be seen right away. It depends on the severity of the patient’s condition,” he said.

Dr. Claveau explained that the study at this point in time is preliminary and ongoing, however, to date he has noticed that roughly one out of 20 patients has skin cancer, and they need to be seen urgently.

“So instead of seeing patients who I think have suspicious lesions three months later their appointment to see me is expedited and their biopsy is accelerated,” he said. “In the case of melanoma, we know that delayed diagnosis can decrease the prognosis. I think teledermatology might be beneficial and help us to reserve time for more important cases.”

Teledermatology and funding

“In my opinion, I think teledermatology should be an adjunct for dermatologists because we want to be able to see the [patient in need of help] at the right time,” said Dr. Claveau. The downside of teledermatology is that it is not paid—it is “pro bono work,” says Dr. Claveau.

“Currently, in Quebec for example, teledermatology is not covered by medicare. The only way the cost of an appointment is covered is if the patient is seen through a video call, but that is not practical time-wise,” he noted. “It is a shame that teledermatology is not covered. Radiologists view a photo of a scan and that is paid for by medicare. I do not understand why dermatologists cannot be paid for their time through teledermatology.”

Dr. Claveau hopes that the findings from this investigation will provide proof that triage teledermatology is worthwhile and beneficial for patients.

“I really would like to prove to different government bodies that there is a place for teledermatology to help facilitate care for our patients,” he said. “I think triage teledermatology can help us see the right patient, at the right time. In the case of spotting skin cancer, timing is everything.”

The e-triage teledermatology study is sponsored by La Roche-Posay and led by Dr. Claveau.

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