American Journal of Clinical Dermatology

, Volume 19, Issue 5, pp 779–785 | Cite as

Piloting the Use of Smartphones, Reminders, and Accountability Partners to Promote Skin Self-Examinations in Patients with Total Body Photography: A Randomized Controlled Trial

  • Andrew J. MarekEmail author
  • Emily Y. Chu
  • Michael E. Ming
  • Zeeshan A. Khan
  • Carrie L. Kovarik
Short Communication



The aim of this study was to evaluate the use of a mobile application (app) in patients already using total body photography (TBP) to increase skin self-examination (SSE) rates and pilot the effectiveness of examination reminders and accountability partners.


Randomized controlled trial with computer generated randomization table to allocate interventions.


University of Pennsylvania pigmented lesion clinic.


69 patients aged 18 years or older with an iPhone/iPad, who were already in possession of TBP photographs.


A mobile app loaded with digital TBP photos for all participants, and either (1) the mobile app only, (2) skin examination reminders, (3) an accountability partner, or (4) reminders and an accountability partner.

Main Outcome Measure

Change in SSE rates as assessed by enrollment and end-of-study surveys 6 months later.


Eighty one patients completed informed consent, however 12 patients did not complete trial enrollment procedures due to device incompatibility, leaving 69 patients who were randomized and analyzed [mean age 54.3 years, standard deviation 13.9). SSE rates increased significantly from 58% at baseline to 83% at 6 months (odds ratio 2.64, 95% confidence interval 1.20–4.09), with no difference among the intervention groups. The group with examination reminders alone had the highest (94%) overall satisfaction, and the group with accountability partners alone accounted for the lowest (71%).


A mobile app alone, or with reminders and/or accountability partners, was found to be an effective tool that can help to increase SSE rates. Skin examination reminders may help provide a better overall experience for a subset of patients.

Trial Registration Identifier: NCT02520622.


Compliance with Ethical Standards


AJM is supported in part by the Institute for Translational Medicine and Therapeutics (ITMAT) and the National Center for Advancing Translational Sciences of the National Institutes of Health under award number TL1TR000138 and Grant number UL1TR000003, respectively. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Science or the National Institutes of Health. EYC is supported by a Dermatology Foundation Dermatopathology Research Career Development Award.

Conflict of interest

Andrew J. Marek, Emily Y. Chu, Michael E. Ming, Zeeshan A. Khan, and Carrie L. Kovarik declare that they have no conflicts of interest.

Ethical Approval

This study was conducted with the approval of the University of Pennsylvania IRB. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of DermatologyJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Department of MedicineMedStar Harbor HospitalBaltimoreUSA
  3. 3.Department of DermatologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of MedicineRowan University School of Osteopathic MedicineStratfordUSA

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