Image and in-person evaluations yield similar malignancy diagnosis rates

This prospective comparative pilot study assessed the accuracy and feasibility of an image-based eyelid lesion service, including diagnosis and management plans, compared with that of a traditional face-to-face clinic consultation.

Study design

In a prospective, comparative study, 97 patients with eyelid lesions were seen in person by an oculoplastic surgeon (Arm A). The lesions were photographed by a clinical photographer (Arm B) and an optometrist (Arm C), and the photographs were evaluated by an independent oculoplastic surgeon. Clinical diagnosis and management plans were made in each of the arms and were then compared.

Outcomes

There was substantial agreement between diagnoses reached by clinicians in Arms A and B and between clinicians in Arms A and C. Ten lesions were identified as suspicious for malignancy in Arm A (the face-to-face visit), eight of which were confirmed as basal cell carcinoma. All of these lesions were also determined to be suspicious in Arms B and C (the photograph assessments).

Limitations

The study is relatively small and should be validated with a larger study. In addition, since all lesions were not biopsied, it is possible that some malignant lesions were missed in all arms. Ideally, a similar study would be performed with a larger number of patients in which all patients undergo biopsy for a definitive diagnosis.

Clinical significance

The pandemic demonstrated the need for more non–in-person clinic encounters. The evaluation of eyelid lesions relies on visual inspection of the lesion to determine the need for biopsy/excision and the likelihood of malignancy. This study demonstrates that the evaluation of photographs shows no significant difference when compared with a face-to-face evaluation for the detection of malignancy.