The TELESPOT Project Implementation of a Teledermoscopy System in Primary Healthcare Centers for Early Skin Cancer Detection

Abstract

The incidence of melanoma and non‐melanoma skin cancer (NMSC) is steadily rising over years (Arnold 2022) and leads to an increased workload for first‐line healthcare providers (FHP) and dermatologists. Furthermore, the shortage of dermatologists and increased skin cancer awareness of the population lead to increasingly long waiting times, hence hampering rapid diagnosis and management, which potentially worsens prognoses (Coates1 2014).

Facing these facts, triage of suspected skin lesions in primary healthcare centers (PHC) could be useful, but FHP often lack faith in their clinical diagnoses (Tensen 2022). Teledermoscopy (TDS), defined as dermoscopic images analyzed at distance using telecommunication technologies, may help to improve the distinction between benign versus malignant skin lesions and consequently speeding up the management of malignant lesions (Coates2 2014). Finally, in terms of public health, early diagnosis followed by appropriate management remains the cornerstone of reduced skin cancer morbidity and mortality (Perez 2022).

In 2019, a pilot TDS project named TELESPOT(TELEdermoscopy Smartphone‐ based Pigmented lesion diagnosis Online Taskforce) was initiated in the French‐ speaking part of Belgium. Enrolled PHCs acquired dermoscopic images of skin lesions clinically judged as suspicious and sent them remotely to a tertiary skin cancer center (TSCC). After a double reading of both the clinical and dermoscopic images by two dermatologists, the TSCC sent a triage report with as main information the prioritization of lesion management: low-priority management (LPM) versus highpriority management (HPM). For HPM lesions, rapid care in the TSCC was proposed if required by the PHC. The study covered two subsequent periods. The initial period included acquisitions from six PHCs, from September 2019 to August 2020. The extension period included data from the six initial PHCs and from three additional PHCs, from September 2020 to August 2022. In fact, a preliminary evaluation was performed after the initial period. This evaluation focused on the raw screening data and its comparison with previous published studies, as well as the satisfaction scores of both involved parties (FHPs and patients). After having achieved the aims of this pilot phase and after the validation of several studied parameters and encouraging feedback from the initial PHCs, it was decided to extend the duration of the study, the number of cases and the number of PHC. A final evaluation was performed after the extension period. This evaluation focused on the statistical analysis of data and its comparison between different groups according to initial versus additional PHCs and initial period versus extension period.

This thesis is based on three main peer-reviewed publications, three posters presented at international scientific congresses and one oral communication presented at the national Dermatology congress. These publications present the intellectual and technological development of the project, its implementation, and the evaluation of the initial and extension periods.