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Ross MW, Bennis SL, Zoschke N, Simon Rosser BR, Stull CL, Nyitray AG, Khariwala SS, Nichols M, Flash C, Wilkerson M. Screening for HPV-Related Oropharyngeal Cancer in Gay and Bisexual Men: Acceptability and Predicting Possible Use of "Oral Selfies" by Smartphone as a Secondary Prevention Approach. VENEREOLOGY (BASEL, SWITZERLAND) 2023; 2:180-193. [PMID: 38515606 PMCID: PMC10956645 DOI: 10.3390/venereology2040016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Oropharyngeal cancers (OPCa) caused by HPV have emerged as one of the leading causes of malignancies caused by HPV infection. They are also significantly more likely to occur in males and in people with a history of oral sex with multiple partners. Gay and bisexual men are disproportionately affected by HPV-positive oropharyngeal cancers. We studied 1699 gay and bisexual men on 2 major dating sites in the US to assess their knowledge about HPV-related OPCa, attitudes toward screening for it, beliefs about oropharyngeal cancer screening based on the Health Belief Model, and attitudes toward possible screening approaches for OPCa. Knowledge on a 12-item scale was low, with a median of 5 items correct: 72% knew of the benefits of HPV vaccination. Significant predictors of needing OPCa screening included perception of risk for OPCa, seeing it as severe, having lower barriers, fewer reasons to avoid screening, higher knowledge, and being HPV vaccinated were significant predictors, explaining half the total variance. Most participants would accept routine, virtual/online doctor or dental appointments, and over half would accept an in-person screening. Nearly two-thirds stated that they would accept getting checked for OPCa if they could do self-screening at home, and half were prepared to use an online screening tool or app, where they could take an "oral selfie" and send it to a healthcare provider for examination. One-third stated that they would trust the results of a home screening completed by themselves and posted to a website equally as cancer screening completed online by a healthcare provider. Data indicate that despite low OPCA knowledge levels, the risk of HPV-associated OPCa was known. Being at personal risk and having knowledge of disease severity had 70% of the sample thinking about, or preparing to get, screening. Self-screening by a smartphone "oral selfie" transmitted to a screening website was acceptable to many gay and bisexual men, and online screening by a doctor or dentist was acceptable to most. OPCa screening in this population using electronic technology, together with the increasing incidence of HPV-associated OPCa in gay and bisexual men, brings together an opportunity to detect OPCa early.
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Affiliation(s)
- Michael W. Ross
- Institute of Sexual and Gender Health, Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN 55454, USA
| | - Sarah L. Bennis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Niles Zoschke
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Brian R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
| | - Cyndee L. Stull
- School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA
| | - Alan G. Nyitray
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI 53202, USA
| | - Samir S. Khariwala
- Department of Otolaryngology, Head and Neck Surgery, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mark Nichols
- Avenue360 Health Services, Houston, TX 77008, USA
| | | | - Michael Wilkerson
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Ross MW, Bennis SL, Nichols CM, Zoschke IN, Wilkerson JM, Rosser BRS, Stull CL, Nyitray AG, Flash C, Khariwala SS. Oral/oropharyngeal "selfies" in gay and bisexual men: a pilot study exploring oropharyngeal screening for HPV-related possible malignancies. Front Public Health 2023; 11:1233274. [PMID: 37780435 PMCID: PMC10537951 DOI: 10.3389/fpubh.2023.1233274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/16/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives This study aims to determine the potential uptake and quality of oropharyngeal "selfies" taken by gay/bisexual men as a screening approach for HPV-associated oropharyngeal cancer. Methods From 1,699 gay/bisexual men in the US, surveyed about knowledge and attitudes to HPV-associated oropharyngeal