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November 21, 2015 / molehunter

another new selfie mole watching smartphone app

I receive a regular Google Alert on melanoma 3 or 4 times a week. Much of the information concerns new medicines for metastatic melanoma and the biotech and pharma companies that make and sell them. Other alerts concern the stories of individual melanoma patients, fundraising etc. One story that comes up a lot is smartphone apps that can apparently help with earlier diagnosis. There are now dozens of these apps.

The latest app to come to my attention in Skinvision. See here, there is a link to a video.

I have not done an appraisal of these apps, and I am neither for nor against them. Some work on mole recognition software, others send images to experts who give an opinion, some link to educational images on line, others enable people to photograph, store images of and follow their own moles digitally (the Skinvision does several of these things according to the video).

None of this is wrong in principle, but as ever its the detail and the actual performance in real life that counts-we ought to be skeptical and watch out for unintended effects and pitfalls of new medical applications-good intentions are not enough, the thing has to WORK, and also be safe. One thing which worries me is the possibility that some of these folks behind these devices might be selling their services as mole removal surgeons and therefore IN THEORY might have a financial interest in diagnosing lots of moles as potentially worrying and needing surgical removal (ker-ching!) {*}

The efficacy and safety of Skinvision and other similar apps would have to be determined by an appropriate professional body or investigator. In principle, they might be a very good thing, but there are drawbacks with any diagnostic system, whether through over diagnosis (false positives) or under diagnosis (false negatives). Anyone involved in cancer diagnosis is terrified of a false negative (people can die from missed melanomas and even if there was no higher motive, doctors are afraid of getting sued in this event). There is therefore a tendency of diagnostic systems to over diagnose, and this may lead to anxiety and avoidable excisions. Just saying.

But we do know there is are potential benefits of skin monitoring. At the 4th World Dermoscopy and Skin Imaging Congress in Vienna last April, I heard 2 presentations from top world experts about the benefits of digitally monitoring the skin for suspicious moles. Professor Scott Menzies of Sydney, Australia presented about short and long term digital monitoring, where high risk patients had quality digital images of their whole skin and/or suspicious individual moles made and were followed up. Basically, if a mole did not change over time, it was OK. If it did change (size, shape, colour, new appearance) it was more carefully evaluated and  if in doubt removed. This proved to be cost effective (avoided unnecessary excisions of marginally worrying moles) and safe (the melanomas detected and removed by this system were thin and easily curable).

So, we have good evidence that professional digital monitoring of high risk patients and worrying flat (never thick) lesions is safe, effective and saves people having operations and scars they don’t need. Sounds like a win win. But setting this up and running it costs money and is only cost effective for high risk patients (e.g. people with 100 or more moles and a history of melanoma). But what if we could use an inexpensive app and a camera or tablet/smartphone we already have to do it ourselves? Not as good as an expert, perhaps, but the principle is the same and, as Bluto famously said in ‘Animal House’, ‘Don’t cost nothing!’

Another talk was by Professor Peter H Soyer who presented some research about people using a mini dermoscope that attached to their mobile phone to photograph any mole they were worried about and email the image to the dermatologist. The evaluation of the emailed mole image  compared with face to face consultation very favourably. This was not a proper trial but a test of concept-certainly it seems to offer potential. This paper was published in April 2015’s British Journal of Dermatology.

So, where does that leave us for now? The gold standard of digital monitoring with a dermatologist and state of the art equipment is not achievable for all, it remains the preserve of the wealthy worried well or high risk patients in enlightened and adequately funded health care systems (so not the British NHS then). But most of us in wealthy countries have access to a smartphone or tablet.

In a future post I will consider how individuals who are worried but don’t have easy access to a dermatologist can do their own mole mapping with an Ipad or similar. Basically, photograph the whole of your skin, or as much as modesty allows (wear a bikini) and check your skin against it every 3 months or so. Be reassured if nothing changes. If of course you do get something new or changing then you have evidence you can take to your GP for onward referral to a specialist.

I must stress that self photography of the skin and home monitoring is not as yet evidence proven by proper trials, but it seems harmless and makes sense. Think of it as ‘poor man’s digital monitoring’ and certainly top world melanoma expert Scott Menzies has shown that monitoring can relieve anxiety and save lives.

 

{*} for younger non British readers, the word ‘ker-ching!’ is meant to sound like an old fashioned cash register ringing up a sale.

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