Research article
Special Issues
A new “hub and spoke” teledermoscopy system involving general practitioners and dermatologists for the early detection of cutaneous melanoma: a pilot study
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Gabriella Fabbrocini
1
,
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Sara Cacciapuoti
1
,
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Gaia De Fata Salvatores
1
,
, ,
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Claudia Costa
1
,
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Paolo Chiodini
2
,
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Maria Antonietta Luciano
1
,
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Serena Poggi
1
,
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Silvestro Scotti
3
,
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Luigi Sparano
3
,
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Giuseppe Di Leo
4
,
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Paolo Sommella
4
,
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Matteo Ferro
4
,
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Massimiliano Scalvenzi
1
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1.
Section of Dermatology–Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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2.
Medical Statistics Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
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3.
FIMMG–Italian Federation General Pratictioners
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4.
Department of Industrial Engineering–University of Salerno, Italy
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Received:
18 May 2020
Accepted:
24 July 2020
Published:
16 October 2020
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The incidence of cutaneous melanoma has been increasing over the past few decades. The introduction of dermoscopy has enriched the diagnostic armamentarium of dermatologists improving diagnostic accuracy. The involvement of General Practitioners (GPs) and the use of telemedicine systems could constitute a new resource to make available early diagnosis to a larger population and to rationalize health resources in favor of patients at high risk of developing skin tumors.
Aims
Primary aim of this study is to assess the feasibility of a “hub and spoke” model for the cooperation between high-specialty hospital units and GPs, using a new online teledermatology platform (I3DermoscopyApp®), that recently has been proved as a valid semiautomatic diagnostic image-based measurement system. Secondary aim is to evaluate the reliability of this semiautomatic diagnostic system in a clinical model of real life.
Methods
An observational cross-sectional study using a “hub and spoke” model, was conducted at Dermatology Unit of Department of Clinical Medicine and Surgery of University Federico II of Naples. GPs and dermatologists were involved in this study after a demormoscopy traninig.
Results
The system proved to be reliable in the triage phase and useful in the rationalization of highly specialized medical resources. Comparing patients diagnosed with malignant skin tumors through teledermoscopy system with patients with the same skin lesions of our department not participating to the study, we noticed that latency time between diagnosis and surgical excision were significantly decreased demonstrating the reliability of this semiautomatic diagnostic system in a clinical model of real life.
Discussion
This study demonstrating the feasibility of a hub and spoke system based on a teledermatology cooperation between GPs and dermoscopy trained dermatologists. The use of teledermoscopy improves the ability of GPs selecting lesions suggestive of skin cancer without increasing the number of unnecessary expert consultations.
Citation: Gabriella Fabbrocini, Sara Cacciapuoti, Gaia De Fata Salvatores, Claudia Costa, Paolo Chiodini, Maria Antonietta Luciano, Serena Poggi, Silvestro Scotti, Luigi Sparano, Giuseppe Di Leo, Paolo Sommella, Matteo Ferro, Massimiliano Scalvenzi. A new “hub and spoke” teledermoscopy system involving general practitioners and dermatologists for the early detection of cutaneous melanoma: a pilot study[J]. AIMS Bioengineering, 2020, 7(4): 306-320. doi: 10.3934/bioeng.2020025
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Abstract
The incidence of cutaneous melanoma has been increasing over the past few decades. The introduction of dermoscopy has enriched the diagnostic armamentarium of dermatologists improving diagnostic accuracy. The involvement of General Practitioners (GPs) and the use of telemedicine systems could constitute a new resource to make available early diagnosis to a larger population and to rationalize health resources in favor of patients at high risk of developing skin tumors.
Aims
Primary aim of this study is to assess the feasibility of a “hub and spoke” model for the cooperation between high-specialty hospital units and GPs, using a new online teledermatology platform (I3DermoscopyApp®), that recently has been proved as a valid semiautomatic diagnostic image-based measurement system. Secondary aim is to evaluate the reliability of this semiautomatic diagnostic system in a clinical model of real life.
Methods
An observational cross-sectional study using a “hub and spoke” model, was conducted at Dermatology Unit of Department of Clinical Medicine and Surgery of University Federico II of Naples. GPs and dermatologists were involved in this study after a demormoscopy traninig.
Results
The system proved to be reliable in the triage phase and useful in the rationalization of highly specialized medical resources. Comparing patients diagnosed with malignant skin tumors through teledermoscopy system with patients with the same skin lesions of our department not participating to the study, we noticed that latency time between diagnosis and surgical excision were significantly decreased demonstrating the reliability of this semiautomatic diagnostic system in a clinical model of real life.
