Abstract
INTRODUCTION
The high incidence of skin cancer in Brazil has resulted in an urgent need for more efficient methods of reducing the time between initial diagnosis and therapy. Such delays are significant in large countries like Brazil, where a considerable proportion of the population live in remote areas with limited access to specialized medical care. To address this problem the use of mobile phones as screening devices for suspicious skin lesions has been incorporated as long-distance teledermatology services. Digital photography is now a convenient ancillary option to minimize treatment delays caused by the distance between the specialist doctor and patients. The authors have developed a friendly mobile application and website to take high quality digital images of suspicious lesions, and to capture patient data easily and quickly to be analyzed by skin cancer professionals at another location.
METHODS
This was a prospective study of a population of 39 individuals monitored by routine skin cancer screening by the Cancer Prevention Department at Barretos Cancer Hospital during 2016. All patients were evaluated in the dermatology clinic, where a differential diagnosis was made based on the clinical information and direct examination of suspicious lesions. A second dermatologist assessed the same clinical information and digital images of all lesions captured by teledermatology, and provided an independent diagnostic opinion on the likelihood of the lesions being benign or suggestive of malignancy. The diagnostic efficiencies of teledermatology and standard dermatology were then compared to the histopathological findings of each biopsy as the diagnostic gold standard, and then statistical parameters of each approach were evaluated.
RESULTS
The lesions studied in this comparison were mostly found on the face (69%), followed by upper limbs (15%), scalp (8%), trunk (6%) and lower limbs (2%). Final histopathological analyses of the biopsies in the study group showed that 71% of lesions were malignant, with 32% being squamous cell carcinoma and 68% being classified as basal cell carcinoma, and 29% were considered benign lesions. The overall sensitivities of teledermatology in comparison to face-to-face evaluation in the clinic were similar (clinic, 80.0%; teledermatology, 80.8%). Other comparisons including accuracy (clinic, 78.9%; teledermatology, 79.5%); specificity (clinic, 76.9%; teledermatology, 76.9%); positive predictive value (clinic, 87.0%; teledermatology, 87.5%); and negative predictive value (clinic, 66.7.0%; teledermatology, 66.7%) all showed equivalence. The inter-observer kappa value between face-to-face examination and teledermatology showed excellent agreement at 0.958.
CONCLUSION
These preliminary findings indicate that the cell phone application developed to aid the diagnosis of skin cancer showed great potential and reliability, and can therefore be considered as an ancillary option in countries like Brazil, with isolated communities that have limited access to dermatology clinics.
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