Background and Aim
Patient-performed teledermoscopy may improve access to dermatologic care, but evidence to guide dermatoscope selection for patient use is limited. This study aimed to compare a lower-cost, ambient-light, nonpolarised dermatoscope with a higher-cost, illuminated, polarised dermatoscope for patient-performed teledermoscopy following treatment for early-stage melanoma.
Methods
This randomised study within a trial was embedded in the MEL-SELF trial. Adults previously treated for early-stage melanoma ((AJCC 0–II) and enrolled in the patient-led surveillance arm were recruited from specialist and general practitioner–led skin cancer clinics across Australia. Participants were randomised to receive either a polarised or ambient-light dermatoscope smartphone attachment. Optional online training was provided. Participants submitted clinician-identified and self-detected lesion images via a secure teledermatology platform at 3-month intervals. The primary outcome was the proportion of participants submitting baseline images of sufficient quality for a teledermatologist to provide a management recommendation. Secondary outcomes included the proportion receiving a management recommendation for at least one image during the study period, per-image recommendation proportions, device costs, and qualitative assessments of image quality and usability.
Results
Of 251 participants (polarised: 128; ambient: 123),175 (69.7%) received a teledermatologist management recommendation for baseline images (polarised: 92 [71.9%]; ambient light: 83 [67.5%]; difference, 4.4%; 95% CI, –7.0% to 15.8%). By 12 months, the proportion receiving at least one recommendation was similar between groups (polarised: 104/128 [81.3%]; ambient light: 94/123 [76.4%]; difference, 4.3%; 95% CI, –8.1% to 16.6%). However, a per-image analysis showed more polarised images (913 of 961 [95.0%]) than ambient-light images (706 of 775 [91.1%]) were reportable and supported a recommendation (difference, 3.9%; 95% CI, 1.5% to 6.3%), with a larger difference for self-detected lesions (6.8%; 95% CI, 3.3% to 10.2%). Teledermatologists more frequently noted blurriness and poor lighting with ambient-light images. Patient usability ratings were similar between devices, but ambient-light dermatoscope users reported more image quality issues. The polarised device was more expensive (AU$493.90 vs AU$53.90).
Conclusions Both devices enabled patients to perform dermoscopy and receive teledermatology recommendations. The modest image quality advantages of the polarised device must be weighed against its substantially higher cost.