If you’re concerned about a suspicious mole, you might not think of looking to the latest “tele-doctor” technology for help. After all, wouldn’t your dermatologist need to see that blemish in person rather than read a description of your symptoms and look at a few cellphone photos?
Actually, no. Tele-dermatology, still somewhat new, is expected to become increasingly popular. Patients enjoy the convenience of a quick checkup via videoconferencing or by submitting photos, while doctors appreciate being able to treat more patients quickly.
Compared with other medical specialties, “dermatology is very visual,” says Margaret Lally, a dermatologist who has a private practice in Pittsburgh and also works through an online service called DermatologistOnCall. “With a high-quality camera, [a patient] can capture the essence of the skin issue very well.” In fact, medical schools use photographs to teach dermatology students how to diagnose skin cancer and other ailments.
For Lisa Pawelski, who also practices dermatology in the Pittsburgh area, being able to see more patients is one of the major reasons she started working with DermatologistOnCall. And patients can send in photographs and fill out forms on their own time, instead of taking time off work or school for appointments.
Pennsylvanians have poor access to dermatology, she says, citing long wait times for appointments. “Most medical dermatologists [as opposed to cosmetic dermatologists] are scheduled out several months, and even emergency slots are filled well into the future.” Pawelski says. “A major challenge for a conscientious medical dermatologist is triaging fairly who gets in quickest because they need us the most.”
Lally and Pawelski say they prefer to teleconference with patients who are within driving distance of their offices. If a problem is discovered, they can usually see the patient in person within a matter of days.
Lally said she reviewed the online visit of a patient at DermatologistOnCall on a Monday night last January and noticed “an atypical mole.” She phoned the patient the next day and saw her on Thursday for a biopsy. By the middle of February, the patient had met with a plastic surgeon for the removal of a melanoma.
Both dermatologists say videoconferencing goes beyond catching skin cancer early. “Diagnoses like acne, rosacea, poison ivy, bug bites, cold sores, shingles, mild cases of eczema and psoriasis — all of these lend themselves well to the online format,” Pawelski says.”
Still, tele-dermatology is not a cure-all. Some conditions must be examined in person for diagnosis. Full-body rashes, Lally notes, are difficult to diagnose and almost always need a complete medical history and personal interview before they can be effectively treated — and not every patient can be counted on to upload clear photographs.
And the field is new and so far has been little studied. In one recent study, researchers found flaws — including incorrect diagnoses — when people posing as patients submitted stock photos of skin conditions to 16 tele-dermatology sites.
Even for sites that are reputable and employ licensed doctors, there are issues of access. Some states do not allow tele-dermatology. (It is allowed in Virginia and the District.) Other states, including Maryland, allow for videoconferencing but not the submission of photographs alone on the first visit.
Of course, some patients prefer in-person interactions, where it may be easier to ask questions. Most tele-dermatologists treat only one condition per visit, although follow-up questions are allowed for 30 days.
On other hand, the price — DermatologistOnCall advertises $59 or less per visit — might make up for the slightly impersonal feel. So, too, might the knowledge that some insurers cover tele-dermatology. And, of course, there’s the peace of mind that comes with getting an answer about a skin concern within days.