Summary
This project set out to demystify dermoscopy and provide free information about budget-friendly technological solutions as alternatives to conventional, expensive modern dermoscopy. The positive impact has been felt around the world. The original objective was to develop a solution to traditional dermoscopy for less than £50 and then develop a product for less than £5 for resource-poor settings, as well as introducing the world’s first open-source, 3D-printed, self-assembly dermatoscope. Dermoscopea received no financial support and contributors gave their time freely.
Method
Dermoscopy is essential for the early detection and diagnosis of skin cancer and increasingly useful to support the diagnosis of inflammatory and infective skin diseases, reducing the need for costly skin biopsies, bringing diagnosis closer to patients’ homes and communities and ensuring appropriate treatment is started as soon as possible. The goals were to design, develop, test and release a variety of budget-friendly alternatives to conventional dermoscopy that would be useful in the community with primary care, in resource-poor, rural and remote settings. The use of the magnifying loupe as a budget-friendly alternative to dermoscopy is understood. The original project set out to create a system of dermoscopic photography for less than £50. The device had to be readily available anywhere in the world and be usable with no technical skill or tools. This was achieved by combining the loupe with a digiscoping adaptor to allow it to be mated to a smartphone for dermoscopic imaging. The second project was to produce a dermoscopic-like examination without imaging for less than £5 that met the requirements for simplicity for the user as described. This was achieved by modifying an old-fashioned technique, known as diascopy, by adding a cheap, illuminated currency microscope. The final aim was to produce plans for a dermatoscope that could be 3D-printed anywhere and assembled without tools.
Stakeholder meetings were held with primary care networks, details of which are available to GPs on several UK Integrated Care Boards’ websites. Partners in other countries, including Egypt, Pakistan and Taiwan, explored the usability of the devices. For both the original loupe digiscoping dermatoscope and the microscopic diascopic dermatoscope a set of instructions was produced in different formats, including pictoral, textual and video, with automatic translation to different languages on how to obtain and assemble. Non-specialist doctors were recruited to test the ease of assembly, give feedback and rate ease of use. The instructions were modified and a final set was made available on the Dermoscopea website. Images produced using these techniques were quality tested against conventional dermoscopy of the same lesions, with the results presented and published following peer review.
Results
The quality of dermoscopic images produced by the budget systems has been verified by comparison with conventional dermoscopy and use of generalist clinicians to judge the added value they may get in a consultation. Diagnostic accuracy and confidence were statistically significantly increased using both conventional dermoscopy alone and using the budget devices. There was no significant difference demonstrated between the budget device and conventional dermoscopy. Feedback from primary care was positive regarding either using the instructions to build budget systems or using the website as a reference resource. Many other organisations are interested in collaboration, including the Primary Care Dermatology Society and REFRAME. Overseas collaborators were pleased with the content. Website and social media analytics showed increasing user engagement with consistent monthly upward trends across a range of metrics.
Sustainability and Spread
The first data was presented at an international conference and in an article in the Journal of The European Academy of Dermatology and Venereology. Dermoscopea set up a website with instructions on how to obtain, assemble and use the budget devices and how to download plans for a 3D-printed version free of charge to all. The project is publicised on social media and includes educational content about dermoscopy. The website also contains a section about basic dermoscopy for the non-specialist, with a focus on adding value to a primary care consultation. Educational content is being improved by ensuring equal representation of skin of colour.
