Program II will create evidence of how to support consumers in the detection of naevi transforming into melanoma and the cognitive processes of naevus selection for monitoring.
Does mobile teledermoscopy as a part of skin self-examination improve participants’ sensitivity and specificity for identifying naevi requiring clinical management, when compared to a dermatologist conducted clinical skin examination as gold standard?
Does repeated mobile teledermoscopy improve sensitivity further?
How concordant are dermatologist tele-diagnoses and is concordance dependent on years of practice?
What are the cognitive processes when people choose naevi they think require management by a doctor?
Objectives: Using data from the CRE Core Study, as well as additional data from existing studies (Nambour Trial and Melanoma Screening Trial), Program II will:
Create evidence for the value and optimal use of consumer driven mobile teledermoscopy
Understand the cognitive processes that lead to consumers’ selection of naevi for photographing and self-monitoring
Show whether the information gained from Programs I and II can be integrated into improved consumer education materials. This will include discussion of combined phenotypic and genetic risk factors.
State of the evidence: Every day, at least 3,000 skin excisions or biopsies are performed in Australia. With the advent of targeted drugs and immunotherapy, costs of treating late stage melanoma have increased exponentially, costing about US$10000-13000 per month/per patient. Melanoma is generally curable when detected and removed early, before metastasis has occurred, so there are enormous benefits to be gained by increasing both the sensitivity and specificity of diagnostic methods.
Industry is rapidly developing online teledermatology services and image recognition using mathematical algorithms, and marketing these directly to consumers. These are convenient and have the potential for faster diagnoses, and for optimisation of case triage, but their benefits are not yet evidence-based.
Previous work has provided insight into the potential benefits and barriers of these technologies for melanoma early detection and care, but there is an urgent need for evidence of effectiveness, safety and feasibility before these can be integrated into clinical practice.
Proposed research: To advance the evidence for the application of mobile teledermoscopy and technology-driven early melanoma detection.
The CRE Core Study will provide mobile teledermoscopy data from half of the participants (n=75) with up to 600 naevi monitored at each time-point over three years. These photographs will be provided to CRE clinicians, allowing comparison of their telediagnosis. The remaining Core Study participants will be asked to conduct skin self-examination (SSE) without teledermoscopy. This will allow comparison between these two groups of the number, type and body site of naevi noticed, as well as improvements over time in both groups.
All participants will complete surveys to elicit their cognitive load while deciding about naevi requiring management by a doctor with or without using technology aids. In-depth qualitative interviews with a sub-sample of participants will be used to improve educational materials guiding participants to naevus selection.
The CRE team will also take a lead on working with consumers to systematically integrate the evidence created through this CRE into better and more modern skin cancer early detection educational materials. These will be rapidly integrated into existing community-based education programs and networks of the Cancer Council Queensland, facilitated by Prof Aitken, as well as relevant dermatology and consumer advocacy channels.
Expected outcomes: New knowledge about the role of consumer facilitated mobile teledermoscopy and enhanced SSE for the management of suspicious naevi will be created. Improved ability to recognise naevi that require management will enhance the effectiveness and cost-effectiveness of melanoma early detection activities.
Significance and innovation: Technology advances will improve access to dermatological care significantly; and this research program will facilitate the evaluation of safety and the feasibility of using these technologies.