cancer, a random sample of 320 men were invited to take an oropharyngeal "selfie" by smartphone and send it to the study website: 113 (35.5%) did so. Images were rated for quality by three healthcare professional raters blinded to each other's rating, with an otolaryngologist as the gold standard. In the second wave, those whose images were rated as unacceptable were sent a short instructional video and asked to send another image. Of the 65 invited, 46 did so. An additional 15.2% sent acceptable images, and a total of 28.3% of the sample was acceptable. Results A total of 1,121 men willing to participate in the future study who believed they could take a quality "oral selfie" were potentially eligible for this activity. A random sample of 320 participated: 153 participants started (47.8%) and 113 participants (35.3%) submitted an image. Responders were more likely to be younger, have higher knowledge scores on oropharyngeal HPV-related cancer, and have had HPV vaccination. There was high agreement between the three raters. Images of good/acceptable quality were 22.1%; oropharynx partially occluded images were 29.2%; oropharynx not visible images were 18.6%; images too dark were 21.2%; and images too small were 8.8%. From the second wave of requests with instructional videos, an additional 15.2% sent in quality images, with the remaining issues being partial occlusion of the tonsils by the tongue. Conclusion One-third of the invited gay and bisexual men sent oropharyngeal selfie images to the study website and a total of 28.3% were of clinically acceptable quality. Following an instructional video on poorer-quality images, additional quality images were received. One barrier, i.e., partial occlusion of the oropharynx by the tongue remained. Quality oropharyngeal "selfies" are obtainable online.
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Affiliation(s)
- Michael W. Ross
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Sarah L. Bennis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | | | - I. Niles Zoschke
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - J. Michael Wilkerson
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Cyndee L. Stull
- School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Alan G. Nyitray
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Samir S. Khariwala
- Department of Otolaryngology, Head and Neck Surgery, Medical School, University of Minnesota, Minneapolis, MN, United States
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Koop C, Kruus P, Hallik R, Lehemets H, Vettus E, Niin M, Ross P, Kingo K. A country-wide teledermatoscopy service in Estonia shows results comparable to those in experimental settings in management plan development and diagnostic accuracy: A retrospective database study. JAAD Int 2023; 12:81-89. [PMID: 37288150 PMCID: PMC10241971 DOI: 10.1016/j.jdin.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 06/09/2023] Open
Abstract
Background Teledermatoscopy accuracy has been examined in experimental settings and is recommended for primary care despite lacking real-world implementation evidence. A teledermatoscopy service has been provided in Estonia since 2013, where lesions are evaluated based on the patient's or general practitioner's suggestion. Objective The management plan and diagnostic accuracy of a real-world store-and-forward teledermatoscopy service for melanoma diagnosis were evaluated. Methods A retrospective study analyzed 4748 cases from 3403 patients using the service between October 16, 2017 and August 30, 2019 by matching country-wide databases. Management plan accuracy was calculated as the percentage of melanoma found that was managed correctly. Diagnostic accuracy parameters were sensitivity, specificity, and positive and negative predictive values. Results Management plan accuracy for melanoma detection was 95.5% (95% CI, 77.2-99.9). Diagnostic accuracy showed a sensitivity of 90.48% (95% CI, 69.62-98.83) and a specificity of 92.57% (95% CI, 91.79-93.31). Limitations Matching the lesions was limited to SNOMED CT location standard precision. Diagnostic accuracy was calculated based on a combination of diagnosis and management plan data. Conclusion Teledermatoscopy for detecting and managing melanoma in real-world clinical practice displays results comparable with those in experimental setting studies.
