Melanoma Diagnosis Via Teledermatology

Telehealth has become a routine part of U.S. healthcare, but it seems particularly well suited for dermatology. With relative ease, people can use their phones to take a picture or a short video of a troubling rash or spot and send it to dermatology practice. Real-time consults are also relatively easy.

Still, there's some uncertainty about how "teledermatology" might be used in the detection and diagnosis of melanoma, the most serious form of skin cancer. The American Cancer Society projects that approximately 98,000 cases of melanoma will be diagnosed in the U.S. this year and just under 8,000 people will die from the disease.

Erik Jaklitsch, a second-year medical school student at the University of Pittsburgh School of Medicine and his colleagues, may have helped filled the gap in understanding of telehealth's role in melanoma care with a presentation of findings from a retrospective study comparing melanoma cases that first presented via a teledermatology visit with those that first presented during an in-person visit. The study included all the melanoma cases identified in the University of Pittsburgh Medical Center system over a two-and-half-year period from 2020 to 2022.

About 800 melanomas cases first presented in in-person visits, but 35 were initially seen via a teleheath visit.

"We were able to see that patients seen through teledermatology had significantly shorter time from first-contact, dermatology-seeking consultation to being seen — and, most importantly, to getting biopsied," Jaklitsch said in an interview with Managed Healthcare Executive.

More specifically, the time to biopsy for the teledermatology group was 13 days compared with 82 days for those seen in-person.

Jaklitsch said the findings also show that the melanomas in the teledermatology were thicker (higher Breslow thickness) and had other characteristics indicative of higher risk. Becaue it was a retrospective study, the results can't address questions concerning false positives and the number of visits involved, he noted, "but it is saying for 35 high-mortality lesions, we were able to catch them sooner."

The demographic information analyzed by Jaklitsch and his colleagues show that the teledermatology users were younger and included a greater proportion of nonwhite patients. Melanin is protective against melanoma, so the melanoma rates are lower in people with darker skin, noted Jaklitsch. African Americans are, however, at higher risk for acral lentiginous melanoma, which appears on the palms, soles of the feet and nails, he pointed out. For reseachers, the low number of melanoma patients among people with darker skin can mean that it is difficult to conduct studies that produce results that reach the common thresholds for statistical significance.

The study was funded in part by the Melanoma Research Foundation.