Implementation of Teledermoscopy and Artificial Intelligence

Description

Study objective:

1. Is teledermoscopy an equally safe method as conventional care for skin cancer patients?
2. How does teledermoscopy affect current care and organization of skin diseases?
3. How should the results of diagnostic algorithms be displayed in real-life health care to achieve the proper effect?
4. In what stage of the assessment of a skin lesion should the results of a diagnostic algorithm be presented to the physician to ensure the highest diagnostic accuracy while minimizing risk of undetected skin cancer?

Material and methods:

1. Study setting Patients scheduled for a skin examination for a suspected skin lesion can be recruited, both in dermatology clinics and participating primary care clinics.
2. Data acquisition Patient data and images will be collected with the Dermicus application. Participating PCP and dermatologists will also fill in a questionnaire about their assessment of the patient. Additional informaiton will be collected from medical records, i.e. histopathological diagnoses, and from national registries. Questionnaires will be entered in a digital data base using REDCap.
3. Statistical analyses 4.1. In part 1, the number of consultations send to dermatologists and for pathological analyses before introduction of teledermoscopy and during the first and second year if using teledermoscopy will be analysed. Descriptive statistics will be presented and differences between the different time periods will be tested with t-tests and paired t-tests.

4.2. In part 2, different ways of displaying the results of the artificial intelligence as well as feeding the results at different time points will be compared using analyses of sensitivity, specificity, and Area under ROC-curve (AUROC). The study will also report the impact the results of the artificial intelligence has on the willingness to change a diagnosis or a management plan.

5. Power set to 0.8 and significance to 0.05. 10% censures. 5.1. Patients recruited to this study can be used in several of the sub-studies. The aim of the study is to collect 8000 patients in total in this study.

5.2. To detect a difference in "unimaged skin cancers" between teledermoscopy and conventional care of patients 1200 cases and 2400 controls need to be included.

5.3. To detect a 10% difference in sensitivity/ specificity of diagnostic ability in PCPs before and after working with teledermoscopy 3400 patients need to be included.

5.4. To investigate how artificial intelligence should be implemented in clinical care the investigators have calculated that 6000 patients are needed to detect a 10% difference in sensitivity and specificity in the subgroups.

Ethical considerations and data management:

Data will be collected using Dermicus, a CE-certified digital platform and mobile application. With the application downloaded on iPhones, locked for any other uses, the history of the patients are registered. Then, by connecting the iPhone to a dermoscope, macroscopic and dermoscopic images are captured. All data will be stored on the servers of the health care region of Skne, where the studies are conducted. Patients participating in the studies will be tagged with a study code enabling the investigators to extract the data from the patients that has agreed to participate in our study. Once a case has been created and sent to the data base all information will be deleted from the iPhone. Additional data will also be retrieved from relevant medical records, e.g. histopathological diagnosis, and manually registered in an electronic database at a highly secure location (LUSEC/ REDCap provided by Lund University) . Data collected from PCP and dermatologists by questionnaires will also be registered in this data base by means of electronic surveys (REDCap). Information from primary care on total number of visits, referrals to dermatologists and referrals to pathology regarding skin lesions will be extracted from patient administrative systems. Age- and sex matched controls will be used for the study investigating missed skin cancer. These controls will be randomly selected from patients that was referred to a skin clinic by paper referral during the same period as the teledermoscopically referred patients were gathered. Algorithms for skin cancer diagnosis will be implemented in the web platform of Dermicus for the studies of introduction of artificial intelligence. Teledermoscopic assessors will be instructed on when and how to use these different tools.

Every week the newly entered data will be checked for completeness, and in the case of missing data, reminders to participating investigators will be send.

Then the data sets are complete, identifiers (such as personal identification number) will be replaced by a code kept secure at a different location than the data set. Data will thereafter be extracted from the data base to perform statistical analysis.

The study is approved by the Swedish Ethical Review Authority and all relevant approvals for data extraction and data storage has been obtained.

Details