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Affiliation(s)
| | - Priit Kruus
- Dermtest OÜ, Tallinn, Estonia
- Department of Health Technologies, Tallinn University of Technology, School of Information Technology, Tallinn, Estonia
| | - Riina Hallik
- Department of Health Technologies, Tallinn University of Technology, School of Information Technology, Tallinn, Estonia
| | | | - Elen Vettus
- East Tallinn Central Hospital, Clinic of Internal Medicine, Centre of Oncology, Tallinn, Estonia
| | | | - Peeter Ross
- Department of Health Technologies, Tallinn University of Technology, School of Information Technology, Tallinn, Estonia
- East Tallinn Central Hospital, Tallinn, Estonia
| | - Külli Kingo
- Department of Dermatology and Venerology, Faculty of Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Dermatology Clinic, Tartu, Estonia
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Jones LK, Oakley A. Store-and-Forward Teledermatology for Assessing Skin Cancer in 2023: Literature Review. JMIR DERMATOLOGY 2023; 6:e43395. [PMID: 37632914 PMCID: PMC10335330 DOI: 10.2196/43395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/15/2023] [Accepted: 04/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The role of teledermatology for skin lesion assessment has been a recent development, particularly, since the COVID-19 pandemic has impacted the ability to assess patients in person. The growing number of studies relating to this area reflects the evolving interest. OBJECTIVE This literature review aims to analyze the available research on store-and-forward teledermatology for skin lesion assessment. METHODS MEDLINE was searched for papers from January 2010 to November 2021. Papers were searched for assessment of time management, effectiveness, and image quality. RESULTS The reported effectiveness of store-and-forward teledermatology for skin lesion assessment produces heterogeneous results likely due to significant procedure variations. Most studies show high accuracy and diagnostic concordance of teledermatology compared to in-person dermatologist assessment and histopathology. This is improved through the use of teledermoscopy. Most literature shows that teledermatology reduces time to advice and definitive treatment compared to outpatient clinic assessment. CONCLUSIONS Overall, teledermatology offers a comparable standard of effectiveness to in-person assessment. It can save significant time in expediting advice and management. Image quality and inclusion of dermoscopy have a considerable bearing on the overall effectiveness.
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Affiliation(s)
| | - Amanda Oakley
- Te Whatu Ora Waikato, Hamilton, New Zealand
- The University of Auckland, Auckland, New Zealand
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Zhou W, Xu X, Cen Y, Chen J. The role of lncRNAs in the tumor microenvironment and immunotherapy of melanoma. Front Immunol 2022; 13:1085766. [PMID: 36601121 PMCID: PMC9806239 DOI: 10.3389/fimmu.2022.1085766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Melanoma is one of the most lethal tumors with highly aggressive and metastatic properties. Although immunotherapy and targeted therapy have certain therapeutic effects in melanoma, a significant proportion of patients still have drug resistance after treatment. Recent studies have shown that long noncoding RNAs (lncRNAs) are widely recognized as regulatory factors in cancer. They can regulate numerous cellular processes, including cell proliferation, metastasis, epithelial-mesenchymal transition (EMT) progression and the immune microenvironment. The role of lncRNAs in malignant tumors has received much attention, whereas the relationship between lncRNAs and melanoma requires further investigation. Our review summarizes tumor suppressive and oncogenic lncRNAs closely related to the occurrence and development of melanoma. We summarize the role of lncRNAs in the immune microenvironment, immunotherapy and targeted therapy to provide new targets and therapeutic methods for clinical treatment.
