The integration of three-dimensional (3D) total-body photography (TBP) and sequential digital dermoscopy imaging (SDDI) via teledermatology into routine dermatological care has led to a higher number of skin excisions, according to a study published in JAMA Dermatology on March 26. The findings suggest that advanced imaging technologies may enhance skin cancer monitoring, particularly for patients at high risk of melanoma.

The study, led by Dr. H. Peter Soyer from the University of Queensland’s Frazer Institute, involved 314 high-risk melanoma patients in a randomized clinical trial. Participants were divided into two groups: one receiving standard clinical care (156 patients) and another undergoing 3D TBP and SDDI every six months via teledermatology (158 patients) in addition to standard care.

Researchers found that patients in the intervention group had significantly more lesions excised than those in the control group, with an average of 5.73 excisions per person compared to 3.99. Despite this increase in procedures, fewer melanomas were detected in the intervention group (24 cases, or 35%) compared to the control group (43 cases, or 64%). The melanoma incidence rate was also lower, at 2.03 cases per person in the intervention group versus 3.62 in the control group.

However, while melanoma detection did not show a significant difference over a 12-month period, the number of keratinocyte cancers diagnosed was higher in the intervention group (0.86 per person) compared to the control group (0.42 per person). Additionally, benign lesion excision rates were also higher among patients who underwent 3D TBP-SDDI (2.01 per person) compared to standard care (1.39 per person).

The study highlights the potential of teledermatology and advanced imaging technologies in enhancing skin cancer surveillance. However, the increase in overall excisions, particularly of benign lesions, raises questions about whether this approach leads to overtreatment.

While the findings indicate promising applications for 3D imaging in skin cancer management, the study also notes potential conflicts of interest. Several authors disclosed financial ties to medical device and technology industries, and one author holds a related patent. Further research is needed to assess the long-term clinical benefits and cost-effectiveness of these technologies in routine dermatology care.