Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2023;13(3):e2023220 1 The Use of Patient-Marketed Dermatoscopes in Dermatology Practice Collin M. Costello1, Jake G. Besch1, Ahmad B. Shahin2, John R. Bottjer3, Harper N. Price4, David L. Swanson1 1 Department of Dermatology, Mayo Clinic, Scottsdale, Arizona, USA 2 Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA 3 Gen Inc., San Juan Capistrano, California, USA 4 Division of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona, USA Key words: Dermoscopy, Patient-focused dermoscopy, teledermatology, telemedicine Citation: Costello CM, Besch-Stokes JG, Shahin AB, Bottjer JR, Price HN, Swanson DL. The Use of Patient-Marketed Dermatoscopes in Dermatology Practice. Dermatol Pract Concept. 2023;13(3):e2023220. DOI: https://doi.org/10.5826/dpc.1303a220 Accepted: April 4, 2023; Published: July 2023 Copyright: ©2023 Costello et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: David L Swanson, MD, Mayo Clinic – Department of Dermatology 13400 E Shea Blvd, Scottsdale, AZ 85259. Phone: 480-301-8508; Fax: 480-301-9272 E-mail: swanson.david@mayo.edu Introduction As smartphones with high-quality cameras have become ubiquitous, and dermoscopy technology has become cheaper, new dermatoscopes designed for use by the layperson have been released. These $125 dermatoscopes connect directly to patients' smartphones. The COVID-19 pandemic has caused a massive shift towards telehealth, including teledermatology and teledermoscopy, making these devices more relevant. There have been several studies evaluating patient-directed dermoscopy during a self-skin examination [1-3]. However, there is limited data on how patients are using these devices in the real world and whether their use is impacting derma- tologic care. This survey-based project was designed to eval- uate how patient-marketed dermatoscopes are being utilized. Case Presentation The Mayo Clinic institutional review board deemed this study exempt. A link to a survey designed in REDCap was sent to 3Gen©, which manufactures a patient-marketed dermatoscope, that was forwarded to customers who pur- chased a HÜD® dermatoscope [4]. An initial email was sent on 12/2/2020, with a reminder email six weeks later. The REDCap and all raw data were stored at Mayo Clinic. Descriptive statistics were utilized for this study. In total, 21 customers responded to the survey (Table 1). Females comprised 66.6% of respondents. The median age was 57 years. Caucasians made up 81% of respondents. Ed- ucation levels included doctorate (38%), master (23.8%), bachelor (23.8%), associate (4.8%), and some college (9.5%). Most (two-thirds) did not work in the medical field. The devices were used on the respondents children in 23.8% of cases. Nearly all (94.7%) had seen a dermatologist, and the majority (73.7%) had heard about this device from their dermatologist. The device primary use was sending photo- graphs to their medical provider (78.9%). These devices did not change the frequency of dermatology appointments in 83.3% of cases. Most (73.7%) patients agreed or strongly agreed that they would recommend the dermatoscope. Most 2 Research Letter | Dermatol Pract Concept. 2023;13(3):e2023220 (68.4%) agreed or strongly agreed that they were satisfied with the device. Most (57.9%) disagreed or strongly dis- agreed that new technology, including this dermatoscope, is challenging to use. Limitations of this study include the small sample size and only one dermatoscope model was assessed. Table 1. Demographic, clinical use, and satisfaction data. Demographics (N = 21) Gender Female 66.6% Male 33.3% Age Mean (SD) 55 (19.8) Race Caucasian 81.0% Asian 4.7% Prefer not to say 14.3% Clinical Use Do you have a dermatologist Yes 94.7% Has the HÜD dermatoscope changed how often you see your dermatologist? No change in frequency 83.3% Less frequent 16.6% Do you send dermoscopic photographs to your medical provider? Yes 78.9% No 21.1% How did you learn about the HÜD dermatoscope Dermatologist / Dermatology Provider 73.7% Internet 15.8% Other 10.5% What is the primary use of your HÜD dermatoscope Bought to use on yourself 78.9% Bought to use on adult family member 10.5% Bought to use on child 5.3% Other reason 15.8% What is the primary reason you purchased a HÜD dermatoscope Send photographs to dermatologist / medical provider 78.9% Track moles yourself 15.8% Track moles using a phone-based application 5.3% Use with self-skin examinations 15.8% Do you perform self-skin examinations Yes 78.9% No 21.1% Do you use your HÜD during self-skin examinations Yes 40.0% No 60.0% Have you received training on how to interpret dermoscopic images Yes 26.3% No 73.7% Satisfaction 1 = strongly disagree, 5 = strongly agree I would be interested in training to interpret dermoscopic images Mean (SD) 3.8 (1.4) Median 4 I would be interested in incorporating the HÜD into my self-skin exam Mean (SD) 3.5 (1.5) Median 3 Using new technology, including the HÜD dermatoscope, is challenging Mean (SD) 2.6 (1.4) Median 2 I am satisfied with my HÜD dermatoscope Mean (SD) 3.8 (1.2) Median 4 I would recommend the HÜD dermatoscope Mean (SD) 3.9 (1.1) Median 4 SD = standard deviation. Research Letter | Dermatol Pract Concept. 2023;13(3):e2023220 3 Conclusions A silver lining for the COVID-19 pandemic may be the in- creased infrastructure, access, and utilization of telederma- tology. Since many institutions have online portals that allow patients to send in photographs, patients are likely sending in photos of concerning lesions. In the appropriate patient, using patient-marketed der- matoscopes could enable the clinician to perform store-and- forward teledermatology visits. The associated expense and narrow user population could conceivably cause healthcare disparity concerns, but this likely would be offset for patients living far from health resources, those who have difficulty with transport to the clinic, and those avoiding healthcare facilities during the COVID-19 pandemic. In most cases, the use of these devices did not decrease the frequency of der- matology in-person appointments, suggesting that they serve as an adjunct for concerning lesions between visits. Overall, most patients were satisfied with the devices, would recom- mend them, and did not find them challenging to use. As technology evolves, dermoscopy guided by artificial intelli- gence will significantly assist in-home lesion analysis. References 1. Horsham C, Loescher LJ, Whiteman DC, Soyer HP, Janda M. Consumer acceptance of patient-performed mobile teleder- moscopy for the early detection of melanoma. Br J Dermatol. 2016;175(6):1301-1310. DOI:10.1111/bjd.14630. PMID: 27037999. 2. Janda M, Loescher LJ, Soyer HP. Enhanced skin self-examination: a novel approach to skin cancer monitoring and follow-up. JAMA Dermatol. 2013;149(2):231-236. DOI: 10.1001/jamadermatol .2013.1218. PMID: 23426490. 3. Manahan MN, Soyer HP, Loescher LJ, et al. A pilot trial of mobile, patient-performed teledermoscopy. Br J Dermatol. 2015;172(4): 1072-1080. DOI:10.1111/bjd.13550. PMID: 25418126. 4. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. Biomed Inform. 2009 ;42(2): 377-381. DOI 10.1016/j.jbi.2008.08.010. PMID: 18929686. PMCID: PMC2700030.