SpotCheck: A skin cancer diagnostic clinical trial comparing dermoscopy-enhanced telemedicine to in-person evaluation.
Authors: Ingrassia Jenne P. , Bajaj Shirin , Kolla Avani , Li Vivienne , Shah Payal , Gulati Nicholas , Criscito Maressa C , Xing Yiping , Lopez Adriana , Tran Duy , Ramachandran Vignesh , Kakpovbia Efe , Shao Yongzhao , Lo Sicco Kristen , Milam Emily , Bieber Amy K , Levine Amanda , Liebman Tracey N , Stein Jennifer A , Polsky David 
Published: June 2023

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Background: Low socioeconomic status and long distances to a diagnosing provider are factors associated with poor melanoma outcomes, including advanced stage at presentation. Telemedicine offers improved access to diagnostic services for patients in medically underserved communities. Dermoscopy is an established skin imaging method with greater diagnostic accuracy for skin cancers compared to naked eye examination alone. We evaluated the safety and efficacy of a dermoscopy-enhanced, store-and-forward telemedicine-based skin cancer diagnostic platform in a prospective clinical trial. Methods: Participants were recruited primarily through advertisements in local newspapers. Subjects with self-identified skin lesions concerning for malignancy could have up to three lesions evaluated. Clinical and dermoscopic images of each lesion were captured, and were stored-and-forwarded to a team of three dermatologists (TeleTeam) working remotely, and independently. Participants were also evaluated face-to-face by a dermatologist (F2F). Participants were offered biopsies by the F2F (if needed) at the time of the visit, or at a follow up visit if the biopsy was only recommended by one or more members of the TeleTeam. The TeleTeam was blinded to the F2F recommendations. Results: We enrolled 146 subjects with 375 lesions of concern for skin cancer between September 2020 and December 2022. Baseline characteristics: 94 (64%) female; median age 65 years (range: 25-90 years); 92 (63%) non-Hispanic White; 22 (15%) Black; 11 (7%) Hispanic White; 8 (6%) Asian; 13 (9%) other or preferred not to say. Nineteen participants (13%) had a prior skin cancer including 2 with melanoma (one also with basal cell carcinoma (BCC)), and 17 with keratinocyte cancers (BCC and/or squamous cell carcinoma (SCC)). Overall, 363/375 (97%) skin lesions were clinically or histopathologically benign; 14/146 (10%) patients had a malignant or atypical skin growth. These included 12 skin cancers: 1 stage IA melanoma (0.5mm in thickness); 1 in-situ melanoma; 8 BCC; 2 in-situ SCC; and 2 moderately or severely atypical nevi. F2F recommended biopsy for both melanomas, 7 BCC and 1 SCC. TeleTeam recommended biopsy for both melanomas, 7 BCC, 2 SCC, and both moderately or severely atypical nevi. F2F identified 10/14 malignant or atypical skin growths; the TeleTeam identified 13/14. The benign:malignant ratio of the F2F and TeleTeam recommended biopsies were 2.7:1 and 5.8:1, respectively. The TeleTeam benign:malignant ratio decreased to 4.5:1 after the first 35 subjects were evaluated. Conclusions: Dermoscopy-enhanced teledermatology evaluation appears to be a safe and effective method to triage skin lesions for in-person medical evaluation and biopsy to diagnose skin cancer. Deployment of this diagnostic modality may help reduce melanoma health disparities arising in communities lacking dermatologists. Clinical trial information: NCT04411810 .