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Application of Teledermoscopy in the Diagnosis of Pigmented Lesions

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Application of Teledermoscopy in the Diagnosis of Pigmented Lesions Hindawi International Journal of Telemedicine and Applications Volume 2018, Article ID 1624073, 6 pages https://doi.org/10.1155/2018/1624073 Research Article Application of Teledermoscopy in the Diagnosis of Pigmented Lesions C. B. Barcaui1 andP.M.O.Lima 2 1 Adjunct Professor of Dermatology, Faculty of Medical Sciences, State University of Rio de Janeiro, PhD in Medicine (Dermatology), by University of Sao˜ Paulo, Dermatology Department, Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de janeiro, Brazil 2Physician Residing in Dermatology, Department of Dermatology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil Correspondence should be addressed to P. M. O. Lima; [email protected] Received 28 June 2018; Accepted 23 September 2018; Published 10 October 2018 Academic Editor: Aura Ganz Copyright © 2018 C. B. Barcaui and P. M. O. Lima. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Dermatology, due to the peculiar characteristic of visual diagnosis, is suitable for the application of modern telemedicine techniques, such as mobile teledermoscopy. Objectives. To evaluate the feasibility and reliability of the technique for the diagnosis of pigmented lesions. Methods. Trough the storage and routing method, 41 pigmented lesions were analyzed. Afer the selection of the lesions during the outpatient visit, the clinical and dermatoscopic images were obtained by the resident physician through the cellphone camera and sent to the assistant dermatologist by means of an application for exchange of messages between mobile platforms. Firstly, the assistant dermatologist described the visualized dermatoscopic structures and defned its diagnosis and conduct, based solely on the evaluation of the clinical and dermatoscopic images, without having the knowledge of the anamnesis data. Aferwards, the same assistant dermatologist evaluated the patient face to face, defning the dermatoscopic structures, diagnosis, and conduct. Te data obtained through teledermoscopy and face-to-face assessments were compared and accuracy was defned as the concordance between the diagnoses. Results. A match rate of 90% between teledermoscopic and face- to-face diagnosis was demonstrated (McNemar’s statistical analysis, whose p value was 0.1366, showed no evidence to support the inferiority of the teledermoscopic method). 1. Introduction Dermatology, due to the peculiar characteristic of visual diagnosis, is ideal for the application of modern telemedicine Te reduction of the morbidity and mortality of nonmel- techniques, with several recent studies proving the viability anoma skin cancer and melanoma is the greatest current and reliability of teledermatology and, in particular, tele- challenge for dermatology and, within this context, this dermoscopy, with high levels of concordance in diagnosis includes the early diagnosis of melanoma, dermatoscopy, and management plan in relation to face-to-face consultation teledermatology, and teledermoscopy. [2]. Early diagnosis results in a better prognosis for the patient Te World Health Organization defnes telemedicine as (thin, <1mm, nonulcerated melanomas have a 95% survival the use of health communication technologies for the ex- rate within 5 years, whereas Breslow ulcerated melanomas> change of medical information for diagnosis, treatment, pre- 4mm and lymph node metastasis have only 24% survival at vention, research, evaluation, and education. One of the 5 years), and dermoscopy is essential, since it consists of a existent ways of telemedicine is teledermatology, which is more accurate method for the diagnosis of melanoma than already well established, whose publications began in 1995 the naked eye one, increasing the detection of early-stage and these ones have been growing exponentially. Within melanoma by up to 49% [1]. teledermatology, teledermoscopy appears as a promising area 2 International Journal of Telemedicine and Applications for the diagnosis and management of pigmented skin lesions, At the second moment, the same assistant dermatologist early detection of skin cancer, and screening [2]. evaluated the patient face-to-face, using the same dermato- Teledermatology has two distinct operation models, the scope and having access to anamnesis data (sex, age, location synchronous, through videoconference and satellite commu- and time of the injury evolution, local symptoms, personal nication, which occurs in real time and the asynchronous, or family history of melanoma, comorbidities, and relevant through a storage and routing system, including the use of e- aspects of