The use of multiple electronic devices for tele-dermoscopic diagnosis of early melanoma: feasibility study of an integrated clinical-dermoscopic approach (Preprint)

BACKGROUND The use of mobile electronic devices as support to medical activity was largely implemented in the last decade. Teledermatology proved to be effective in the triage of patients with pigmented skin lesions. Dermosocpic algorithms were developed to help dermatologists in the non-invasive diagnosis of difficult melanocytic skin lesions, but they were not yet tested in a tele-dermoscopy web platform setting. OBJECTIVE To evaluate the frequency and feasibility of different electronic devices (personal computer, notebook, tablet, smartphone) in multiple teledermoscopic testing sessions on a teledermatology web platform (TWP) over clinically and dermoscopically difficult melanocytic skin lesions (MSLs). METHODS The devices’ technical characteristics were recorded, along with the diagnostic performances of 111 dermatologists with different experience in dermoscopy. They gave both intuitive diagnosis (i.e., pattern analysis) and algorithm-assisted diagnoses (i.e., iDScore, ABCD rule, 7-point-checklist) on standardized images of difficult MSLs blinded cases. RESULTS Young generation of dermoscopists are more prone to alternately use different devices, while elderly generation still prefer to use the pc. There was no difference in the diagnostic performances obtained with small/large screen or fixed/mobile devices, either in intuitive diagnosis (AUC=0.666 with fixed, AUC=0.688 with portable) and in algorithm-assisted diagnosis (e.g, iDScore method; AUC=0.766 with fixed, AUC=0.785 with portable). The overall highest AUC (AUC=0,82) was obtained by young generation dermoscopists (level I+II) when using the iDscore-assisted diagnosis on a notebook. CONCLUSIONS The tele-dermoscopic diagnostic accuracy on difficult MSLs cases adequately selected for image quality and homogenous standard seems not to be negatively affected by using different electronic devices. Using this TWP with both educational and testing purposes enabled participants of different experience to achieve adequate diagnostic accuracy in difficult MSLs, especially with iDScore-assisted diagnosis.