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Teledermatology in Rural, Underserved, and Isolated Environments: A Review. CURRENT DERMATOLOGY REPORTS 2022; 11:328-335. [PMID: 36310767 PMCID: PMC9589860 DOI: 10.1007/s13671-022-00377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
Abstract
Purpose of Review Recent Findings Summary
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Castillo F, Peracca S, Oh DH, Twigg AR. The Utilization and Impact of Live Interactive and Store-and-Forward Teledermatology in a Veterans Affairs Medical Center During the COVID-19 Pandemic. Telemed J E Health 2021; 28:1186-1192. [PMID: 34919470 DOI: 10.1089/tmj.2021.0275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Teledermatology has emerged as a promising method of continuing dermatologic care during the coronavirus 2019 (COVID-19) pandemic, including in the Department of Veterans Affairs (VA). Analysis of the utilization and impact of teledermatology within the San Francisco Veterans Affairs Health Care System (SFVAHCS) may elucidate the ways that teledermatology programs can continue to be optimized. Methods: We conducted a retrospective analysis of live interactive encounters, Veterans Affairs Video Connect (VVC), store-and-forward telehealth (SFT), and face-to-face (FTF) consultations, performed within the SFVAHCS from March 2020 to December 2020. To assess utilization, we analyzed numbers of encounters throughout 2020. To assess impact, we analyzed primary diagnoses for each encounter and rates of recommendations for medications and lesion biopsies. Additionally, we assessed diagnostic accuracy associated with each teledermatology type by measuring concordance between teledermatologists' clinical diagnoses and histopathological diagnoses. Results: Two thousand two hundred fifty FTF, 347 VVC, and 470 SFT encounters were conducted from March to December 2020. More female patients utilized VVC, and patients who utilized VVC were younger than SFT and FTF users (p < 0.01). SFT was utilized more by patients from rural areas (p < 0.01). Diagnoses addressed were significantly different between VVC and SFT. A majority of VVC encounters involved referrals for inflammatory conditions; primary diagnoses associated with SFT consultations were most frequently neoplasms. Comparison of VVC and SFT outcomes showed that more VVC visits resulted in a medication recommendation, while more SFT consultations resulted in a biopsy recommendation. Conclusions: Teledermatology contributed to meeting patient needs throughout 2020 and created an impact on clinical management. Patient characteristics, diagnoses, and type of impact associated with encounters varied between SFT and VVC. This analysis provides insight into teledermatology utilization within the VA system and can contribute to efforts to improve the quality of teledermatology care for veterans.
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Affiliation(s)
- Francine Castillo
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Sara Peracca
- Dermatology Research Unit, San Francisco VA Health Care System, San Francisco, California, USA
| | - Dennis H Oh
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA.,Dermatology Research Unit, San Francisco VA Health Care System, San Francisco, California, USA
| | - Amanda R Twigg
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA.,Dermatology Research Unit, San Francisco VA Health Care System, San Francisco, California, USA
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Skudalski L, Waldman R, Kerr PE, Grant-Kels JM. Melanoma: How and When to Consider Clinical Diagnostic Technologies. J Am Acad Dermatol 2021; 86:503-512. [PMID: 34915058 DOI: 10.1016/j.jaad.2021.06.901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
In response to rising rates of melanoma worldwide, novel non-invasive melanoma detection techniques are emerging to facilitate the early detection of melanoma and decrease unnecessary biopsies of benign pigmented lesions. Because they often report similar study findings, it may be difficult to determine how best to incorporate these technologies into clinical practice based on their supporting studies alone. As an expansion of the recent article by Fried et al.1, which reviewed the clinical data supporting these non-invasive melanoma detection techniques, the first article in this continuing medical education series provides practical advice on how and when to use various non-invasive melanoma detection techniques into clinical practice.
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Affiliation(s)
- Lauren Skudalski
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Reid Waldman
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Philip E Kerr
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA.
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9
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Abi-Saab LS, Meirelles BHS, Demo MLO. Economic assessment of teledermatology in the state of Santa Catarina - Brazil. Public Health 2021; 201:35-40. [PMID: 34742115 DOI: 10.1016/j.puhe.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES In locations with poor public dermatology services, teledermatology emerges as a viable way to fill this need. Thus, the aim was to estimate how much could be saved with the use of teledermatology in the state of Santa Catarina, Brazil, from 2015 to 2018. STUDY DESIGN Observational study of the analytical type with a cross-sectional design and collection of secondary data in electronic media. METHODS A total of 95,828 teledermatology test protocols from the period were evaluated. The amount that would be necessary to refer all the patients of the several regions of the state for evaluation by General Dermatology (secondary network) was estimated, as it occurred before the deployment of teledermatology, considering the cost of displacement, consultation with a specialist, cost aid and opportunity cost of patients and companions. This amount was compared with the amount effectively spent on the screening deployment via teledermatology. RESULTS There was a minimum savings of $1,170,550.82 during the period, with an average cost savings of $21.94 per protocol not forwarded to the secondary network. The greater the distance and time spent to evaluate the patient by a specialist, the greater the savings. CONCLUSIONS Teledermatology provides savings in public resources, reduces the number of patient referrals, and improves the dermatological assistance provided to the population of Santa Catarina. This is a relevant and efficient health technology.
