Dermatologists’ and General Practitioners’ views on the role of patient-led melanoma surveillance using digital technologies

Abstract

Background: There is an increasing disparity between the number of dermatologists in Australia and the number of melanoma patients who need ongoing surveillance, particularly outside of metropolitan areas. Digital technologies that enable remote dermatological review of patient performed mobile teledermosopy may be one potential solution. Clinicians’ acceptance of mHealth tools is one of the most influential factors for their adoption and sustainability.

Aims: To explore clinicians’ views of mobile teledermoscopy and their experiences of being involved in a pilot trial of patient-led melanoma surveillance, to gain understanding of their acceptability of the digital technologies used and remote care delivery.

Methods: Semi-structured interviews and thematic analysis. This qualitative study was nested within a pilot randomised controlled trial (RCT) of 100 patients conducted at specialist and GP-led melanoma clinics in NSW.

Results: 8 clinicians were interviewed (1 dermatologist, 1 surgical oncologist, and 3 skin specialist general practitioners). Clinicians identified several benefits such as early detection of skin cancer, reassurance for patients between scheduled visits, facilitation of remote monitoring, and reduction in unnecessary visits. However poor image quality, inability to make an adequate assessment of the imaged lesion, concern that suspicious lesions may be missed, and medico-legal considerations mean mobile teledermatology also has the potential to prompt unnecessary clinic visits and procedures.

Conclusions: Clinicians are enthusiastic about the hypothetical and experienced benefits of mobile teledermoscopy however, ways of appropriately managing clinical uncertainty will be key to achieving these benefits in real life, and to minimising potential harms.