Abstract PO-042: Would dermoscopic photographs help triage teledermatology consults in the COVID-19 era?
Authors: McCrary Myles R. , Rogers Tova , Yeung Howa , Krueger Loren , Chen Suephy C. 
Published: December 2020

Abstract
Background: The coronavirus pandemic led to a rapid transition to telemedicine across medical specialties. Dermatologists can utilize digital images to remotely manage skin diseases, including determining the urgency with which patients need to be seen in person. Accurately triaging urgent cases can be impacted by imaging modality. Dermoscopy is the examination of the skin with polarized light, which for some providers can increase their diagnostic accuracy and confidence in managing potential skin cancers. It has been increasingly viewed as a standard adjunct for examining skin lesions. Dermoscopic photographs have been shown to improve providers' abilities to correctly diagnose telemedicine consults. However, this has only been studied with a limited subset of skin neoplasms and is limited to a workflow involving a photographer with a dermatoscopic imaging capability. In the pandemic, the ability of patients to access dermoscopy is exceedingly limited. This study aims to assess the impact of dermoscopy on decision-making by dermatologists, including confidence, diagnostic accuracy, and triaging urgency. Our premise is that if dermoscopy is impactful, innovative means to increase accessibility to dermoscopy would be valuable for cancer management during COVID.
Methods: Twenty sets of clinical and dermoscopic photographs were selected as representative of commonly seen skin pathologies in our teledermatology consults. Study participants were first shown a clinical photograph and asked to determine their diagnoses, management decisions, level of urgency, and confidence in their triage decisions. The responses were scaled ranging from non-neoplastic to malignant, 0-100% confidence, and non-urgent (1) to emergent (3), respectively. They were then asked to answer the same questions after viewing the associated dermoscopic image.
Results: Twenty-six physicians participated in the study: 16 dermatology attendings and 10 residents. The majority reported using dermoscopy in ≥25% of their clinical practice. Fifty-nine percent rated themselves as "somewhat confident" in their dermoscopic abilities. Providers correctly diagnosed 45.3% of study cases using clinical images alone. This increased to 53.6% after viewing the associated dermoscopic images (p=0.02). The greatest increase was for malignant neoplasms (31% vs. 54%, p=0.0007). Dermoscopy significantly reduced triage urgency scores for both non-neoplastic (mean 1.6 vs. 1.2, p&lt;0.001) and benign neoplastic (mean 1.43 vs. 1.35, p=0.01) pathologies. Dermoscopy significantly increased urgency scores for malignant neoplasms (mean 1.47 vs. 1.64, p=0.01). There was a 7.6% increase in providers' confidence in their management decisions with dermoscopy (p&lt;0.0001).
Conclusions: Dermoscopic photographs improve providers’ abilities to correctly diagnose and prioritize skin lesions. In the COVID-19 era, innovative means to make dermoscopy available to patients at risk for skin cancer would be valuable.
Citation Format: Myles R. McCrary, Tova Rogers, Howa Yeung, Loren Krueger, Suephy C. Chen. Would dermoscopic photographs help triage teledermatology consults in the COVID-19 era? [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-042.