Summary
Dermoscopy is a vital part of skin cancer diagnosis. Increasingly, telemedicine involves having to send high quality images of skin lesions to a specialist. Training and equipment to be able to do this well can be prohibitively expensive. A method of examining skin lesions and capturing high quality images using cheap, readily available materials, requiring no tools or technical ability to put together, has been developed by North Bristol NHS Trust. The aim of this project was to disseminate this information globally, free of charge forever, to bring teledermoscopy to primary care and resource-poor settings for patients.
Method
Dermoscopy and teledermatology are essential in skin lesion diagnosis, including identification of skin cancer. Lack of training and equipment is a significant barrier, particularly in resource-poor settings. A low-cost LED loupe magnifier attached to a cheap digiscoping adaptor, to fit the apparatus to the user’s smartphone, was found to enable reliable, high quality images to be taken inexpensively. Education sessions were held for non-specialists to raise awareness of this solution, provide basic training in dermoscopy and information on how to build the set-up. Medical student teaching sessions were run, based around similar lesion recognition. A website was developed to provide educational resources on basic dermoscopy, plus instructions on how to build the budget device in as many accessible ways as possible, to widen its use. Outcomes were measured by post-training session questionnaires to assess user confidence in using images produced by both conventional dermoscopy and loupe. These demonstrated no significant difference in diagnostic accuracy or the confidence of the clinician. The findings were published following peer review and presented at international meetings.
Results
The effectiveness of the tool to transform user confidence in dermatological diagnosis has been well proven and demonstrated in presentations and publications. The intention was to educate and increase the confidence of the non-specialist to bring this technology to more people and help to diagnose common, benign skin lesions that might otherwise be referred for a specialist opinion. This confidence from the teaching means fewer patients will have to wait anxiously for an unnecessary specialist opinion on whether they have cancer. A specialist opinion can be sought via teledermatology with good quality images that primary care physicians can assess based on this educational programme and resources.
Sustainability and Spread
The project has been disseminated on the internet free of charge. The website is free and available to anyone anywhere and intended to remain free forever. There will never be a charge for this resource, nor will access to it be restricted. Further presentations to raise awareness are planned at future national and international meetings and the resource will continue to grow.