the anamnesis), defning the dermatoscopic struc- mail,web,andmobileteledermatology,andwhichprovides tures and / or pattern analysis, diagnosis, and procedures. high levels of diagnostic accuracy, with lower cost, greater Te data obtained through teledermoscopy and face-to- convenience, and practicality [3]. face examinations were compared, the diferences between Storage and routing teledermatology are constantly grow- them being analyzed and what was essential being defned, ing around the world with improvements in communication in face-to-face examination, for decision-making. Te face- and imaging technologies, allowing expert judgment in situ- to-face examination was defned as the gold standard for the ations in which access to a dermatologist might be difcult fnal procedure. Te diagnostic accuracy was defned as the due to geographic distance or excessive demand. agreement between the teledermoscopic diagnosis and the Mobile teledermoscopy consists of a new application of gold standard. Clinical and dermatoscopic face-to-face diag- teledermatology, in which clinical and dermatoscopic images noses were considered suitable in patients with clinically and are captured and transmitted by mobile devices (e.g., smart- teledermoscopically benign and nonsuspected lesions and phones, tablets) [4]. Te image quality of these devices has no biopsy procedure was performed. Te lesions considered been improved and no longer represents a barrier in teleder- malignant or suspicious were studied histopathologically and matology [5]. were correlated with clinical-dermatoscopic diagnosis. In this mobile teledermoscopy study, the frst one devel- Te diagnostic agreement between teledermatology/tele- oped in Brazil, we aimed to study the feasibility and relia- dermoscopy and face-to-face assessment was calculated using bility of the technique for the dermatological diagnosis of the McNemar test, hypothesis test for paired data. Tis test pigmented lesions. works with two hypotheses: the null hypothesis, in which there is no diference between the representativeness between 2. Methods the diagnoses by the two methods and the alternative hypoth- esis, in which there is statistical diference. At the signifcance Patients were prospectively selected from the outpatient clinic level of 5% (0.05), the null hypothesis is accepted when the p of the Department of Dermatology from April to June 2017. value is greater than 0.05. Te inclusion criteria consisted of men or women, of any age, with pigmented lesions, whether melanocytic or not. 3. Results Afer the selection of the lesions during the outpatient visit, the clinical and dermatoscopic images were obtained by the Forty-one lesions were studied in 31 patients, 22 females, and resident physician and sent to the assistant dermatologist 9 males. Te mean age was 56.5 years (11 to 78 years). Te before face-to-face assessment. lesions were present for an average duration of 80.4 months Te clinical images were obtained using the cell phone (from 1 day to 40 years), excluding those not specifcally camera (Iphone 6 model A1549, with an integrated camera determined, only reported as present ones since childhood of 8 megapixels, resolution 3264x2448 pixel, digital stabiliza- or as time of unknown onset. Te specifc locations included tion, autofocus and without fash, with a good natural light- back (11 lesions), hand (7 including palmar lesion), malar ing) in two panoramic and macromodes (at an established (4), upper eyelid (2), cervical (2), thorax (2), breast (2), distance of 20 cm from the lesion to be further studied). Te thigh, plantar (2), infraorbital (1), temporal (1), nose (1), dermatoscope which has been used was DermLite DL4 from retroauricular (1), armpit (1), abdomen (1), and leg (1 lesion). 3Gen5,SanJuanCapistrano,CA92675,USA;and,forthe Eight patients reported local symptoms in the lesions, which acquisition of the dermatoscopic images, the camera lens was consisted of growth (4), bleeding (1), color change (2), and applied to the DermoLite5 MagnetiConnect TM device of the pruritus (1). No patient had previous history of melanoma, 3Gen5 Connection Kit for iPhone6 P / N: DLCKi6-MC, San one of whom had a personal history of basal cell carcinoma JuanCapistrano,CA92675,USA,withthedermatoscopeat andonethathadafamilyhistoryofmelanoma(frstdegree position 0, in polarized mode, without making use of fash or relative). Nineteen patients reported comorbidities: psoriasis zoom camera assets. To the large lesions, we performed more (3), systemic arterial hypertension (8), diabetes (3), bullous than one dermatoscopic image. lupus (1), cystic fbrosis (1), renal transplantation (1), and At frst, the images were sent via WhatsApp Messenger, a Sjogren's syndrome (1). We highlight
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