Teledermatology / teledermoscopy and Firstcheck – a medical overview
This material on this page is primarily intended for health practitioners and health providers (such as general practitioners (GPs), non-dermatologic physicians, practice nurses, pharmacists and other healthcare professionals). The notes are designed for health professionals to use, so you may find the language more technical than on the rest of the website.
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1. What is teledermatology?
Teledermatology is the ability to take an image of a skin lesion and send the digital image, securely, to a dermatologist or skin specialist to triage, diagnose or advise on a suitable condition management plan.
In other words, it is a remote or virtual skin doctor consultation.
It is part of the broader field of medicine referred to as e-health, virtual health care and telemedicine. (Teledermatology can also include reference to consultations via ‘video’ communication, but this is not the form of teledermatology (‘store and forward’) referred to here).
As our colleagues at UC Davis School of Medicine put it, “Teledermatology is the use of communication technology to connect patients with [doctors] to improve skin health”.
Telemedicine is well suited to skin conditions, and teledermatology is used around the world to improve access to health care and to improve health outcomes.
There are numerous studies which support the use of:
- the use of consumer teledermatology (where consumers consult with doctors directly), and
- the economics of teledermatology
A few of which will be referred to in the material which follows, but a wealth of further evidence exists beyond this.
“Good teledermatology is not about technology and it’s not about money. It is about providing our patients with good medicine, whether it is in our office or using technology [or both!]. Technology-based medicine is going to happen…” (Dr. Kovarik, “Quality teledermatology is part of the future for dermatology“)
Teledermoscopy or teledermatoscopy is where dermoscopic images (highly magnified images) are also provided to the specialist.
2. What are the benefits of teledermatology for primary health care practitioners?
Teledermatology provides primary health care professionals with effective collegial support from dermatologists and skin cancer doctors – for improved certainty in patient triage, diagnosis and management plans.
To triage and direct patients to the most appropriate service in a timely fashion. It assists with prioritising of urgent or ‘above-average risk’ cases.
“Teledermatology referrals that use a smartphone with an attached dermoscope allowed dermatologists to manage their patients faster and more efficiently than by traditional paper referrals.[The study] found that when physicians [the patient’s primary care doctor] referred patients [this way], patients who needed surgery had significantly shorter wait times, triage decisions were more reliable, the time needed to diagnose and treat skin cancer was reduced, and more patients from this group were treated on their first visit to the dermatologist.” (“Smartphone Teledermoscopy Referrals: A Novel Process for Improved Triage of Skin Cancer Patients.” and also reported by Aditi Pai, here).
The Ministry of Health’s Dermatology Workforce Service Forecast also found that, “In New Zealand, a Clinical Research Seminar ‘Improving access and grading evaluations using in-depth teledermatology: image it trial’ made several relevant findings including that there was excellent concordance between face-to-face and teledermatology diagnosis for all lesions and that teledermatology can be used as a triage tool to improve healthcare access and delivery.”
For example, in cases where you are uncertain about diagnosis. “Physicians who need expert opinion can ask for it, sending images…about patients’ lesions for which they do not feel comfortable.” (“Dermoscopy: Distinguishing Malignant Tumors from Benign“).
For management plan advice:
Whereby “an expert dermoscopist…analyzes the lesions and draws up a report with diagnosis and recommendations.” (“Dermoscopy: Distinguishing Malignant Tumors from Benign“) Teledermatology facilitates management of a greater number of conditions at primary care level, with specialist support. In the majority of cases once the specialist report is received the case can be returned to the primary care practitioner, together with a suitable management plan.
For professional development:
Because “physicians who desire to learn dermoscopy or improve their level of dermoscopic expertise can easily access expert [assistance].” (“Dermoscopy: Distinguishing Malignant Tumors from Benign“)
For alignment with Ministry of Health strategy
One of the strategic themes underpinning the Ministry of Health strategy is the concept of “one team” – whereby measures to enhance “working together; designing and delivering services and support in a coordinated way” are to be encouraged. Teledermatology assists with this “one team” approach.
The Ministry acknowledges “A strong primary health care system is central to improving the health of all New Zealanders”. Teledermatology can support primary health care practitioners to improve patient outcomes in skin health.
