JMIR Publications

ABSTRACT

Background:

In Nouvelle-Aquitaine (a French region with a population of almost 6 million), the density of dermatologists is less than 3.8/100,000 inhabitants. This lack of dermatological care is delaying diagnosis and management, especially for skin cancer. The SmartDerm Project is a store-and-forward (SAF) teledermatology platform for primary care in Nouvelle-Aquitaine providing dermatological counselling to general practitioners (GPs).

Objective:

The main objective was to determine the concordance between the diagnosis of skin cancer made by dermatologists and the pathologists’ diagnosis.

Methods:

GPs in 3 pilot departments of Nouvelle-Aquitaine (Lot-Et-Garonne, Deux-Sèvres, Creuse) sent their dermatology requests with their smartphone in the app called “PAACO/Globule”; dermatologists at the University Hospital of Bordeaux answered within 48-72 hours during the period. Consecutive cases of skin cancer cases suspected by the referent dermatologists during the intervention were included, if the result of biopsy interpreted by a certified pathologist was available at the time of the study.

Results:

Among the 1727 requests, 163 (9%) concerned a possible diagnosis of skin cancer and were eligible. For 61 cases, the histopathological findings were not available. Eventually, 93 patients were included with 102 skin lesions. Median age was 75 years [26-97], with 53% women. The skin lesions had progressed for 8 months on average [0.5-36]. The median response time was 1 day [0-61] ; 65 days [1- 667] elapsed on average between the SAF opinion and the histological sample. Histopathology diagnosed 83 malignant lesions (57 basal cell carcinomas (69%), 18 squamous cell carcinomas (22%), 6 melanomas (7%), 1 cutaneous lymphoma (1%), 1 secondary location of a primary cancer (1%)), 1 precancerous lesion and 18 benign lesions. The concordance between the opinion of the referent dermatologist and the final pathological finding was 83% for non-melanocytic lesions and 67% for melanocytic lesions.

Conclusions:

This study showed the reliability of SAF teledermatology in the diagnosis of skin cancer, comparable to literature data in the absence of dermatoscopy. The median delay of two months between request and histology improved the delay of usual appointments in the intervention area. The lack of data for 61 patients showed that SAF telemedicine requires better coordination and follow-up, especially for the management of skin cancer. With this reservation in mind, teledermatology offers an alternative answer for the triage of patients with skin cancer residing in areas with low medical density.