Photography in teledermatology: comparing the clinical photographer-, general practitioner- and patient-led model in skin cancers.

Abstract

The use of teledermatology is increasing to meet rising demands, particularly for urgent suspected skin cancer referrals. High-quality photography is imperative in facilitating clinical assessments. In this article we therefore seek to evaluate different modalities of image capture obtained by clinical photographers (CPs), general practitioners (GPs) and patients to support reliable and scalable teledermatology services. Interpretable dermoscopic and macroscopic images of suspicious lesions must be captured for safe patient assessment. This relies on appropriate training, access to and use of equipment, and reliable infrastructure to support transfer of confidential images to specialists. CPs are specifically trained in these domains and therefore well suited to the conventional 'store-and-forward' teledermatology model. Within the GP model, consistent dermoscopy use is resource intensive, when considering device costs, maintenance and training for appropriate use. Time constraints within the primary care system further limit full buy-in to this model. There are little data about patient-initiated images, although there is some suggestion that these may be more appropriate for nonlesional skin disease (i.e. excluding benign or malignant skin lesions), such as in inflammatory skin disease or skin infections. The evidence for a CP-led model remains superior, given the reliability of delivering high-quality images. It is, however, best suited to populations in urban centres. Remote populations may benefit from community hubs, but this is resource dependent. There may be a role for GP- and patient-initiated models for these groups, although they require further research to test their efficacy and safety. Overall, these findings promote the implementation of standardized and consistent clinical photography departments in the country, either within hospitals or as part of a community diagnostic hub.