3. What are the benefits of teledermatology for patients?
Teledermatology enhances patient outcomes and quality of care
The outcome of such a review will, more often than not, be confirmation the lesion is benign (that is, the exclusion of a skin cancer) and will therefore save a visit or referral to a skin specialist or dermatologist.
A recent article by The Listener referred to Dr Amanda Oakley’s findings. “Dr Amanda Oakley, a Waikato dermatologist and honorary associate professor at the University of Auckland, [supports] GPs to send photographs of suspicious-looking moles for assessment by specialist dermatologists. In about 75% of cases, she says, the lesions are benign. And a diagnosis can be made on photographs alone 95% of the time.”
Dr Amanda Oakley also noted (in “GP Liaison“) that “Smart phones and iPads actually performed better than SLR cameras, as long as a quality dermatoscope was attached.”
Teledermatology provides patients with a specialist opinion within hours
It is rare for a patient to be able to see a skin specialist within hours. With effective teledermatology platforms, patients can receive an expert specialist report within hours –
- at the time of flare-up (in the case of general skin disease)
- at the time of concern (in the case of possible skin cancer, where early detection saves lives).
Longer wait times for results have been linked with increased anxiety for patients. Timely responses further mitigate against this.
Teledermatology saves patients time, money and is environmentally friendly
Teledermatology reduces travel time to attend unnecessary in-patient appointments with specialists, which saves both time and money for the patient.
For example, in a UC Davis study, patients avoided “travel distances that totalled more than 5 million miles [to see a specialist in person]. Those patients also saved nearly nine years of travel time and about $3 million in travel costs.”
By reducing unnecessary travel there is also reduction of travel-related environmental impact. The study also calculated the amount of greenhouse emissions that were likely avoided by reduced miles driven. “Overall environmental impacts were calculated to be nearly 2,000 metric tons of carbon dioxide, 50 metric tons of carbon monoxide, 3.7 metric tons of nitrogen oxides and 5.5 metric tons of volatile organic compounds.”
In a New Zealand study “Patients seen by teledermatology at their own health centre travelled an average of 12 km, whereas those who attended a conventional clinic travelled an average of 271 km. The telemedicine group spent an average of 51 [minutes] attending the appointment compared with 4.3 [hours] for those seen at the hospital.”
Furthermore, time and money are two of the reported barriers to patients getting skin checks currently. “Many patients do not have the time or resources to access health care many miles from home.” (James Marcin, chief of the UC Davis Division of Pediatric Critical Care Medicine)
One of the Ministry of Health’s strategic health themes focuses on “Closer to home”, in other words “making it easier for people to access health services and, working with local communities to provide tailored support on the ground”. Teledermatology makes this a reality.
Teledermatology reaches patients who are not currently receiving skin check advice
Teledermatology of lesions is a perfect complement to full body in-person skin examinations.
Only a small percentage of the population are getting annual full body skin checks (New Zealand surveys suggest less than 5%). 90% of people currently having full body skin checks with a certain provider in New Zealand are the “worried well” – and not those at elevated risk of skin cancer. So many of those who are at the highest risk of skin cancer are not getting the timely specialist advice they need.
In the US “approximately 77% of all melanomas and 88% of lethal melanomas are detected by patients or their family members rather than physicians, and more than 75% of the U.S. population has never undergone a clinician-performed skin examination.” (“Smartphone’ diagnosis of melanoma”)
Teledermatology empowers the majority of the population who are not currently getting the appropriate checks to do so, by helping to remove the barriers to getting checked – allowing them to get lesions of suspicion checked as and when they notice them.
“Because telemedicine is cheaper and more convenient for patients…they are more likely to seek medical care.” (James Marcin, chief of the UC Davis Division of Pediatric Critical Care Medicine).
Teledermatology can empower patients to become more involved in maintaining health and wellness
Teledermatology puts the tools for skin health and wellbeing in the hands of patients. It encourages a proactive approach to wellness, as opposed to the ambulance at the bottom of the cliff.
“Most participants who conducted mobile teledermoscopy (86%) agreed that mobile teledermoscopy motivated them to conduct SSE [skin self-examination] regularly” (“Consumer acceptance of patient-performed mobile teledermoscopy for the early detection of melanoma“).
Reputable teledermatology providers encourage people to conduct their own skin self-examinations, to complement their current engagement with their doctor/specialist.