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Affiliation(s)
- L S Abi-Saab
- Dermatology Service, Hospital Universitário Polyodoro Ernani de São Thiago, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil.
| | - B H S Meirelles
- Department of Nursing - Health Informatics Graduate Program, Federal University of Santa Catarina - UFSC, Florianópolis, Brazil.
| | - M L O Demo
- Department of Medicine, South Santa Catarina University - Unisul, Tubarão, Brazil.
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10
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Goodier MC, DeKoven JG, Taylor JS, Sasseville D, Fowler JF, Fransway AF, DeLeo VA, Marks JG, Zug KA, Hylwa SA, Warshaw EM. Inter-rater variability in patch test readings and final interpretation using store-forward teledermatology. Contact Dermatitis 2021; 85:274-284. [PMID: 33837533 DOI: 10.1111/cod.13856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data regarding teledermatology for patch testing are limited. OBJECTIVES Compare patch test readings and final interpretation by two in-person dermatologists (IPDs) with eight teledermatologists (TDs). METHODS Patch tested patients had photographs taken of 70 screening series of allergens at 48 hours and second readings. Eight TDs reviewed photos and graded reactions (negative, irritant, doubtful, +, ++, +++) at 48 hours and second readings; in addition, they coded a final interpretation (allergic, indeterminant, irritant, negative) for each reaction. TDs rated overall image quality and confidence level for each patient and patch test reaction, respectively. Percentage of TD-IPD agreement based on clinical significance (success, indeterminate, and failure) was calculated. Primary outcome was agreement at the second reading. RESULTS Data were available for 99, 101, and 66 participants at 48 hours, second reading, and final interpretation, respectively. Pooled failure (+/++/+++ vs negative) at second reading was 13.6% (range 7.9%-20.4%). Pooled failure at 48 hours and final interpretation was 5.4% (range 2.9%-6.8%) and 24.6% (range 10.2%-36.8%), respectively. Confidence in readings was statistically correlated with quality of images and disagreement. CONCLUSION For patch testing, teledermatology has significant limitations including clinically significant pooled failure percentages of 13.6% for second readings and 24.6% for final interpretation.
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Affiliation(s)
- Molly C Goodier
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,Department of Dermatology, Health Partners Institute Dermatology, St. Louis Park, Minnesota, USA
| | - Joel G DeKoven
- Department of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Department of Dermatology, Montreal General Hospital, McGill University, Montreal, Québec, Canada
| | - Joseph F Fowler
- Department of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sara A Hylwa
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Contact Dermatitis Clinic, Park Nicollet, Minneapolis, Minnesota, USA.,Department of Dermatology, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Contact Dermatitis Clinic, Park Nicollet, Minneapolis, Minnesota, USA
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11
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Clarke EL, Reichenberg JS, Ahmed AM, Keeling B, Custer J, Rathouz PJ, Jambusaria-Pahlajani A. The utility of teledermatology in the evaluation of skin lesions. J Telemed Telecare 2021; 29:382-389. [PMID: 33461401 DOI: 10.1177/1357633x20987423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Past studies have shown mixed results about the accuracy of store-and-forward (SAF) teledermatology in the evaluation of skin lesions. The objective of this study is to determine the accuracy of SAF teledermatology in the diagnosis of skin lesions and biopsy decision compared to in-person clinical evaluation. METHODS Histories and photographs of skin lesions gathered at clinic visits were sent as SAF consults to teledermatologists, whose diagnoses and biopsy decisions were recorded and compared statistically to the clinic data.Results and Discussion: We enrolled 206 patients with 308 lesions in the study. The study population was composed of 50% males (n = 104), and most patients were white (n = 179, 87%) and not Hispanic/Latino (n = 167, 81%). There was good concordance for biopsy decision between the clinic dermatologist (CD) and teledermatologist (TD) (Cohen's kappa (κ) = 0.51), which did not significantly differ when melanocytic lesions were excluded (κ = 0.54). The sensitivity and specificity of teledermatology based on biopsy decision was 0.71 and 0.85, respectively. Overall concordance in first diagnosis between the CD and TD was good (κ = 0.60). While there was no difference between CD and TD in proportion of correct diagnoses compared to histopathology, two skin cancers presentations were missed by TD. Study limitations included sample size, enrolment bias and differing amounts of teledermatologist case experience. Teledermatology has good concordance in diagnosis and biopsy decision when compared to clinic dermatology. Teledermatology may be utilized in the evaluation of skin lesions to expand access to dermatologic care.
