Diagnosing Skin Disorders With Selfies

By Danielle Krol, M.D.

Snapping a selfie of that worrying mole may be enough to save you a trip to the dermatologist, a small new study suggests.

This increasingly common practice, known as teledermatology, involves sending a photo of a suspicious skin lesion to a dermatologist, who can then evaluate the image and let the sender know whether it is harmless - or if it needs further examination in a clinical setting.

Because these images can be captured with a cellphone camera, it is a notably convenient approach. But is it as good as an actual doctor's visit?

That's the question researchers at the University of Pennsylvania sought to answer in the new study, published Wednesday in the journal JAMA Dermatology. They studied 50 patients who were in the hospital for various reasons, but who also had a skin issue that required an expert opinion. The researchers lined up a consultation with a dermatologist for each of these patients - but they also took a picture of the suspicious skin using a smartphone and sent these images to two additional board-certified dermatologists to see if all of the doctors' opinions matched up.

What they found was that in the cases where the in-person dermatologist recommended a biopsy of a suspicious lesion, the teledermatologists had agreed with this opinion an average of 95 percent of the time. They also found that if the in-person dermatologist recommended the patient get additional tests the same day, the teledermatologists agreed 90 percent of the time.

Study author Dr. Misha Rosenbach, an assistant professor of dermatology at the Hospital of the University of Pennsylvania, said the findings may be particularly important for those who live in areas that make a special trip to the dermatologist inconvenient.

"We can improve patient satisfaction and increase access to health care with the incorporation of teledermatology," said Rosenbach, who added that he has been using the method for years. "Teledermatology has been a useful tool in our practice."

Dermatologists who were not involved with the research agreed that the approach holds a great deal of potential for those who do not have easy access to a qualified dermatologist.

"Adapting this widespread technology of transmitting information to a distant location, we can help make patient care more efficient," said Dr. Martin Weinstock, a professor of dermatology at Brown University who also has used teledermatology to treat patients.

Dermatologist Dr. Darrell Rigel, meanwhile, said he feels the approach has promise. But he added that the idea comes attached with concerns about accuracy of diagnosis and other issues.

"By the use of innovative mobile technology, we can reach patients in rural communities that may not otherwise have access to healthcare," said Rigel, a clinical professor of dermatology at New York University. "But in general, we are just not there yet."

Doctor's Take

What's clear about teledermatology is that it is becoming increasingly popular. Given the fact that so many people carry cellphone cameras with them on a daily basis, it is a potentially convenient approach that may one day put the power, quite literally, in the hands of the patient.

And for many, it means increased access to professionals they would not otherwise be able to see. In a rural community hospital in Wyoming without dermatologist readily available, for instance, one could send images shot on a smartphone to larger centers, allowing complicated skin conditions to be more readily diagnosed.

What remains to be seen is whether teledermatology can ever truly replace the opportunity to have a trained professional physically examine and scrutinize a worrying lesion from every angle in person. The answer to this question will only come with additional research.

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