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Digital 3D total-body photography of the skin surface is an emerging imaging modality that can facilitate the identification of new and changing nevi.
We aimed to describe the experiences of study participants drawn from the general population who were provided 3D total-body photography and dermoscopy for the monitoring of nevi.
A population-based prospective study of adults aged 20-70 years from South East Queensland, Australia was conducted. Participants underwent 3D total-body photography and dermoscopy every 6 months over a 3-year period. Participants were asked to provide closed and open-ended feedback on their 3D total-body photography and dermoscopy experience (eg, comfort, trust, intended future use, and willingness to pay) at the halfway study time point (18 months) and final study time point (36 months). We assessed changes in participants’ reported experience of 3D total-body photography, and patient characteristics associated with patient experience at the end of the study (36 months) were analyzed.
A total of 149 participants completed the surveys at both the 18- and 36-month time points (median age 55, range 23-70 years; n=94, 63.1% were male). At the 18-month time point, most participants (n=103, 69.1%) stated they completely trusted 3D total-body imaging for the diagnosis and monitoring of their nevi, and this did not change at the 36-month (n=104, 69.8%) time point. The majority of participants reported that they were very comfortable or comfortable with the technology at both the 18- (n=138, 92.6%) and 36-month (n=140, 94%) time points, respectively; albeit, the number of participants reporting that they were very comfortable reduced significantly between the 18- and 36-month time points, from 71.1% (n=106) to 61.1% (n=91;
The majority of participants expressed positive attitudes toward 3D total-body photography for the monitoring of their moles. Half of the participants identified potential barriers to uptake.
The presence of many moles, or melanocytic nevi, is the strongest known risk factor for melanoma [
Total-body photography may help to confirm if nevi are stable or new and may reduce the number of nevus biopsies [
Currently 3D total-body photography is not widely available for commercial use. Few people have experienced 3D total-body photography to monitor their nevi, and no previous studies have described consumer-reported attitudes of using 3D photography in detail. The
This study was part of a 3-year, population-based, prospective cohort study of adults aged 20-70 years from South East Queensland, Australia. The study protocol has previously been described [
This study was approved by the Metro South Health Human Research Ethics Committee (approval number HREC/16/QPAH/125).
The sociodemographic characteristics of participants collected at baseline included age, sex, income, highest educational attainment, and employment status. The phenotypic and clinical characteristics collected at baseline included the innate skin color of the ventral upper arm, eye color, natural hair color at 21 years of age, BMI, and personal and familial skin cancer history.
At the 18-month (visit four) and 36-month (final visit) follow-up visits, participants were asked to provide feedback on 3D total-body photography (see
In optional open-ended questions, participants were asked to list benefits or disadvantages (if any) of using 3D total-body photography both at 18 months and the final visit (36 months). Two independent researchers (MO and SS) read through the complete data set twice to familiarize themselves with the qualitative data [
At the 36-month follow-up visit, participants were asked additional one-off questions with the entire photography process including if they thought it could improve the diagnosis and monitoring of skin lesions, it could be used for discovering new insights into skin well-being, they would recommend it to others, it was useful, it could help improve teaching people about their skin conditions, and it feels like an intrusion of their privacy. Participants were asked about the follow up of images including if they would like to see them at the end of the consultation, would like a copy, or would like to discuss the images with a doctor. Response options for each of these questions was
Sample size calculations, including the number of nevi expected for observation, have been previously reported [
Descriptive statistics were used to present participant characteristics, experience, and satisfaction with 3D total-body photography.
The Wilcoxon matched pairs signed rank test was used to determine a change to participants’ satisfaction with 3D total-body photography between the 18- and 36-month time points (including questions surrounding comfort, trust, intended future use, and willingness to pay). Chi-square tests (or Fisher exact tests when appropriate) for categorical factors and Mann-Whitney
A total of 193 eligible participants participated at the baseline visit. Of these, 149 (77.2%) participants completed both the 18-month and 36-month time point patient experience questionnaire and were included in this analysis. Included participants had a median age of 55 (range 23-70) years, 63.1% (n=94) were male, and 6.7% (n=10) had previously been diagnosed with melanoma. Most participants had a fair skin type (n=116, 77.9%). Participants had a median of 49 (range 4-341) nevi >2 mm and a mean of 4 (range 0-72) nevi >5 mm (
Attrition analysis showed that, compared to people included in the analysis, people who dropped out were mostly women (55/149, 36.9% vs 27/44, 61%;
Participant characteristics (N=149).
