JAMA Dermatology

<jats:sec><jats:title>Importance</jats:title><jats:p>Three-dimensional (3D) total-body photography (TBP) can support clinicians in monitoring and identifying changes to skin lesions in patients at high risk of melanoma.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To assess clinical outcomes between patients at high risk of melanoma receiving usual clinical care compared with those receiving usual care plus 3D TBP and sequential digital dermoscopy imaging (SDDI) every 6 months via teledermatology.</jats:p></jats:sec><jats:sec><jats:title>Design, Setting, and Participants</jats:title><jats:p>This randomized clinical trial was conducted at a research hospital in Brisbane, Australia, from April 2018 to October 2021, with adult patients (≥18 years) at high risk of developing a primary or subsequent melanoma. Data analysis was conducted from March 2022 to June 2024.</jats:p></jats:sec><jats:sec><jats:title>Intervention</jats:title><jats:p>Usual care plus 3D-TBP in person and SDDI via teledermatology at baseline, 6, 12, 18, and 24 months. The control group continued usual care and completed online surveys every 6 months.</jats:p></jats:sec><jats:sec><jats:title>Main Outcome Measures</jats:title><jats:p>Number and rates of excisions and/or biopsies of lesions suggestive of melanoma, and results of histopathologic testing.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The analysis included 314 participants (mean [SD] age, 51.6 [12.8] years; 194 females [62%]) who completed all of the study procedures (158 in the intervention and 156 in the control). In all, 1527 excisions (905 intervention and 622 in the control) were performed among 226 participants (122 intervention and 104 controls), with 67 (4%) histopathologically confirmed as melanoma and 402 (26%) as keratinocyte cancer (KC). The mean (SD) number of lesions of any type excised per person was significantly higher in the intervention (5.73 [6.77]; 95% CI, 4.66-6.79) compared to the control group (3.99 [5.72]; 95% CI, 3.08-4.89; <jats:italic>P</jats:italic> = .02). Fewer melanomas were detected among the intervention group compared with the control (24 [35%] vs 43 [64%], respectively), and therefore, a lower incidence rate: 2.03 (95% CI, 1.30-3.02) vs 3.62 (95% CI, 2.62-4.88), respectively. After 1 year of follow-up, the intervention had a lower, but not statistically significant, rate of melanoma per person: 0.08 (95% CI, 0.03-0.13) compared with 0.16 (95% CI, 0.08-0.25) in the control; an average of 0.86 (95% CI, 0.55-1.16) vs 0.42 (95% CI, 0.24-0.59) KCs per person; and 2.01 (95% CI, 1.50-2.51) vs 1.39 (95% CI, 0.98-1.82) excisions or biopsies per person, respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusions and Relevance</jats:title><jats:p>The results of this randomized clinical trial indicate that the addition of 3D-TPB and SDDI to usual care in a teledermatology setting without AI (artificial intelligence) increased the number and rate of skin excisions and biopsies performed. Further studies are required to compare teledermatology to usual care rather than adding it, and to study whether the use of AI can improve the teledermatology outcomes. Larger studies in multiple settings with a greater number of teledermatologists are needed. This study shows that conducting clinical trials in this setting is feasible.</jats:p></jats:sec><jats:sec><jats:title>Trial Registration</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://anzctr.org.au">anzctr.org.au</jats:ext-link> Identifier: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374309">ACTRN12618000267257</jats:ext-link></jats:p></jats:sec>

Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.

CA Cancer J Clin

Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual.

State of the science on prevention and screening to reduce melanoma incidence and mortality: the time is now.

Screening for skin cancer: US Preventive Services Task Force Recommendation Statement.

JAMA

Patients’ views about skin self-examination after treatment for localized melanoma.

JAMA Dermatol

Strategies to improve adherence to skin self-examination and other self-management practices in people at high risk of melanoma: a scoping review of randomized clinical trials.

Multiplicity of skin cancers in Queensland and their cost burden to government and patients.

Aust N Z J Public Health

Estimated healthcare costs of melanoma and keratinocyte skin cancers in Australia and Aotearoa New Zealand in 2021.

Int J Environ Res Public Health

Specialized surveillance for individuals at high risk for melanoma: a cost analysis of a high-risk clinic.

Cost-effectiveness of skin surveillance through a specialized clinic for patients at high risk of melanoma.

J Clin Oncol

The value of total body photography for the early detection of melanoma: a systematic review.

Clinical perspective of 3D total body photography for early detection and screening of melanoma.

Front Med (Lausanne)

Management of cutaneous melanoma in Australia: a narrative review.

Med J Aust

Store-and-forward teledermatology for assessing skin cancer in 2023: literature review.

JMIR Dermatol

Evaluation of the efficacy of 3D total-body photography with sequential digital dermoscopy in a high-risk melanoma cohort: protocol for a randomised controlled trial.

BMJ Open

Cost-effectiveness analysis of 3D total-body photography for people at high risk of melanoma.

On reporting results from randomized controlled trials with recurrent events.

BMC Med Res Methodol

Exact estimates for a rate ratio.

Epidemiology

Repeated events survival models: the conditional frailty model.

Stat Med

Frailty pack: an R package for the analysis of correlated survival data with frailty models using penalized likelihood estimation or parametrical estimation.

J Stat Softw

The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care.

Expert Rev Anticancer Ther

The effect of screening on melanoma incidence and biopsy rates.