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Affiliation(s)
- Emily L Clarke
- Dell Medical School at the University of Texas at Austin, USA
| | - Jason S Reichenberg
- Division of Dermatology, Dell Medical School at the University of Texas at Austin, USA
| | - Ammar M Ahmed
- Division of Dermatology, Dell Medical School at the University of Texas at Austin, USA
| | - Brett Keeling
- Division of Dermatology, Dell Medical School at the University of Texas at Austin, USA
| | - James Custer
- Department of Population Health, Dell Medical School at the University of Texas at Austin, USA
| | - Paul J Rathouz
- Department of Population Health, Dell Medical School at the University of Texas at Austin, USA
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Jiang CY, El-Kouri NT, Elliot D, Shields J, Caram MEV, Frankel TL, Ramnath N, Passero VA. Telehealth for Cancer Care in Veterans: Opportunities and Challenges Revealed by COVID. JCO Oncol Pract 2020; 17:22-29. [PMID: 32970512 DOI: 10.1200/op.20.00520] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Veterans Health Administration system is one of the largest integrated health care providers in the United States, delivering medical care to > 9 million veterans. Barriers to delivering efficient health care include geographical limitations as well as long wait times. Telehealth has been used as a solution by many different health care services. However, it has not been as widely used in cancer care. In 2018, the US Department of Veterans Affairs (VA) Pittsburgh Healthcare System expanded the use of telehealth to provide antineoplastic therapies to rural patients by creating a clinical video telehealth clinic of the Virtual Cancer Care Network. This allows oncologists located at the tertiary center to virtually deliver care to remote sites. The recent COVID-19 pandemic forced oncologists across the VA system to adopt telehealth to provide continuity of care. On the basis of our review and personal experience, we have outlined opportunities for telehealth to play a role in every step of the cancer care journey from diagnosis to therapy to surveillance to clinical trials for medical, surgical, and radiation oncology. There are many advantages, such as decreased travel time and potential cost savings; however, there continues to be challenges with veterans having access to devices and the Internet as well as understanding how to use telehealth equipment. The lessons learned from this assessment of the VA telehealth system for cancer care can be adopted and integrated into other health systems. In the future, there needs to be evaluation of how telehealth can be further incorporated into oncology, satisfaction of veterans using telehealth services, overcoming telehealth barriers, and defining metrics of success.
