The importance of total-body photography and sequential digital dermatoscopy for monitoring patients at increased melanoma risk.

BACKGROUND AND OBJECTIVES: The incidence of melanoma is rising and prevention plays an important role. Multiple nevi as well as a medical history of melanoma are important risk factors. In affected patients, a two-step algorithm consisting of total-body photography (TBP) and sequential digital dermatoscopy (SDD) is a helpful diagnostic tool. PATIENTS AND METHODS: This was a retrospective observational study that lasted six years in order to evaluate the significance of the two-step algorithm. Cases were evaluated based on distinct dermoscopic patterns and statistical analyses were performed with the latest version of SPSS. RESULTS: 6020 dermoscopic images of 214 patients were included. TBP was performed at a mean interval of 16.9 months (SD ± 1.43 months), while SDD was performed every 9.9 months (SD ± 1.68 months). The number needed to excise was 4.6 and the number needed to monitor was 548. Excisions were mostly performed because dynamic changes were observed. A total of eleven melanomas were detected and had a mean tumor thickness of 0.44 mm (SD ± 0.15 mm; range 0.2-0.6 mm). CONCLUSIONS: Invasive melanomas had a tumor thickness of less than 0.6 mm, thus providing evidence of an effective strategy for early melanoma detection. Excisions of benign nevi were minimized as indicated by a low number needed to excise.

[Mobile teledermatology in the treatment of chronic ulcers]. / Mobile Teledermatologie in der Behandlung chronischer Ulzera.

BACKGROUND: Treatment of chronic ulcers is challenging. Advanced age, comorbidities, and a lack of medical knowledge of the caretaker's relatives are additional burdens. This study analyses if patient driven teledermatology could support them in the treatment of leg ulcers. Another purpose was the evaluation of savings in time and costs through telemedicine. PATIENTS AND METHODS: Over a period of approximately 6 months, 50% of the patients were treated in an ambulant setting, the other 50% used mainly teledermatology. The tele-group used an application to upload their pictures, clinical results, and history. After examination, the expert sent back a treatment plan and a date for the next teleconsultation. RESULTS: In all, 40 patients-20 in the tele-group and 20 in the control group-(18 women, 22 men; median age: 75 years [39-88 years]) were included in the study. A total of 4 patients managed the teleconsultation on their own, while 3 patients were supported by relatives and 11 by nurses. Overall, 196 outpatient treatments took place in the control group (1.6 visits/patient/month), compared to 97 outpatient treatments (0.6 visits/patient/month) and 182 teledermatology consults (1.3/patient/month) in the tele-group. Six patients were only treated in the teledermatology setting. CONCLUSIONS: Results from this study suggest that teledermatology is well qualified for the treatment of chronic ulcers; at the same time teledermatology is able to reduce the number of outpatient treatments, in some cases teleconsultation alone is possible. This decreases waiting time and travel costs for patients. Mobile teledermatology for treatment of ulcers was well-accepted among the patients.