Consumer views of melanoma early detection using 3D total-body photography: cross-sectional survey.

BACKGROUND: Three-dimensional (3D) total-body photography is a recent advance in melanoma early detection that can aid in monitoring and identifying new and changing skin lesions over time. METHODS: A cross-sectional survey of adults living in metropolitan and rural areas of Australia was conducted to assess perceptions of 3D total-body photography. Participants completed a survey detailing their previous use of skin cancer photography, personal skin checking history, perceptions of 3D total-body photography, and willingness to pay. Participants were also asked to describe the potential barriers and facilitators of 3D total-body photography in their own words. RESULTS: A total of 1056 participants completed the survey, with 739 (70%) from metropolitan areas of Australia and 317 (30%) from rural areas. Most participants (95%, n = 1004/1056) indicated they would consider using 3D total-body photography if it became commercially available at their regular medical practice. Most participants indicated 3D total-body photography would be effective to identify suspicious skin spots (94%, n = 995/1056), monitor lesion changes (94%, n = 997/1056), and reduce skin cancer related anxiety (90%, n = 950/1055). In open-ended feedback, participants (87%, n = 918/1056) identified perceived benefits, including more comprehensive screenings, earlier detection, and less human error. Participants (84%, n = 889/1056) also identified potential barriers to 3D total-body photography, including cost, accessibility and availability, trust in the technology, and digital security concerns. CONCLUSIONS: Participant feedback indicated a high level of acceptance and confidence in the technology. To facilitate clinical translation, addressing consumer-identified barriers to 3D total-body photography will be vital.

Consumer Preference and Willingness to Pay for Direct-to-Consumer Mobile Teledermoscopy Services in Australia.

OBJECTIVE: To investigate consumer preference and willingness to pay for mobile teledermoscopy services in Australia. METHODS: Consumers who were taking part in a randomised controlled trial comparing mobile teledermoscopy and skin self-examination were asked to complete a survey which incorporated a discrete choice experiment (DCE) and a contingent valuation question. Responses were used to determine their willingness to pay for mobile teledermoscopy services in Australia and their overall service preferences. RESULTS: The 199 consumers who responded were 71% female and had a mean age of 42 years (range, 18-73). The DCE results showed that consumers prefer a trained medical professional to be involved in their skin cancer screening. Consumers were willing to pay AUD 41 to change from a general practitioner reviewing their lesions in-person to having a dermatologist reviewing the teledermoscopy images. Additionally, they were willing to pay for services that had shorter waiting times, that reduced the time away from their usual activities, and that have higher accuracy and lower likelihood of unnecessary excision of a skin lesion. When asked directly about their willingness to pay for a teledermoscopy service using a contingent valuation question, the majority (73%) of consumers selected the lowest two value brackets of AUD 1-20 or AUD 21-40. CONCLUSION: Consumers are willing to pay out of pocket to access services with attributes such as a dermatologist review, improved accuracy, and fewer excisions.

The Future of Precision Prevention for Advanced Melanoma.

Precision prevention of advanced melanoma is fast becoming a realistic prospect, with personalized, holistic risk stratification allowing patients to be directed to an appropriate level of surveillance, ranging from skin self-examinations to regular total body photography with sequential digital dermoscopic imaging. This approach aims to address both underdiagnosis (a missed or delayed melanoma diagnosis) and overdiagnosis (the diagnosis and treatment of indolent lesions that would not have caused a problem). Holistic risk stratification considers several types of melanoma risk factors: clinical phenotype, comprehensive imaging-based phenotype, familial and polygenic risks. Artificial intelligence computer-aided diagnostics combines these risk factors to produce a personalized risk score, and can also assist in assessing the digital and molecular markers of individual lesions. However, to ensure uptake and efficient use of AI systems, researchers will need to carefully consider how best to incorporate privacy and standardization requirements, and above all address consumer trust concerns.

Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial.