Discussion
This study demonstrating the feasibility of a hub and spoke system based on a teledermatology cooperation between GPs and dermoscopy trained dermatologists. The use of teledermoscopy improves the ability of GPs selecting lesions suggestive of skin cancer without increasing the number of unnecessary expert consultations.
Statement of ethics
A written informed consent was obtained from the patients for the publication of this study and accompanying images. The authors have no ethical conflicts to disclose.
Disclosure statement
The authors have no conflicts of interest to declare.
Funding sources
The authors declare they had no funding sources supporting this work.
Author contributions
Gabriella Fabbrocini conceived the work.
Massimiliano Scalvenzi approved the version to be published.
Paolo Chiodini, Matteo Ferro, Giuseppe Di Leo, Paolo Sommella wrote the manuscript and analysed data.
Sara Cacciapuoti wrote the manuscript and revised it critically.
Claudia Costa, Mariantonietta Luciano, Serena Poggi and wrote the manuscript and acquired data.
Silvestro Scotti and Luigi Sparano acquired data.
Gaia De Fata Salvatores drafted the work and ensured the accuracy of any part of it.
Conflict of interest
The authors declare no conflict of interest.
References
[1]
|
Geller AC, Swetter SM, Brooks K, et al. (2007) Screening, early detection, and trends for melanoma: current status (2000–2006) and future directions. J Am Acad Dermatol 57: 555-572. doi: 10.1016/j.jaad.2007.06.032
|
[2]
|
Siegel R, Naishadham D, Jemal A (2013) Cancer statistics. CA Cancer J Clin 63: 11-30. doi: 10.3322/caac.21166
|
[3]
|
Binder M, Puespoeck-Schwarz M, Steiner A, et al. (1997) Epiluminescence microscopy of small pigmented skin lesions: short-term formal training improves the diagnostic performance of dermatologists. J Am Acad Dermatol 36: 197-202. doi: 10.1016/S0190-9622(97)70280-9
|
[4]
|
Sadeghi M, Razmara M, Lee T K, et al. (2011) A novel method for detection of pigment network in dermoscopic images using graphs. Comput Med Imag Grap 35: 137-143. doi: 10.1016/j.compmedimag.2010.07.002
|
[5]
|
Kirk J (2020) Count loops in a graph. Available from: https://www.mathworks.com/matlabcentral/fileexchange/10722-count-loops-in-a-graph.
|
[6]
|
Frangi AF, Niessen WJ, Vincken KL, et al. (1998) Multiscale vessel enhancement filtering. Medical Image Computing and Computer-Assisted Intervention—MICCAI'98 Heidelberg: Springer, 130-137.
|
[7]
|
Mirzaalian H, Lee TK, Hamarneh G (2012) Learning features for streak detection in dermoscopic color images using localized radial flux of principal intensity curvature. 2012 IEEE Workshop on Mathematical Methods in Biomedical Image Analysis USA: IEEE, 97-101. doi: 10.1109/MMBIA.2012.6164758
|
[8]
|
Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143: 29-36. doi: 10.1148/radiology.143.1.7063747
|
[9]
|
DeLong ER, DeLong DM, Clarke-Pearson DLComparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44: 837-845. doi: 10.2307/2531595
|
[10]
|
Youden WJ (1950) Index for rating diagnostic test. Cancer 3: 32-35. doi: 10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3
|
[11]
|
Barcaui CB, Lima PMO (2018) Application of teledermoscopy in the diagnosis of pigmented lesions. doi: 10.1155/2018/1624073
|
[12]
|
Janda M, Horsham C, Koh U, et al. (2019) Redesigning skin cancer early detection and care using a new mobile health application: protocol of the SKIN research project, a randomised controlled trial. Dermatology 235: 11-18. doi: 10.1159/000493729
|
[13]
|
Kukutsch NA, Argenziano G, Bergman W (2017) The opinion of dermoscopy experts about teledermoscopy involving primary care physicians and dermatologists. J Eur Acad Dermatol Venereol 31: e470-e471. doi: 10.1111/jdv.14259
|
[14]
|
National Collaborating Centre for Cancer (UK) (2015) Melanoma: assessment and management. National Institute for Health and Care Excellence: Clinical Guidelines. Available from: https://pubmed.ncbi.nlm.nih.gov/26334080/.
|
[15]
|
Piccolo D, Smolle J, Wolf IH, et al. (1999) Face-to-face diagnosis vs telediagnosis of pigmented skin tumors: a teledermoscopic study. Arch Dermatol 135: 1467-1471. doi: 10.1001/archderm.135.12.1467
|
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