Skin cancers

Full-body imaging: Do dermatology benefits trump privacy?

Emerging imaging techniques like 3D total-photography, which can create sensitive and identifiable images, are prompting concerns about privacy among dermatologists and patients.

The technology, which involves photographing the whole body for the early detection of melanoma, it is not yet widely used in clinical practice but is showing promising results in Australian trials.

Benefits include being able to present cutaneous lesions in their skin ecosystem – which can provide important clinical context to aid dermoscopy interpretation – while it has also shown potential in a recent study for accurately monitoring lesions over time.

However, 3D total-body photography also presents unique problems in terms of privacy and confidentiality, argue the authors of a new paper in Australasian Journal of Dermatology (link here).

They point out images are usually nude or  semi-nude and may be visually identifiable as well as potentially unflattering.

“They can include the patient’s face and other identifiable features (e.g. tattoos, body piercings, birthmark and body habitus) which are easily recognisable,” the University of Queensland team wrote.

Stored 3D images may also raise concerns about identification via facial recognition systems, they warn.

“Addressing privacy is imperative for the clinical adoption and secondary use of digital total-body imaging,” they said.

To shed further light on the issue, the team polled participants at a consumer forum involving patients from previous and current 3D total-body imaging studies back in March, with 39 taking part in the survey.

A tenth said they would not be comfortable with clinicians or researchers sharing even non-identifiable images on social media. Some participants were also unhappy with non-identifiable imaging being shared with overseas research institutes, publicly accessible database or for education and training in classrooms.

All participants said they were OK with non-identifiable images being kept in medical records.

But, predictably, patients were far more hesitant when it came to the sharing of their identifiable and/or sensitive images, with 77% saying they would not want them on social media.

More than half of respondents also said they were uncomfortable with sensitive images going on publicly-accessible databases, presented at conferences or with researchers in overseas countries.

Some 15% said they were uncomfortable with identifiable images being shared even with their own personal medical record.

“As the potential sensitivity of images increased, an increasing proportion of participants reported that they would have reservations about sharing such data for multiple purposes,” the researchers noted.

“Due to the concerns participants in our forum raised about control over their images and a lack of current guidelines, researchers and healthcare providers should prioritise privacy concerns to facilitate uptake, by providing clear privacy policies and safeguards, including outlining transparently any secondary uses of data.”

They said a key lesson was that patients should be given the ability to opt-in to certain secondary uses of their images, as their comfort levels changed depending on the scenario.

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