BACKGROUND: Skin self-examinations supplemented with mobile teledermoscopy might improve early detection of skin cancers compared with naked-eye skin self-examinations. We aimed to assess whether mobile teledermoscopy-enhanced skin self-examination can improve sensitivity and specificity of self-detection of skin cancers when compared with naked-eye skin self-examination. METHODS: This randomised, controlled trial was done in Brisbane (QLD, Australia). Eligible participants (aged ≥18 years) had at least two skin cancer risk factors as self-reported in the eligibility survey and had to own or have access to an iPhone compatible with a dermatoscope attachment (iPhone versions 5-8). Participants were randomly assigned (1:1), via a computer-generated randomisation procedure, to the intervention group (mobile dermoscopy-enhanced self-skin examination) or the control group (naked-eye skin self-examination). Control group and intervention group participants received web-based instructions on how to complete a whole body skin self-examination. All participants completed skin examinations at baseline, 1 month, and 2 months; intervention group participants submitted photographs of suspicious lesions to a dermatologist for telediagnosis after each skin examination and control group participants noted lesions on a body chart that was sent to the research team after each skin examination. All participants had an in-person whole-body clinical skin examination within 3 months of their last skin self-examination. Primary outcomes were sensitivity and specificity of skin self-examination, patient selection of clinically atypical lesions suspicious for melanoma or keratinocyte skin cancers (body sites examined, number of lesions photographed, types of lesions, and lesions missed), and diagnostic concordance of telediagnosis versus in-person whole-body clinical skin examination diagnosis. All primary outcomes were analysed in the modified intention-to-treat population, which included all patients who had a clinical skin examination within 3 months of their last skin self-examination. This trial was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12616000989448. FINDINGS: Between March 6, 2017, and June 7, 2018, 234 participants consented to enrol in the study, of whom 116 (50%) were assigned to the intervention group and 118 (50%) were assigned to the control group. 199 participants (98 participants in the intervention group and 101 participants in the control group) attended the clinical skin examination and thus were eligible for analyses. Participants in the intervention group submitted 615 lesions (median 6·0 per person; range 1-24) for telediagnosis and participants in the control group identified and recorded 673 lesions (median 6·0 per person; range 1-16). At the lesion level, sensitivity for lesions clinically suspicious for skin cancer was 75% (95% CI 63-84) in the intervention group and 88% (95% CI 80-91) in the control group (p=0·04). Specificity was 87% (95% CI 85-90) in the intervention group and 89% (95% CI 87-91) in the control group (p=0·42). At the individual level, the intervention group had a sensitivity of 87% (95% CI 76-99) compared with 97% (95% CI 91-100) in the control group (p=0·26), and a specificity of 95% (95% CI 90-100) compared with 96% (95% CI 91-100) in the control group. The overall diagnostic concordance between the telediagnosis and in-person clinical skin examination was 88%. INTERPRETATION: The use of mobile teledermoscopy did not increase sensitivity for the detection of skin cancers compared with naked-eye skin self-examination; thus, further evidence is necessary for inclusion of skin self-examination technology for public health benefit. FUNDING: National Health and Medical Research Council (Australia).

Is Teledermoscopy Ready to Replace Face-to-Face Examinations for the Early Detection of Skin Cancer? Consumer Views, Technology Acceptance, and Satisfaction with Care.

BACKGROUND: Previous cross-sectional research indicates high acceptance of mobile teledermoscopy-enhanced skin self-examination (SSE) by consumers based on the technology acceptance model (TAM) domains: perceived usefulness, ease of use, compatibility, attitude and intention, subjective norms, facilitator, and trust. However, no study has assessed this outcome longitudinally among people who actually used the technology in their own homes. METHODS: Participants were living in Brisbane, Australia, aged 18 years or older, and at high risk of skin cancer. Participants randomly assigned to the intervention group (n = 98) completed a self-administered questionnaire on mobile teledermoscopy acceptance for skin cancer detection both before use and after performing mobile teledermoscopy-enhanced SSE in their homes. The survey included a 25-item scale assessing seven TAM domains. Item scores ranged from 5 (strongly agree) to 1 (strongly disagree). Participants also answered survey questions on satisfaction with use of teledermoscopy, and a 9-item "thoughts about melanoma" scale that measures cancer worry. RESULTS: Participants were 19-73 years old, had high skin cancer risk, blue or grey eyes (53.1%), fair or very fair skin (88.8%), and previous skin cancer treatments (61.2%). Participants were more accepting of mobile teledermoscopy at baseline: mean TAM score of 4.15 (SE 0.05); their level of acceptance decreased significantly after teledermoscopy use: mean score 3.94 (SE 0.05; p = 0.001). In linear regression analysis, the decrease in TAM scores was similar across demographic and skin cancer risk categories. Ninety-two percent (n = 90) of participants agreed that mobile teledermoscopy was easy to use. The mean score of the "thoughts about melanoma" scale did not change significantly from baseline to follow-up. CONCLUSION: Consumers had high TAM scores before they used mobile teledermoscopy within a randomised control trial. At the end of the intervention period, TAM scores decreased, although participants' average score still indicated "agreement" that mobile teledermoscopy was acceptable.

