A new 'hub and spoke' teledermoscopy system involving general practitioners and dermatologists for the early detection of cutaneous melanoma: a pilot study

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.