Primary teledermatology means a mobile dermatology linking directly patient and dermatologist, while secondary teledermatology is a way to enlarge the access to specialist care.
There are more than 100 mobile apps devoted to melanoma detection. Some of them make use of advanced algorithms to provide a risk assessment of the lesion, some examples:
- SkinVision (automated assessment and – when needed – expert advice).
- First Derm Skin Image Search (optionally available with an add on for the acquisition of dermoscopic images).
- MoleScope app by MetaOptima used to share skin pictures with a remote dermatologist.
The patient receives feedback from the doctor through the app and if needed the app directs the patient to the closest dermatologist.
Most of the applications use photos and it reduces the accuracy of the assessment; it was proved that the use of dermoscopic images provides better accuracy in the diagnosis (accuracy over 90%), mainly in terms of reduction of “false positive” (25% improvement at least).
In 2015 the Federal Trade Commission took action against two melanoma detection apps, MelApp and Mole Detective, for the wrong messages given to the patients (“Apps must have substantial scientific backing in order to make claims such as it provides a risk analysis of the uploaded picture being a melanoma” (MelApp) or “it could analyse your mole and give you a risk factor based on the symptoms your mole may or may not be showing” or “the solution increases the chance of detecting skin cancer in early stages,” and “save lives through the early detection of potentially fatal melanoma”).
In any case all these apps have the added value of creating awareness and reducing the delay from the initial suspicion of the patients to the first professional consultation.
In several countries the access to specialist skin care is limited; through the mediation of a medical professional (e.g. the general practitioner) the secondary teledermatology has the potential to overcome this situation. In addition it offers opportunities for dermatological education of primary care physicians.
Providers of secondary teledermatology services
Here below some names:
- DermEngine (MetaOptima) referral platform; it allows GPs to refer challenging patient cases to a dermatologist while providing all the relevant documents (such as images, history, and other notes).
- Dermicus by Gnosco, Sweden (www.dermicus.com).
- 3Derm (3derm.com).
 Ferrandiz L, Ojeda-Vila T, Corrales A, et al. Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: a randomized teledermoscopy trial. J Am Acad Dermatol. 2017;76(4):676–682.
 Dinnes J. et al. – “How accurate is dermoscopy compared to visual inspection of the skin for diagnosing skin cancer (melanoma) in adults?” - www.cochrane.org; Cochrane Database of Systematic Reviews 2018, Issue 12. Art. No.: CD011902. DOI: 10.1002/14651858.CD011902.pub2. – 4 December 2018.