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Affiliation(s)
- Cindy Y Jiang
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | - David Elliot
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | - Megan E V Caram
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Ann Arbor, MI.,VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Timothy L Frankel
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Nithya Ramnath
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Ann Arbor, MI.,VA Ann Arbor Healthcare System, Ann Arbor, MI
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Young AT, Vora NB, Cortez J, Tam A, Yeniay Y, Afifi L, Yan D, Nosrati A, Wong A, Johal A, Wei ML. The role of technology in melanoma screening and diagnosis. Pigment Cell Melanoma Res 2020; 34:288-300. [PMID: 32558281 DOI: 10.1111/pcmr.12907] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/28/2022]
Abstract
Melanoma presents challenges for timely and accurate diagnosis. Expert panels have issued risk-based screening guidelines, with recommended screening by visual inspection. To assess how recent technology can impact the risk/benefit considerations for melanoma screening, we comprehensively reviewed non-invasive visual-based technologies. Dermoscopy increases lesional diagnostic accuracy for both dermatologists and primary care providers; total body photography and sequential digital dermoscopic imaging also increase diagnostic accuracy, are supported by automated lesion detection and tracking, and may be best suited to use by dermatologists for longitudinal follow-up. Specialized imaging modalities using non-visible light technology have unproven benefit over dermoscopy and can be limited by cost, access, and training requirements. Mobile apps facilitate image capture and lesion tracking. Teledermatology has good concordance with face-to-face consultation and increases access, with increased accuracy using dermoscopy. Deep learning models can surpass dermatologist accuracy, but their clinical utility has yet to be demonstrated. Technology-aided diagnosis may change the calculus of screening; however, well-designed prospective trials are needed to assess the efficacy of these different technologies, alone and in combination to support refinement of guidelines for melanoma screening.
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Affiliation(s)
- Albert T Young
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Niki B Vora
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jose Cortez
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Andrew Tam
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Yildiray Yeniay
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Ladi Afifi
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Di Yan
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Adi Nosrati
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Andrew Wong
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Arjun Johal
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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14
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Circ_0002770, acting as a competitive endogenous RNA, promotes proliferation and invasion by targeting miR-331-3p in melanoma. Cell Death Dis 2020; 11:264. [PMID: 32327630 PMCID: PMC7181653 DOI: 10.1038/s41419-020-2444-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/28/2020] [Accepted: 03/31/2020] [Indexed: 12/02/2022]
Abstract
Melanoma is a kind of tumor that originates from melanocytes and is characterized by chemoresistance and distant metastasis. Although the complete pathogenesis of melanoma remains unclear, increasing evidence suggests that circular RNAs (circRNAs) may be involved. In the present study, we identified a circular RNA, circ_0002770, which is produced from the well-known oncogene MDM2, and was sharply increased in melanoma and correlated with a poor prognosis. Knockdown of circ_0002770 suppressed melanoma cell invasion, migration and proliferation. Mechanistically, circ_0002770 acted as a sponge of miR-331-3p and could indirectly regulate DUSP5 and TGFBR1. Inhibition of miR-331-3p reversed the inhibitory effect of si-circ_0002770 on melanoma cell proliferation and invasion. In vivo evidence further confirmed that silencing circ_0002770 inhibited melanoma tumor formation. In conclusion, circ_0002770 facilitated melanoma cell proliferation, invasion and migration by sponging miR-331-3p and modulating DUSP5 and TGFBR1.
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15
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Gemelas J, Capulong D, Lau C, Mata-Diaz S, Raugi GJ. Positive Predictive Value of Melanoma Diagnosis in Store-and-Forward Teledermatology. Telemed J E Health 2019; 25:701-707. [DOI: 10.1089/tmj.2018.0056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jordan Gemelas
- School of Public Health, University of Washington, Seattle, Washington
- School of Public Health, Oregon Health and Science University/Portland State University, Portland, Oregon
| | - Dana Capulong
- Department of Microbiology, University of Washington, Seattle, Washington
| | - Clayton Lau
- School of Public Health, University of Washington, Seattle, Washington
| | - Sandra Mata-Diaz
- School of Public Health, University of Washington, Seattle, Washington
| | - Gregory J. Raugi
- VA Puget Sound Health Care System, Seattle, Washington
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington
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16
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Peracca SB, Jackson GL, Weinstock MA, Oh DH. Implementation of Teledermatology: Theory and Practice. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-0252-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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17
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Janda M, Horsham C, Koh U, Gillespie N, Vagenas D, Loescher LJ, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Peter Soyer H. Evaluating healthcare practitioners' views on store-and-forward teledermoscopy services for the diagnosis of skin cancer. Digit Health 2019; 5:2055207619828225. [PMID: 30792879 PMCID: PMC6376520 DOI: 10.1177/2055207619828225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/13/2019] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of the study is to evaluate healthcare practitioners’ views on and
satisfaction with (i) digital image acquisition and storage and (ii)
store-and-forward teledermoscopy services for the diagnosis of skin cancer
in their clinical practice. Methods An online survey was conducted among 59 healthcare practitioners (GPs
(n=17), dermatologists (n=22),
dermatology registrars (n=18), a dermatology research
fellow (n=1) and a plastic surgeon (n=1))
to assess usability of digital image acquisition and storage for when the
imaging process is conducted by the healthcare practitioners themselves, or
by their patients. The study identifies the enablers and barriers of this
emerging mode of medical practice. A thematic analysis was used to extract
key themes from open-ended responses, which involved identifying themes and
patterns within and across participants. Results Thirty-four healthcare practitioners (58%) had previously used a mobile
dermatoscope within their practice. Participants most appreciated its use in
their practice for lesion monitoring (59%) and record keeping (39%).