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Participants | |||
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Mean (SD) | 53.2 (11.5) | |
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Median (range) | 55 (23-70) | |
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≤50 years, n (%) | 54 (36.2) | |
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≥51 years, n (%) | 95 (63.8) | |
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Female | 55 (36.9) | |
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Male | 94 (63.1) | |
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Mean (SD) | 27.00 (4.58) | |
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Median (range) | 25.97 (18.36-42.75) | |
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18.5-24.9 (healthy), n (%) | 58 (38.9) | |
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25-29.9 (overweight), n (%) | 54 (36.2) | |
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30 or more (obese), n (%) | 35 (23.5) | |
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Not reported, n (%) | 2 (1.3) | |
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≤$39,999 | 16 (10.7) | |
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$40,000-$79,999 | 29 (19.5) | |
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$80,000-$124,999 | 31 (20.8) | |
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≥$125,000 | 53 (35.6) | |
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Unsure | 8 (5.4) | |
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Prefer not to answer | 12 (8.1) | |
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University degree | 66 (44.3) | |
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No university degree | 83 (55.7) | |
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Full-time | 74 (49.7) | |
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Part-time | 19 (12.8) | |
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Retired | 36 (24.2) | |
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Otherb | 20 (13.4) | |
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Yes | 10 (6.7) | |
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No | 139 (93.3) | |
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Yes | 38 (25.5) | |
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No | 111 (74.5) | |
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Fair | 116 (77.9) | |
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Medium/olive | 32 (21.4) | |
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Not reported | 1 (0.7) | |
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Light brown | 59 (39.6) | |
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Fair or blonde | 22 (14.8) | |
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Red or auburn | 6 (4.0) | |
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Dark brown or black | 62 (41.6) | |
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Blue or gray | 72 (48.3) | |
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Green or hazel | 51 (34.2) | |
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Brown | 25 (16.8) | |
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Not reported | 1 (0.7) | |
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Mean (SD) | 68.01 (61.88) | |
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Geometric mean | 47.94 | |
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Median (range) | 49 (4-341) | |
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Mean (SD) | 7.23 (9.72) | |
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Geometric mean | 4.34 | |
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Median (range) | 4 (0-72) |
aA currency exchange rate of AU $1=US $0.71 is applicable.
bIncluded home duties, self-employed, student, and unemployed.
cTotal nevus counts calculated using artificial intelligence software.
A statistically significant difference was observed between the 18- and 36-month time points for comfort using this technology, with a reduction in the proportion of participants reporting the technology as
Almost all participants would pay a fee to use this service, and this did not change between the 18- and 36-month time points. At the end of the study, only 6.7% (n=10) of the 149 participants would not pay to use this service, 58.4% (n=87) would pay between AU $1 and AU $100, and 33.5% (n=50) would pay AU $101 or more (AU $1=US $0.71). The majority of participants (140/149, 94%) would consider using the technology in the future if it were commercially available with their regular medical practitioner, and this did not change between the 18- and 36-month time points.
A total of 149 participants provided a response to the open-ended question about advantages of 3D total-body photography (
Many of the 149 participants (n=95, 63.8%) stated that the technology provided a “Comprehensive overview of all the body surface.” Participants (n=88, 59.1%) were positive about 3D total-body photography providing an accurate baseline to record, compare, and follow changes in their skin over time. Over one-tenth (n=16, 10.7%) of participants described the process of 3D total-body photography as “painless,” “non-intrusive,” and “less invasive than [a] regular skin check procedure.”
Half (n=74, 49.7%) of the 149 participants reported disadvantages of 3D total-body photography. Four key themes emerged, including (1) physical privacy, (2) travel, (3) concerns about new technology, and (4) cost. In terms of physical privacy, 20 (13.4%) participants stated they were “not comfortable in underwear” and disliked “feeling exposed.” One-fifth (n=30, 20.1%) of participants expressed concerns regarding the new technology, including its ability to accurately detect suspicious lesions and body areas unable to be imaged, and 3 participants mentioned concerns about digital security.
Patient experience of using 3D total-body photography at 18- and 36-month follow-up visits (N=149).
