Apps and Telemedicine H. Peter Soyer Dermatology Research Centre

Transcription

1 Apps and Telemedicine H. Peter Soyer Dermatology Research Centre

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3 William Gibson The future is already here it's just not very evenly distributed

4 Vision 3D Telederm Network via PACS Cognitive Computing Germline genomics will complement phenotypic risk assessment Protocol driven Decision Support Systems (AI) Partner assisted skin self-examination will lead to early intervention

5 J Am Acad Dermatol. 2011; 64:759

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7 Cell Phone Addiction We check these devices up to 150 times per day.

8 2012 / 6 /

9 Massone C. et al (2007). Melanoma Screening with Cellular Phones 18 patients at the Department of Dermatology, Medical University of Graz. (67% male, age range 14-78) Cellular phone with built in 2 megapixel camera (Sony Ericson K 750i - pictured). This study used a pocket dermoscopy device for magnification. Two teleconsultants obtained a score of correct telediagnoses of 89% (clinical) and of 91.5% (dermoscopic) images. Two dysplastic nevi were over-diagnosed as melanomas, a dermatofibroma was diagnosed as dysplastic nevus and a melanoma was underdiagnosed as seborrheic keratosis. Massone C, Hofmann-Wellenhof R, Ahlgrimm-Siess V, Gabler G, Ebner C, Soyer HP. Melanoma screening with cellular phones. PLoS One May 30;2(5):e483

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12 Histopathologic Diagnosis HPS evaluation SVM by SG Histopathologic Diagnosis HPS evaluation Melanoma -- M Dysplastic Naevus -- D 1 M M 37 D D 2 M M 38 M D 3 M M 39 M D 4 M M 40 D D 5 M M 41 M D 6 M M 42 * D M 7 M M 43 M D 8 M M 44 * D M 9 M M 45 M M 10 M M 46 M M 11 M M 47 M D 12 M M 48 M D 13 * D M 49 * D M 14 M M 50 * D M 15 M M 51 D D 16 M M 52 * D M 17 M M 53 M D 18 M M 54 M D 19 M M 55 M M 20 * D M 56 D D 21 M D 57 D D 22 M M 58 D D 23 M M 59 * D M 24 M D 60 M D 25 M M 61 D D 26 M M 62 * D M 27 M M 63 M D 28 M D 64 M D 29 M D 65 M M 30 M M 66 D D 31 M M 67 M M 32 M M 68 M D 33 M M 69 D D 34 M M 35 M M 36 M M SVM by SG Combining expert knowledge and machine learning: no missed melanomas

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14 Case example 1 Telediagnosis: basal cell carcinoma (BCC) Likelihood of Malignancy: 4 out of 5 (5 is very likely and 1 is unlikely) Recommendation for patient to excise: 4 out of 5 Face-to-Face: This diagnosis was confirmed on clinical examination Patient was asked to see GP for excision BCC confirmed on histology

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17 Melanoma search on AppStore Educational apps, diary apps storing photos for comparison, store and forward teledermatology apps and apps using inbuilt algorithms to assess lesions

18 Tested apps using smartphone camera and underlying algorithm to assess risk without clinician input or dermoscopic attachments

19 App 1 ios App 1 Android App 2 Direct submission App 2 Indirect Submission App 3 Android

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21 None of the Melanoma Apps tested had high enough agreement with dermatologist s clinical opinion, to be considered to provide additional benefit to patient s in assessing their skin for high risk pigmented lesions. Development of highly sensitive and specific Melanoma Apps remains a work in progress

22 Apps for melanoma provide a range of functions including information, education, classification, risk assessment and monitoring change. A more engaged consumer is almost always a healthier consumer

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24 9 th World Congress of MELANOMA October 2017, Brisbane Australia

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27 PAST Consumer Mobile Teledermoscopy Pilot data shows participants can take photos appropriate for telediagnosis; telediagnosis concordant in vast majority of cases with clinical diagnosis, and; consumers are interested in this service model Increases access to specialist care with great potential for remote locations FUTURE Assess health economics and business models Consumer acceptability cost, trust, accessibility Assess value of combining mobile teldermoscopy with computerised algorithm screening for added precision Assess value of combining mobile teldermoscopy with microbiopsies and disease biomarkers

28 Case example 2 Telediagnosis: seborrhoeic keratosis Likelihood of Malignancy: 1 out of 5 Recommendation for patient to excise: 1 out of 5 Face-to-Face: Diagnosis confirmed with face-to-face clinical examination.

29 Case example 3 Telediagnosis: Labial lentigo with recommendation for annual follow up Likelihood of malignancy: 2 out of 5 Recommendation for patient to excise: 2 out of 5 Face-to-Face: Prior to face to face appointment, patient was worried about lesion and had it biopsied by his GP Biopsy confirmed oral melanocytic macule