The majority (up to 70%) of melanomas are detected by patients themselves, or their partners, according to research reviewed by Cancer Council Australia and the Australasian College of Dermatologists. Research studies have shown evidence of the value of early detection through skin self-examination (SSE) and screening. For example, “demonstrating a potential reduction in melanoma mortality by as much as 63 %, with mean thickness of melanomas significantly reduced in the patients who performed SSE compared with those who did not.” (Screening and Prevention Measures for Melanoma: Is There a Survival Advantage?) and the fact that “randomized trials testing different methods of patient education have also shown that…education can further optimize self-examination and recognition of melanoma.” (“The role of public education in the early detection of melanoma“)
Studies have also shown that simple educational material can improve the likelihood that suspicious moles and lesions are detected by the person. With basic education and training, patients have shown themselves to be effective at identifying which lesions would benefit from being checked by a doctor: “consumers receiving brief education can identify suspicious lesions and submit dermoscopic images of sufficient quality for telediagnosis.” (Skin self-examination with mobile teledermoscopy: A new consumer triage tool?). This would suggest that there is a considerable opportunity for more than 70% of melanomas to be picked up by the person or a family member.
DermNet New Zealand on its webpage “See your doctor for a skin check” says “For most people self skin-checks done every 1–3 months is all that is needed to pick up early signs of skin cancer and melanoma.”
Teledermatology can assist with patient education and empowerment – encouraging self skin examinations and self mole mapping to monitor skin health in addition to, and in between, full body skin examinations by a medical professional.
Additionally, one of the themes underpinning the Ministry of Health strategy focuses on “providing information that helps people take control of their health and wellbeing” – and teledermatology clearly assists with this aim.
4. How does Firstcheck fit in?
Firstcheck takes teledermatology and makes it affordable, simple to use and smartphone accessible – with a platform developed in New Zealand, alongside doctors.
Via an intuitive, easy-to-use interface you can submit (high quality) photos – macroscopic/clinical and dermoscopic images taken using a dermoscope (Firstcheck’s SkinScope™). You are also prompted to supply the relevant supporting information consistent with teledermatology guidelines.
What can Firstcheck offer primary health care practitioners?
Firstcheck offers all the benefits of teledermatology – to both healthcare practitioners, and patients.
Specifically, Firstcheck provides health practitioners with:
* an affordable dermatoscope, which is compatible with all smartphones and tablets. The Firstcheck SkinScope™ is registered as a medical device in Australia and New Zealand, and is available for purchase online in our store here. Please contact us if you would like to arrange access to wholesale pricing and bulk-buy discounts. We believe every GP should have access to a dermoscope in their ‘toolbox’ to improve certainty in diagnosis and management. Notably, dermoscopic images are becoming a requirement for all high suspicion of cancer (HSC) e-referrals of suspected melanoma.
Firstcheck has been praised by many respected industry personnel including MoleMap CEO Adrian Bowling who says it has “overcome the challenge of getting good-quality photos” – and the Firstcheck SkinScope™ is now being promoted at dermoscopy courses led by leading practitioners.
See high quality dermoscopic images captured using the Firstcheck SkinScope here:
* an affordable software platform for second opinions from, and referrals to, skin specialists. No set-up costs apply, and the cost is a maximum of $19.95 per case submitted (with pricing able to be agreed between clinicians).
* a streamlined and efficient referral process with prompts for relevant referral information consistent with teledermatology guidelines – and using patient NHIs to link cases to patients.
* timely access to collegial support and specialist opinions – with average response time less than 24 hours.
* improved certainty in patient triage, diagnosis and management plans.
* a tool to offer patients for use in-between appointments with you to encourage a proactive approach to health and wellness (for example for self-skin examinations, ongoing DIY mole mapping, or monitoring a mole you have assessed. or for follow up).
* a secure, cloud-based platform to reduce your compliance risk, avoiding unsecure email and messaging systems.
5. How can I get started offering this to my patients?
Download the software – for free – from the app store today.
Purchase your Firstcheck SkinScope™ online here.
And try it out for yourself right now.
Please feel free to get in touch as we are here to support you, and your practice, through the process of getting up and running. We can also discuss how the pricing is set between practitioners, and provide you with information to print and distribute to patients.