Stanford's New Teledermatology Program Helps Screen for Skin Cancer in Nursing Home Residents and Other Seniors

The new program provides dermatologic care for the less-mobile elderly.

Stanford University has developed a telehealth program to provide patients living in long-term and senior living facilities with the ability to submit high-quality photos of their skin for providers to screen.

The elderly are at highest risk of developing skin cancer, with 74% of new melanomas found in those over the age of 55, according to the research for the new program, designed to prevent delays in cancer diagnosis.

Conditions such as skin cancer are detected incidentally when patients either come in for a screening or another reason and their provider notices it, said Kavita Sarin, MD, PhD, co-author of the research.

Teledermatology could potentially play a big role in dermatologic care, though it does have some limitations, she said.

"Teledermatology, the way it's implemented now, doesn't allow for the identification of incidental findings, nor does it enable full body skin exams," Sarin explained. "It’s hard for [a provider] to take full pictures of every part of their body as they could do in person."

Another limitation for teledermatology is the inability of providers to the patient's skin, which she said is an important part of detecting skin cancer.

For the study, Sarin and her team piloted teledermatology solution in a local senior living community during the COVID-19 pandemic. Using guided, in-residence skin scanning and outlier lesion identification, they evaluated the value and use of a service like it for patients having difficulty accessing dermatological care, along with patient satisfaction.

Twenty-seven residents participated, with three skin cancers identified within the group. Eleven of the 27 residents were scheduled for follow-up appointments and four began home treatment.

The clinic also offered its teledermatology option to younger patients during the pandemic, many of whom preferred it to in-person appointments. While the younger patients were comfortable with useability of the application, their older patients struggled with logging on and following prompts.

The cohort did see that some residents were relogging on to the application with the assistance of a caregiver or family member. This motivated them to send clinical staff into the senior living community to help patients navigate the application, take pictures of their skin for her to review, note their clinical history and any questions they may have about their skin or changing lesions.

"While teledermatology was an excellent option, it was difficult for many elderly patients to access and be able to use," Sarin said. "So they were, in many ways, our highest-risk patients during COVID, but they were also the ones with the most barriers to access for care."

As they conducted the in-residence screening, clinical staff used dramatiscopes, a tool that allows them to see features such as pigmentation of a mole, to examine the patient's skin.

"If someone just sent in photos from home, they wouldn't have dermascopic photos. We would just be able to only look clinically which provides us with less information," Sarin said. "But if we suspect something we would have you come in, and then when they come into the clinic, we could look we could look with the dramatiscope and determine if it needed a biopsy."

While dramatiscopes are complex pieces of technology to handle, Sarin believes that in the future a user-friendly version may be beneficial add-on device when screening high-risk individuals with dramatiscopes.

Out of the participants, 88% were  satisfied with the application, and 77% said they would recommend it to others. For the accuracy of the photos, 92% agreed that they accurately represented their skin. However, despite its positive reception, 31% of patients said that they'd prefer to see a dermatologist in-person after the pandemic.

The study also notes that the in-residence screening took longer than the usual 15 minutes an in-person visit takes, with the full body photography and dermoscopy conducted by clinical staff taking about 35 minutes. The doctor reviewing the photos and speaking with the resident virtually took a total of 20 minutes.

"I think there's a lot of potential in teledermatology," Sarin said. "The biggest challenge, of course, is that a lot of the people in senior living communities and nursing homes are slower to take up modern technology; so usability is very important in building teledermatology for the elderly."