Evaluating healthcare practitioners' views on store-and-forward teledermoscopy services for the diagnosis of skin cancer.

OBJECTIVE: The aim of the study is to evaluate healthcare practitioners' views on and satisfaction with (i) digital image acquisition and storage and (ii) store-and-forward teledermoscopy services for the diagnosis of skin cancer in their clinical practice. METHODS: An online survey was conducted among 59 healthcare practitioners (GPs (n=17), dermatologists (n=22), dermatology registrars (n=18), a dermatology research fellow (n=1) and a plastic surgeon (n=1)) to assess usability of digital image acquisition and storage for when the imaging process is conducted by the healthcare practitioners themselves, or by their patients. The study identifies the enablers and barriers of this emerging mode of medical practice. A thematic analysis was used to extract key themes from open-ended responses, which involved identifying themes and patterns within and across participants. RESULTS: Thirty-four healthcare practitioners (58%) had previously used a mobile dermatoscope within their practice. Participants most appreciated its use in their practice for lesion monitoring (59%) and record keeping (39%). Challenges reported were the increased time to support the additional workload (45%), technical issues (33%) and cost of equipment (27%). Practitioners were unsure (36%) or did not advocate teledermoscopy for direct-to-consumer use (41%). Only 23% supported the use of direct-to-consumer teledermoscopy. CONCLUSION: While most practitioners are receptive to mobile teledermoscopy, there was less support for patient-initiated use, whereby the patient controls the imaging process. As technology improves rapidly it is important to evaluate practitioners' acceptance and satisfaction of evolving telehealth services, moving forward with models of practice where healthcare practitioners and other healthcare providers will feel comfortable engaging in telehealth services.

Consumer Acceptance and Expectations of a Mobile Health Application to Photograph Skin Lesions for Early Detection of Melanoma.

BACKGROUND: Mobile teledermoscopy may facilitate skin self-examinations (SSEs) and further improve monitoring and detection of melanoma. OBJECTIVE: To assess consumer acceptability and expectations of a mobile health app used to: (i) instruct SSE and (ii) conduct consumer-performed mobile teledermoscopy. METHODS: People aged 18 years and above were invited to participate in either (i) an online survey or (ii) focus group in Brisbane, Australia. Participants were asked about their SSE practices, mobile teledermoscopy acceptance, and app design and functionality. The online survey responses and focus group discussions were coded by two researchers who conducted thematic analysis. RESULTS: Four focus groups were held with a total of 28 participants; 88 participants completed the online survey. The mean ages of participants in the focus group and online survey were 46 and 38 years, respectively. There were more males in the focus groups (61%, 17/28) compared to the online survey (19%, 17/88). Regular SSEs were conducted by 56 (64%) of the online survey participants. Barriers to SSE were forgetfulness (44%), low self-perceived risk of melanoma (25%) and low confidence in conducting SSEs (25%). The large majority of online survey participants (95%) would consider sending photos of their skin lesions to a medical practitioner via an app. Focus group participants reported that they would accept using mobile teledermoscopy; however, they would prefer to use it to monitor lesions between face-to-face consultations. CONCLUSIONS: Overall, participants had positive views on using mobile teledermoscopy to send images of skin lesions to a dermatologist or other medical practitioner.