Question | Time point, n (%) | |||||||
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18-month | 36-month |
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.68 | |||||||
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Completely trust | 103 (69.1) | 104 (69.8) |
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Slightly trust | 26 (17.4) | 29 (19.5) |
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Unsure/slightly/completely do not trust | 16 (10.7) | 16 (10.7) |
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Not reported | 4 (2.7) | 0 (0.0) |
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.01 | |||||||
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Very comfortable | 106 (71.1) | 91 (61.1) |
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Comfortable | 32 (21.5) | 49 (32.9) |
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Indifferent | 2 (1.3) | 3 (2.0) |
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Slightly not comfortable | 5 (3.4) | 5 (3.4) |
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Not at all comfortable | 0 (0.0) | 0 (0.0) |
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Not reported | 4 (2.7) | 1 (0.7) |
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.71 | |||||||
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Yes | 140 (94.0) | 141 (94.6) |
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No | 4 (2.7) | 6 (4.0) |
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Not reported | 5 (3.4) | 2 (1.3) |
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.68 | |||||||
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$0 | 6 (4.0) | 10 (6.7) |
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$1 to $50 | 31 (20.8) | 27 (18.1) |
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$51 to $100 | 64 (43.0) | 60 (40.3) |
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$101 to $200 | 37 (24.8) | 40 (26.8) |
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$201 or more | 6 (4.0) | 10 (6.7) |
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Not reported | 5 (3.4) | 2 (1.3) |
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aA currency exchange rate of AU $1=US $0.71 is applicable.
Patient characteristics associated with patient trust and comfort at the end (36 months) of the intervention.
Demographic characteristics | Trusta (N=149) | Comfortb (n=148) | |||||||||
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Yes (n=133) | Unsure/no (n=16) | Yes (n=140) | Unsure/no (n=8) | |||||||
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.10 |
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.14 | |||||||
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≤50, n (%) | 45 (83.3) | 9 (16.7) |
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48 (90.6) | 5 (9.4) |
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≥51, n (%) | 88 (92.6) | 7 (7.4) |
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92 (96.8) | 3 (3.2) |
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Median (range) | 56 (23-70) | 48.5 (27-67) |
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55 (23-70) | 47 (26-64) | .39 | ||||
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.59 |
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.05 | |||||||
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Female | 48 (87.3) | 7 (12.7) |
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48 (88.9) | 6 (11.4) |
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Male | 85 (90.4) | 9 (9.6) |
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92 (97.9) | 2 (2.1) |
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.18 |
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.47 | |||||||
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University degree | 56 (84.8) | 10 (15.2) |
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61 (92.4) | 5 (7.6) |
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No university degreed | 77 (92.8) | 6 (7.2) |
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79 (96.3) | 3 (3.7) |
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.99 |
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.99 | |||||||
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Yes | 9 (90.0) | 1 (10.0) |
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10 (100.0) | 0 (0.0 |
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No | 124 (89.2) | 15 (10.8) |
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130 (94.2) | 8 (5.8) |
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.12 |
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.99 | |||||||
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Yes | 31 (81.6) | 7 (18.4) |
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35 (94.6) | 2 (5.4) |
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No | 102 (91.9) | 9 (8.1) |
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105 (94.6) | 6 (5.4) |
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.99 |
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.69 | |||||||
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Fair | 103 (88.8) | 13 (11.2) |
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108 (93.9) | 7 (6.1) |
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Medium/olive | 29 (90.6) | 3 (9.4) |
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31 (96.9) | 1 (3.1) |
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.44 | |||||||
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Healthy, n (%) | 48 (82.8) | 10 (17.2) |
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54 (93.1) | 4 (6.9) |
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Overweight/obese, n (%) | 84 (94.4) | 5 (5.6) |
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85 (96.6) | 3 (3.4) |
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Median (range) | 26.2 (18.3-42.7) | 23.4 (19.5-34.5) | .06 | 26.0 (18.3-42.7) | 25.0 (21.1-34.9) | .78 | ||||
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.86 |
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.34 | |||||||
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0-19, n (%) | 21 (95.5) | 1 (4.5) |
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19 (90.5) | 2 (9.5) |
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20-49, n (%) | 46 (85.2) | 8 (14.8) |
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50 (92.6) | 4 (7.4) |
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≥50, n (%) | 66 (90.4) | 7 (9.6) |
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71 (97.3) | 2 (2.7) |
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Median (range) | 49 (4-341) | 43.5 (8-266) | .90 | 50 (4-332) | 38.5 (17-341) | .60 | ||||
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.72 |
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.63 | |||||||
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0-4, n (%) | 72 (91.1) | 7 (8.9) |
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74 (93.7) | 5 (6.3) |
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5-10, n (%) | 36 (87.8) | 5 (12.2) |
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39 (97.5) | 1 (2.5) |
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≥20, n (%) | 25 (86.2) | 4 (13.8) |
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27 (93.1) | 2 (6.9) |
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Median (range) | 4 (0-72) | 6.5 (0-67) | .87 | 4 (0-36) | 3.5 (2-72) | .59 |
aCompletely trust and slightly trust were combined into a single category of trust, and unsure, slightly do not trust, or completely do not trust were combined into a single category of distrust.