Challenges reported were the increased time to support the additional
workload (45%), technical issues (33%) and cost of equipment (27%).
Practitioners were unsure (36%) or did not advocate teledermoscopy for
direct-to-consumer use (41%). Only 23% supported the use of
direct-to-consumer teledermoscopy. Conclusion While most practitioners are receptive to mobile teledermoscopy, there was
less support for patient-initiated use, whereby the patient controls the
imaging process. As technology improves rapidly it is important to evaluate
practitioners’ acceptance and satisfaction of evolving telehealth services,
moving forward with models of practice where healthcare practitioners and
other healthcare providers will feel comfortable engaging in telehealth
services.
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Affiliation(s)
- Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Uyen Koh
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lois J Loescher
- Colleges of Nursing and Public Health, The University of Arizona, Tucson, Arizona, United States of America
| | | | | | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
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18
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Lee KJ, Finnane A, Soyer HP. Recent trends in teledermatology and teledermoscopy. Dermatol Pract Concept 2018; 8:214-223. [PMID: 30116667 PMCID: PMC6092076 DOI: 10.5826/dpc.0803a13] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/21/2018] [Indexed: 11/28/2022] Open
Abstract
Teledermatology is a useful alternative where specialized dermatological assistance is not available and has been used successfully to support health professionals in a wide range of settings worldwide, in either an asynchronous store-and-forward format or a real-time video conferencing format. Teledermoscopy, which includes dermoscopic images in the teleconsultation, is another addition that improves remote assessments of pigmented lesions. A more recent variant is mobile teledermoscopy, which uses a smartphone to deliver the same type of service. Teledermoscopy’s greatest strength may be as a triage and monitoring tool, as it can reduce the number of unnecessary referrals, wait times, and the cost of providing and receiving dermatological care. While face-to-face (FTF) care remains the gold standard for diagnosis, drawbacks of not using FTF care as the primary method can be mitigated if teleconsultants are willing to refer to FTF care whenever there is uncertainty. Teledermatology has generally been well accepted by patients and practitioners alike. Barriers to the large-scale use of teledermatology remain. Assigning medicolegal responsibility and instituting a reimbursement system are critical to promoting widespread use by medical professionals, while privacy and security features and a mechanism to link teleconsultations to patients’ existing health records are essential to maximize patient benefit. Direct-to-consumer services also need attention from regulators to ensure that consumers can enjoy the benefits of telemedicine without the dangers of unregulated or untested platforms.
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Affiliation(s)
- Katie J Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - Anna Finnane
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,The University of Queensland, School of Public Health, Herston, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
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19
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Doarn CR, Merrell RC. An Empty Frame: What Canvas Will You Put in It? Telemed J E Health 2018; 24:327-328. [PMID: 29746234 DOI: 10.1089/tmj.2018.29007.crd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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