Redesigning Skin Cancer Early Detection and Care Using a New Mobile Health Application: Protocol of the SKIN Research Project, a Randomised Controlled Trial.

Patients often detect melanoma themselves; therefore, regular skin self-examinations (SSEs) play an important role in the early detection and prompt treatment of melanoma. Mobile teledermoscopy is a technology that may facilitate consumer SSEs and rapid communication with a dermatologist. This paper describes the planned randomised controlled trial of an intervention to determine whether mobile technologies can help improve the precision of SSE in consumers. A randomised controlled trial will be conducted to evaluate mobile teledermoscopy-enhanced SSE versus naked-eye SSE. Participants in each group will conduct three home whole-body SSEs at baseline, 1 and 2 months, then present for a clinical skin examination (CSE) by a doctor after the 2-month SSE. Specifically, participants will identify skin lesions that meet the AC (asymmetry and colour) rule for detecting a suspicious skin spot. The primary outcomes are sensitivity and specificity of the skin lesions selected by the participants as needing attention by a doctor, compared to the clinical diagnosis by the dermatologist that will serve as the reference standard for this analysis. For the mobile teledermoscopy-enhanced SSE group, researchers will assess the number, location and type of lesions (1) sent by the participant via mobile teledermoscopy, (2) found at CSE or (3) missed by the participant. For the naked-eye SSE group, researchers will assess the number, location and type of lesions (1) recorded on their body chart by the participant, (2) found at CSE or (3) missed by the participant. Secondary outcomes are based on participants' self-reported data via online questionnaires.

Direct-to-consumer mobile teledermoscopy for skin cancer screening: Preliminary results demonstrating willingness-to-pay in Australia.

Introduction Internationally, teledermoscopy has been found to have clinical and economic efficacy. This study aims to identify the attributes of a mobile teledermoscopy service that consumers prefer. This preliminary study was set within a broader randomised control trial (RCT) investigating the effectiveness of direct to consumer mobile teledermoscopy. Methods We undertook a discrete choice experiment (DCE). The DCE comprised 24 choice sets, divided into in two blocks of 12. For each choice set, respondents were asked to make discrete choices between two opt-out choices and two skin cancer screening service options described by seven attributes. A mixed logit model was used to estimate preferences for skin cancer screening services. Consumer preferences weights were used to calculate marginal willingness-to-pay (WTP) for skin cancer screening services. Results The DCE was completed by 113 consumer respondents. Consumers' preference for dermatologist involvement in their diagnosis, increased accuracy, and reduced excisions were all statistically significant in driving choice between service models. Consumers preferred having a professional involved in their skin cancer screening, rather than performing a self-examination. Consumers were only WTP $1.18 to change from a GP visit to mobile teledermoscopy (diagnosis using a phone camera). However, they were WTP $43 to have their results reviewed by a dermatologist rather than a GP, and $117 to increase the chance of detecting a melanoma if it was present from 65-75% to 95%. Conclusion Skin cancer screening services which are delivered by health professionals, rather than skin self-examination, are preferred by consumers. Consumers were willing to pay for their preferred skin cancer screening method, especially if a dermatologist was involved.

Transdermal patch drug delivery interactions with exercise.

Transdermal drug delivery systems, such as the transdermal patch, continue to be a popular and convenient way to administer medications. There are currently several medications that use a transdermal patch drug delivery system. This article describes the potential untoward side effects of increased drug absorption through the use of a transdermal patch in individuals who exercise or participate in sporting events. Four studies have been reported that demonstrate a significant increase in the plasma concentration of nitroglycerin when individuals exercise compared with rest. Likewise, several case reports and two studies have been conducted that demonstrate nicotine toxicity and increased plasma nicotine while wearing a nicotine patch in individuals who exercise or participate in sporting events compared with rest. Healthcare providers, trainers and coaches should be aware of proper transdermal patch use, especially while exercising, in order to provide needed information to their respective patients and athletes to avoid potential untoward side effects. Particular caution should be given to individuals who participate in an extreme sporting event of long duration. Further research that includes more medications is needed in this area.