bVery comfortable and comfortable were combined into a single category of comfort, and indifferent and slightly not comfortable were combined into a single category of discomfort.
cItalics indicate that the
dNo university degree includes those who completed secondary school, certificate, diploma, trade, or apprenticeship.
eData missing: 1 participant’s skin type and BMI.
Qualitative feedback from participants on the advantages and disadvantages of total 3D total-body photography to monitor nevi.
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Participants (N=149), n (%) | Example | |
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Comprehensive skin check and early detection | 95 (63.8) |
“It covers every angle of the skin, comprehensive system, if anything is observed, it is sent to a specialist for review...can be followed up and acted on quickly.” (male, 45 years old) “Gives a clear picture of entire body.” (male, 66 years old) |
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Improved monitoring (follow and record changes to skin over time; improved awareness and self-management) | 88 (59.1) |
“Additional reassurance to have a thorough skin examination, kept on record, can be reviewed, can monitor changes over time.” (male, 58 years old) “Excellent way of tracking your moles, having a baseline for assessment.” (male, 45 years old) “Peace of mind, having a photographic record means you can track changes over time.” (male, 61 years old) |
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Satisfaction, time efficiency, and improved health output | 64 (43.0) |
“Fantastic, quicker to take photos, more detail from patient photos, overall great idea.” (female, 56 years old) “Time saving, maybe don't need a Doctor to check every single spot at time of appointment. Patient more likely to have skin checked if time efficient process, like VECTRA.” (female, 37 years old) |
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Noninvasive procedure | 16 (10.7) |
“Painless, not intrusive.” (male, 53 years old) “Simple process, non-invasive, comprehensive reference to look back on.” (male, 58 years old) |
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Accuracy and artificial intelligence | 33 (22.1) |
“Accuracy and precise - shows the whole body. Exciting new technology.” (female, 64 years old) “More preci[se], up to date technology, not just human only assessment of skin.” (female, 52 years old) |
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Contribution to research (altruism) | 23 (15.4) |
“To assist in research to benefit future generations.” (female, 66 years old) “Research towards future diagnosis of melanoma.” (male, 52 years old) |
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No comments | 5 (3.4) |
N/Aa |
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Physical privacy (body image, self-conscious) | 20 (13.4) |
“Undressing in front of strangers.” (female, 38 years old) “Looking at your body in 3D is confronting...” (female, 46 years old) “Not everyone is comfortable taking [their] clothes off.” (male, 32 years old) |
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Concerns about new technology (trust, ability to accurately detect suspicious lesions, digital security, and privacy) | 30 (20.1) |
“[I] wouldn't trust 3D total-body photography without having a trained clinician present to look at [my] skin and/or review the images.” (male, 45 years old) “Do still need the naked eye. Doesn’t take away the need for a human.” (female, 34 years old) “Should always be complimented by a doctor looking at the skin.” (male, 65 years old) “Human eye gives a more complete view of the whole body. Some areas are missed by VECTRA (scalp, soles of feet).” (male, 44 years old) “Knowing there are all these identifiable photos of you stored.” (female, 36 years old) |
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Travel (accessibility to machine) | 14 (9.4) |
“Having to come into the hospital to do it. It is a big machine, so would not be able to have one in many locations.” (female, 29 years old) “One location at PA [Princess Alexandra Hospital], way to travel.” (female, 48 years old) “The time cost of travelling to the machine.” (male, 66 years old) |
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Cost | 10 (6.7) |
“If there was a cost associated with [3D body imaging], depending on the magnitude...” (male, 58 years old) “Machine expensive.” (male, 62 years old) |
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No disadvantages identified | 75 (50.3) |
N/A |
aN/A: not applicable.
Participant satisfaction with 3D total-body imaging at the 36-month time point (n=148).