Br J Dermatol

Benefits, harms and cost-effectiveness of cancer screening in Australia: an overview of modelling estimates.

Public Health Res Pract

Early detection of melanoma: a consensus report from the Australian Skin and Skin Cancer Research Centre Melanoma Screening Summit.

Early detection of skin cancer in Australia - current approaches and new opportunities.

Prevalence of skin examination behaviours among Australians over time.

Cancer Epidemiol

Digital monitoring by whole body photography and sequential digital dermoscopy detects thinner melanomas.

J Prim Health Care

A national budget impact analysis of a specialised surveillance programme for individuals at very high risk of melanoma in Australia.

Appl Health Econ Health Policy

Consumer perceptions on privacy and confidentiality in dermatology for 3D total-body imaging.

Australas J Dermatol

Diagnostic tools used for melanoma: a survey of Australian general practitioners and dermatologists.

Assessing the value of precision medicine health technologies to detect and manage melanoma.

The future of precision prevention for advanced melanoma.

Overdiagnosis in malignant melanoma: a scoping review.

BMJ Evid Based Med

Five-year outcomes of a melanoma screening initiative in a large health care system.

Overdiagnosis in melanoma screening: is it a real problem?

Dermatol Pract Concept

Patient-reported outcomes associated with cancer screening: a systematic review.

BMC Cancer

The experience of 3D total-body photography to monitor nevi: results from an Australian general population-based cohort study.

‘Mind your moles’ study: protocol of a prospective cohort study of melanocytic naevi.

Consumer views of melanoma early detection using 3D total-body photography: cross-sectional survey.

Int J Dermatol

ACEMID cohort study: protocol of a prospective cohort study using 3D total body photography for melanoma imaging and diagnosis.

Artificial intelligence in melanoma: a systematic review.

J Cosmet Dermatol

Distinguish the value of the benign nevus and melanomas using machine learning: a meta-analysis and systematic review.

Mediators Inflamm

Human-computer collaboration for skin cancer recognition.

Nat Med

Informing a position statement on the use of artificial intelligence in dermatology in Australia.

A narrative review: opportunities and challenges in artificial intelligence skin image analyses using total body photography.

J Invest Dermatol

Dermatologists’ perspectives on artificial intelligence and augmented intelligence: a cross-sectional survey.

The complex impact of COVID-19 on cancer outcomes in Australia.

Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects.

J Clin Epidemiol

Geographical patterns in melanoma incidence across Australia: can thickness differentials reveal the key drivers?

Ann Cancer Epidemiol

Three-dimensional (3D) total-body photography (TBP) can support clinicians in monitoring and identifying changes to skin lesions in patients at high risk of melanoma.
To assess clinical outcomes between patients at high risk of melanoma receiving usual clinical care compared with those receiving usual care plus 3D TBP and sequential digital dermoscopy imaging (SDDI) every 6 months via teledermatology.
This randomized clinical trial was conducted at a research hospital in Brisbane, Australia, from April 2018 to October 2021, with adult patients (≥18 years) at high risk of developing a primary or subsequent melanoma. Data analysis was conducted from March 2022 to June 2024.
Usual care plus 3D-TBP in person and SDDI via teledermatology at baseline, 6, 12, 18, and 24 months. The control group continued usual care and completed online surveys every 6 months.
Number and rates of excisions and/or biopsies of lesions suggestive of melanoma, and results of histopathologic testing.
The analysis included 314 participants (mean [SD] age, 51.6 [12.8] years; 194 females [62%]) who completed all of the study procedures (158 in the intervention and 156 in the control). In all, 1527 excisions (905 intervention and 622 in the control) were performed among 226 participants (122 intervention and 104 controls), with 67 (4%) histopathologically confirmed as melanoma and 402 (26%) as keratinocyte cancer (KC). The mean (SD) number of lesions of any type excised per person was significantly higher in the intervention (5.73 [6.77]; 95% CI, 4.66-6.79) compared to the control group (3.99 [5.72]; 95% CI, 3.08-4.89; P = .02). Fewer melanomas were detected among the intervention group compared with the control (24 [35%] vs 43 [64%], respectively), and therefore, a lower incidence rate: 2.03 (95% CI, 1.30-3.02) vs 3.62 (95% CI, 2.62-4.88), respectively. After 1 year of follow-up, the intervention had a lower, but not statistically significant, rate of melanoma per person: 0.08 (95% CI, 0.03-0.13) compared with 0.16 (95% CI, 0.08-0.25) in the control; an average of 0.86 (95% CI, 0.55-1.16) vs 0.42 (95% CI, 0.24-0.59) KCs per person; and 2.01 (95% CI, 1.50-2.51) vs 1.39 (95% CI, 0.98-1.82) excisions or biopsies per person, respectively.
The results of this randomized clinical trial indicate that the addition of 3D-TPB and SDDI to usual care in a teledermatology setting without AI (artificial intelligence) increased the number and rate of skin excisions and biopsies performed. Further studies are required to compare teledermatology to usual care rather than adding it, and to study whether the use of AI can improve the teledermatology outcomes. Larger studies in multiple settings with a greater number of teledermatologists are needed. This study shows that conducting clinical trials in this setting is feasible.
anzctr.org.au Identifier: ACTRN12618000267257.

3D Total-Body Photography in Patients at High Risk for Melanoma: A Randomized Clinical Trial.

3D Total-Body Photography in Patients at High Risk for Melanoma

Papers