title: A pilot trial of mobile, patient-performed teledermoscopy.
abstract: BACKGROUND
  Early detection by skin self-examination (SSE) could improve outcomes for melanoma. Mobile teledermoscopy may aid this process.
  
  
  OBJECTIVE
  To establish the clinical accuracy of SSE plus mobile teledermoscopy vs. clinical skin examination (CSE) and to test whether providing people with detailed SSE instructions improves accuracy.
  
  
  METHODS
  Men and women aged 50-64 years (n = 58) performed SSE plus mobile teledermoscopy in their homes between May and November 2013 and were given technical instructions plus detailed SSE instructions (intervention) or technical instructions only (control). Within 3 months, they underwent a CSE. Outcome measures included (i) body sites examined, lesions photographed, and missed; (ii) sensitivity of SSE plus mobile teledermoscopy vs. in-person CSE using either patients or lesions as denominator; and (iii) concordance of telediagnosis with CSE.
  
  
  RESULTS
  Overall 49 of 58 randomized participants completed the study, and submitted 309 lesions to the teledermatologist. Intervention-group participants were more likely to submit lesions from their legs compared with controls (P = 0·03), with no other differences. Eleven participants (22%) did not photograph 14 pigmented lesions that the dermatologist considered worthwhile photographing or monitoring. The sensitivity of SSE plus mobile teledermoscopy was 82% using the patient as denominator and 42% using the lesion as denominator. There was substantial agreement between telediagnosis and CSE (κ = 0·90), accounting for differential diagnoses.
  
  
  CONCLUSIONS
  SSE plus mobile teledermoscopy is promising for surveillance of particular lesions even without detailed SSE instructions. However, in the format tested in this study, consumers may overlook lesions and send many nonpigmented lesions. This investigation demonstrates that high-quality dermoscopic images can be taken by patients at home with high accuracy.
authors.affiliation: Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland Institute of Technology, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
authors.forename: M N
authors.initials: MN
authors.lastname: Manahan
authors.forename: H P
authors.initials: HP
authors.lastname: Soyer
authors.forename: L J
authors.initials: LJ
authors.lastname: Loescher
authors.forename: C
authors.initials: C
authors.lastname: Horsham
authors.forename: D
authors.initials: D
authors.lastname: Vagenas
authors.forename: D C
authors.initials: DC
authors.lastname: Whiteman
authors.forename: C M
authors.initials: CM
authors.lastname: Olsen
authors.forename: M
authors.initials: M
authors.lastname: Janda
mesh_terms: D040421:Cell Phone; D057210:Delayed Diagnosis; D046169:Dermoscopy / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D010865:Pilot Projects; D016353:Self-Examination / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology*; D017216:Telemedicine / Q000379:methods*