To Screen or Not to Screen… That is the Online Dermatology Question!
by Mark P. Seraly, MD – founder of Iagnosis
Direct-to-Patient teledermatology is a new and evolving "on demand" access point into the healthcare system for patients seeking dermatologic care. Direct-to-Patient teledermatology is also a new opportunity for dermatologists to expand their clinical services and deliver care in a manner that improves patient satisfaction, eliminating the wait and the worry factors.
Direct to patient teledermatology is not intended to be a replacement for the direct relationship between a patient and his/her healthcare provider, nor is it intended to be a substitute for a total body skin examination!
At Iagnosis®, we are learning that patients are using online care to have new and changing skin lesions evaluated (in about 15% of submitted cases). Rather than wait for an in-office appointment, patients can conveniently use online teledermatology as a "spot-check" to relieve anxiety.
One area of "push-back" by prospective dermatologists who are considering direct-to-patient teledermatology, and also by the naysayers of teledermatology who just don't want to evolve away from traditional patient care models, is "I always do full body skin checks for patients who point out lesions! What other skin cancers will I be missing online?"
In a recent article published by Hoorens et al in the January 2016 issue of JAMA Dermatology, the investigators demonstrated in their nonrandomized, population-based, cross-sectional study that total body skin examinations (TBE-2.3%) and lesion-directed screening (LDS-3.2%) have similar skin cancer detection rates, but LDS is faster and less costly. In addition, patients in the LDS group had significantly higher baseline levels of anxiety than patients in the TBE screening group.
So how might the results of this study apply to direct-to-patient teledermatology? Patients are now choosing online dermatology care because of convenience, not wanting to wait for an appointment, but to still have their case reviewed by a dermatologist. Patients are also using online care as a "spot-check" or lesion-directed screening.
Based on the referenced publication, dermatologists should first and foremost recognize and be reassured that skin cancer detection rates are not significantly different between LDS and TBE during an in-office setting. Second, teledermatology can be used as a tele-triage tool to identify suspicious lesions for in-office referral and surgical management. Last, an in-office total body skin examination would be indicated if an individual is observed with a suspicious lesion during a teledermatology encounter.
To learn more about using Iagnosis to deliver teledermatology to new and existing patients, please request a demo from our team. If you're a patient interested in screening a suspicious skin mark or to get diagnosis for another skin condition, you can start an online visit now.
Hoorens I et al. Total-Body Examination vs. Lesion-Directed Skin Cancer Screening. JAMA Dermatology. 2016; 152(1): 27-34.