Teledermatology-dermoscopy: Expanding access to skin cancer screening to reduce healthcare disparities.

Abstract

1653 Background: Skin cancer, the most common malignancy in the United States, continues to rise in incidence. Underserved populations face significant barriers to care, including lack of insurance, language differences, and limited access to specialists. The Augusta Free Dermatology Clinic, a student-run clinic, collaborates with the Teledermatology in Rural Georgia program to address these challenges through store-and-forward (SAF) teledermatology-dermoscopy. This approach involves transmitting dermoscopic images to a dermatologist for remote analysis. Implemented during Community Health Fairs (CHFs), this initiative aims to enhance access to skin cancer screening in underserved communities. Methods: Volunteer medical students (MS) from the Medical College of Georgia (MCG) and general physicians underwent training to use a dermatoscope effectively. Trained MS collected brief medical histories and dermoscopic images for SAF referrals during CHFs serving individuals with incomes below 200% of the federal poverty line. Polarized dermoscopic images were captured using iPhones equipped with magnetic dermatoscope attachments and were securely transmitted to a board-certified dermatologist via a teledermatology platform. Dermatological recommendations were provided within one hour and communicated to patients, with Spanish translators facilitating communication. Results: Across two CHFs (~8 hours each), 10 MS volunteered in shifts under the supervision of a general physician (n = 1) or dermatology resident (n = 1). A total of 141 patients presented with dermatological concerns, of whom 24 (17.02%) were referred for SAF consultations due to suspicious skin lesions. Among these, 17 (70.83%) had benign lesions, while 7 (29.17%) were identified as potentially malignant and referred for in-person follow-up at the Augusta Free Dermatology Clinic for further evaluation or biopsy. Comprehensive data were available for 112 patients (79.43%), most of whom were female (58.04%, n = 65) and Latino/Hispanic (98.21%, n = 110). The majority were uninsured (73.21%, n = 82), Spanish-speaking (98.21%, n = 110), and required translation services (98.21%, n = 110). Nearly all participants worked in skilled agricultural roles (98.21%, n = 110) and reported a median of two household dependents (range: 0–9). Common diagnoses among follow-up patients included healthy skin (45.54%, n = 51), acne (5.36%, n = 6), melasma (5.36%, n = 6), benign nevi (5.36%, n = 6), dermatitis (4.46%, n = 5), and folliculitis (3.57%, n = 4). Other less common conditions were diagnosed in 30.36% (n = 34) of patients. Conclusions: The implementation of teledermatology-dermoscopy at CHFs effectively addressed barriers to dermatological care in underserved populations. This approach demonstrated the potential to improve early detection of skin cancer, facilitate timely care, and reduce healthcare disparities.