JMIR Publications

ABSTRACT

Background:

Cryotherapy is an effective treatment for benign lesions, although current unstandardized approaches may result in inadequate response and unwanted side effects. Monitoring treatment characteristics, lesion response, and patient-reported outcomes using patient-derived mobile imaging may allow for data to be collected in the future for treatment monitoring.

Objective:

To determine reliability of metrics for assessing response to cryotherapy in actinic and seborrheic keratoses using remote photographic monitoring.

Methods:

Patients were enrolled who were recommended cryotherapy by their physician for treating seborrheic and/or actinic keratoses (N = 22 patients, N= 31 lesions). After treatment, participants took an “overview” and “close up” photo of their lesion(s) and rated appearance, pain, and degree bothered on a custom smartphone application at eight post-treatment timepoints (Day 0, 3, 7, 10, 14, 30, 60, 90). After study completion, independent raters scored images for local skin response (erythema, scaling, crust, swelling, vesiculation, erosion), cosmetic outcome (hyperpigmentation, hypopigmentation, scarring, atrophy), and lesion resolution.

Results:

Local skin response peaked on post-cryotherapy Day 3, with 26% of patients reporting pain. There was substantial agreement between raters for lesion resolution (κ: 0.71 [0.62-0.79]), erythema (κ: 0.66 [0.57, 0.74]), and local skin response index (κ: 0.69 [0.61, 0.77]) as measured by quadratic weighted Cohen's Kappa. Overall, 77% of submitted photos were good quality, and most image derived metrics had higher agreement in good quality compared to poor quality photos. Peak local skin response had a moderate positive association with lesion response at 90 days (r = 0.556, p=.01, spearman).

Conclusions:

This study shows the utility of patient self-imaging for achieving longitudinal assessment of response to cryotherapy.