Skin Cancer Screening and Prevention During the COVID-19 Pandemic
Practice Points
- It is important for dermatologists to maintain skin cancer screening and prevention efforts during the coronavirus disease 2019 pandemic.
- Patient populations at increased risk for skin cancer should be prioritized for in-person evaluations, but teledermatology should be considered for initial examination in new patients and patients at average risk for skin cancer.
- Teledermatology presents a learning curve for dermatologists and patients, but the confidence level will increase, and evidence-based data will pave the way to enhance this experience.
There is no clear definition of SSE or guidelines on how to educate a patient to perform regular SSE; however, the AAD provides patients with resources on how to perform an SSE.8 Just as dermatologists would provide education, advice, and guidance by directing patients to the AAD website for the SSE during an in-person visit, we encourage dermatologists to continue this practice during all teledermatology visits.
,The role of teledermatology in skin cancer screening and prevention is limited; dermatologists will not be able to adequately perform TBSE as it would be done at in-person visits. Furthermore, the true implications of teledermatology compared to in-person visits during the COVID-19 pandemic have yet to be realized and analyzed. It is nonetheless important to appreciate that teledermatology holds great promise of benefit in skin cancer prevention, especially in the form of patient education by dermatologists. Practices in the realm of screening and prevention by health care professionals should be continually addressed during the pandemic; it is important to consider the implications associated with delays in diagnosis and treatment.
Teledermatology Limitations and Recommendations for High-Quality Visits
A benefit of video consultation (VC) vs telephone visits is visual interaction—the crux of dermatology. A 2019 study investigated VC experiences among providers and patients in the primary care setting. Benefits of VC were reported to include convenience for working patients and patients with mobility or mental health problems, visual cues, building rapport, and improving communication.9
Despite these benefits, VC is not without limitations. Many technical factors create variability in the quality of teledermatology VCs for a melanocytic lesion, including patient environment and lighting, color distortion, video resolution, and Internet connection. We make the following recommendations:
• Environment: Locate or create a dedicated space for teledermatology visits that is well lit, private, and has minimal background noise. Place the device on a level surface, center yourself in the frame, and keep the camera at eye level.
• Lighting: Use neutral lighting, placing the light source in front of you but behind the camera of the device. Avoid placing light sources, such as a window, behind you.
• Video resolution: Regardless of the type of camera (eg, integrated webcam, external camera), close out all other running software programs to optimize bandwidth during the visit.
• Internet connection: Use a wired connection (via an Ethernet cable) instead of a Wi-Fi connection to greatly decrease the chance of losing the connection during the visit. It also is faster than Wi-Fi.
• Addressing specific lesions: Patients should keep the device in place, repositioning themselves to show the lesions rather than moving the device by hand.
• Video capacity: Test your device’s video capacity beforehand, which can be as simple as video-calling a family member or friend from your designated space. Feedback regarding video and audio quality will help fine-tune your setup.
• Instructions to the patient: Provide clear instructions to the patient when photographs of specific lesions are needed for further review. Specify what view(s) you need and whether size or bilateral comparison is needed. A web post by VisualDx10 provides advice to patients on taking high-quality photographs.
Final Thoughts
Teledermatology indubitably presents a learning curve for dermatologists and patients. As with other technological advances in society, we are optimistic that, first, the confidence level in teledermatology use will increase, and, second, evidence-based data will pave the way to enhance this experience. We realize the inherent limitation of accessibility to certain technologies, which is regrettably far from equitable. Patients need a personal device equipped with audio and video; access to a high-quality Internet connection; some degree of technological literacy; and a quiet private location.
We hope to learn from all experiences during the current pandemic. Future innovation in teledermatology and in telemedicine generally should aim to address technological inequities to allow for the delivery of quality care to as many patients as possible.