Question | Participants, n (%) | |
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Yes | 147 (99.3) |
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No | 1 (0.7) |
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Yes | 145 (98.0) |
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No | 3 (2.0) |
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Yes | 9 (6.1) |
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No | 139 (93.9) |
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Man | 0 (0.0) |
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Woman | 18 (12.2) |
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No opinion | 130 (87.8) |
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Yes | 145 (98.0) |
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No | 3 (2.0) |
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Yes | 146 (99.3) |
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No | 1 (0.7) |
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Yes | 143 (97.3) |
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No | 4 (2.7) |
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Yes | 110 (74.8) |
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No | 37 (25.2) |
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Yes | 70 (47.6) |
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No | 77 (52.4) |
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Yes | 115 (78.8) |
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No | 31 (21.2) |
This study explored participants’ experiences of 3D total-body photography. The majority of participants were comfortable and trusted the imaging process at both the 18- and 36-month time points. Results also showed almost all participants would pay a fee to use this service in the future and would recommend it to others. Furthermore, most participants thought it could improve diagnosis and monitoring of skin lesions. While high levels of satisfaction were reported, when asked to list barriers, half of the participants identified one or more including trust, privacy, cost, and travel requirements. The feedback collected in this study is important, as perceived usefulness and ease of use are essential constructs for the adoption of new technologies [
Developing and implementing a new medical device or technology requires insight into consumer preferences to ensure that the service is used. While 3D total-body photography is practiced in Australia, it is done so primarily in research settings and in an informal manner in practical settings. Total-body photography has been found to result in detection of a higher proportion of in situ melanomas and thin invasive melanomas compared to consults without total-body photography [
Issues surrounding trust are well known when researching new technological innovations in health care and have been previously reported in other studies assessing melanoma imaging [
We found that the majority of the participants were satisfied with this technology, and there were some differences in satisfaction based on gender, age, and BMI. The factors identified may help to create a profile of patients who would require attention to ensure adequate uptake of the technology. We found males were more likely to be comfortable with the imaging process than their female counterparts. Some females reported in the qualitative comments that undressing in front of strangers and looking at their body in the images could be confronting. In addition, after further analysis of the 18 participants who would prefer to be photographed by a woman, 16 were female (data not shown). Overall, we found participants in this study showed high engagement by wanting to discuss the images with their doctor, and this could be used as a potential learning opportunity in the future for clinicians to show their patients what changes to look for to further support monitoring and early detection efforts.
This prospective cohort study recruited participants from a population-based registry and achieved a good number of participants who completed both the 18- and 36-month time point questionnaires to provide feedback on 3D total-body photography (149/193, 77.2%), providing a rich data set of their attitudes and changes over time.
The limitations include that the data were self-reported and subject to potential biases (eg, recall bias and socially desirable responses). This study involved participants having regular skin checks, and therefore, the volunteer sample might be more motivated and accepting of this technology. Just under half the participants in the study had a high level of education.
Participants were first asked about their experiences of 3D total-body photography at the fourth photography session after using the technology several times. Asking participants about their views prior to use at baseline would have allowed greater insights into how participant views changed over time.
Participants from the general population supported the use of 3D total-body photography for the monitoring of their nevi; albeit, half had some concerns regarding the technology. Consultation with participants and understanding their experience using the new technology will be important for the future translation of 3D total-body photography into standard dermatological care.
The 3D total-body imaging questionnaire.
artificial intelligence
National Health and Medical Research Council
This research was conducted with the support of the following: Centre of Research Excellence for the Study of Naevi funded by the National Health and Medical Research Council (NHMRC; Grant ID APP1099021), Centre of Research Excellence in Skin Imaging and Precision Diagnosis by the NHMRC (Grant ID APP2006551), and Australian Cancer Research Foundation. HPS holds an NHMRC MRFF Next Generation Clinical Researchers Program Practitioner Fellowship (APP1137127).
MJ, HPS, JFA, RAS, and TP contributed to the conception of the study and trial design. MJ, HPS, MO'H, and CH collected data. CH, MO'H, and SM drafted the manuscript. CH, DJ, and SS conducted the quantitative statistical analysis. SS and MO'H conducted the qualitative analysis. All authors reviewed, edited, and approved the final version.
HPS is a shareholder of MoleMap NZ Limited and e-derm consult GmbH, and undertakes regular teledermatological reporting for both companies. HPS is a medical consultant for Canfield Scientific Inc, MoleMap Australia Pty Ltd, Blaze Bioscience Inc, and Revenio Research Oy, and a medical advisor for First Derm.