Technology in Dermatology, Friend or Foe?

Skin cancer is the most common type of cancer in the United States. Approximately 1 in 5 individuals will get this diagnosis in their lifetime, with the incidence increasing every year among Caucasian men and women over 20 years of age. This includes basal cell carcinoma, squamous cell carcinoma, and melanoma. In 2009 the incidence of melanoma alone (which is the least common, but most deadly, type of skin cancer) was estimated to be between 23 and 32 people per 100,000 Massachusetts’s residents.

The Center for Disease Control and Prevention (CDC) performed a national survey in 2008 which gives us some insight as to why this incidence may be increasing.  Causative factors are thought to include limited or no use of sun-protective behaviors by adults and adolescents, increased adolescent use of tanning facilities, and a large incidence of more than one sunburn within the past year among adolescents and young adults.

Regardless of reason, skin cancer is becoming more and more common and thus new technologies and devices are being developed to help identify these cancers earlier, educate and increase awareness among the public, and prevent adolescents and adults from excessive sun exposure that increases their skin cancer risk dramatically. This is extremely important because research has shown that a single diagnosis of skin cancer increases one’s risk for a second skin cancer and other, non-skin related, types of cancer.

The American Academy of Dermatology has a “Suntelligence Quiz”  for you to test your knowledge on sun protective behaviors and determine your risk for developing a skin cancer, with advice on how to alter your behavior to prevent it. Hopefully, by the end of this article you will agree that dermatologic technology is definitely your friend and can be invaluable resources.

Smart Phone Apps

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UM Skin Check is an excellent tool to assist patients in monitoring their moles.

There’s an app for that,” a saying we have all reiterated or heard dozens of times. However, 9 times out of 10, it’s likely true. It is no different when it comes to apps for medicine and specifically, dermatology.  There has recently been a lot of controversy over the accuracy of medical apps utilized by patients to aide in identification and diagnosis of skin lesions. Whether some apps pose more risks than they do benefits and prevent patients from seeking proper medical assessment and treatment is a true concern among healthcare providers.  These worrisome and irresponsible apps claim to analyze a lesion through comparison to other malignant lesions in a computer software system or by sending the photograph (taken on your smartphone) to a dermatologist, who then diagnoses it. These apps often charge per lesion analyzed and cannot assess other characteristics of a lesion that are important in determining it’s diagnosis, such as texture not visible on a smart phone photo, and don’t take into account factors such as personal or family history, exposure risks, and if a lesion is changing or symptomatic. While no diagnostic test or procedure is 100% accurate, studies have shown that misdiagnosis of a melanoma or other malignant skin lesions occurs more frequently in these apps than it should.

UM Skin Check is an excellent tool to assist patients in monitoring their moles.

UM Skin Check is an excellent tool to assist patients in monitoring their moles.

Recommended Apps

  • UMSkinCheck” is an excellent free app, developed by the University of Michigan that we often recommend to our patients at Krauss Dermatology.   It helps patients to monitor their moles and other skin lesions, set reminders for monthly self-skin exams, and take photographs of  lesions to track any possible changes.  It helps educate people on the most effective sunscreen use and sun-protective behaviors, instructs patients in specific lesion characteristics when looking at moles during a self-skin exam.
  • Epi-Tracker”: an app for those afflicted with acne that will help to monitor the progression of treatment through the use of a photo journal, set medication reminders, provide tips on how to prevent scarring, and information on Epiduo (a common acne medication).
  • The Eczema App“: can help patients track their flares and identify potential triggers while providing an on-the-go resource dedicated solely to eczema.
  • Sun Effects Booth“: developed by the Queensland Government, Australia to help users predict their skin’s future. It asks a series of questions about your sun-protective behaviors (or lack of them!) and analyzes your answers and the average UV index of your location to predict what your face will look like in the future. The results may be shocking, but the app also provides information on how to save your skin and prevent the results that you see.
  • The Rosacea App“: endorsed by the National Rosacea Society, this app can help patients afflicted with rosacea identify and track triggers, learn about the variety of treatment options, and how to alter one’s lifestyle to help reduce flare-ups. This app also provides information on a common rosacea medication, called Finacea.
  • CARD-Contact Allergen Replacement Database“: an app to help those with persistent contact allergies and have had patch testing keep track of their identified allergens and identify both safe products and products to avoid. This app also has a diary to help identify products that may cause flaring of allergies.
  • Psoriasis Symptom Monitor“: helps patients set appointment and medication reminders, track the progress of their treatment, label body areas affected by psoriasis, take photos of flare-ups and/or improvement to help you and your dermatologist follow your treatment and insure it is working well. It is password protected to insure your photos are secure and private.

While this is not an all-encompassing dermatology “app-list” and none of these apps are the sole solution to one’s ailment, they can help those afflicted better manage their condition while providing education and helpful tips. If you are more of a game-oriented individual, check out these fun dermatology game apps:

  • Smack A Mole“: A dermatology spin on the old-time arcade favorite “smack a mole.” However, instead of a pesky rodent, these moles are abnormal skin moles that have border irregularities, uneven pigmentation, grow (or evolve), and have a larger than 6mm diameter. These are all lesion characteristics to assess when performing your monthly self-skin exam and thus, this game may help you better identify abnormalities within your moles.”Safe Sun Game“:  This game emphasizes the importance of proper sunscreen application and mirrors the popular game angry birds, as it has the gamer strategically shoot sunscreen onto beachgoers.

Dermoscopy

A lesion is seen with visual inspection (top left corner) and then viewed with Dermoscopy with greater detail appreciated.

A lesion is seen with visual inspection (top left corner) and then viewed with Dermoscopy with greater detail appreciated.

A dermatoscope is a non-invasive diagnostic instrument utilized by dermatologists, with special training in its use, to magnify a skin lesion and assess its potential for malignancy. Skin surface microscopy dates back to 1663 but dermoscopy started in the early 1900s and only gained wide acceptance in the late 1900’s with the first dermoscopy international conference in 2001. Dermoscopy, also known as epiluminescent microscopy, magnifies a skin lesion in such a manner that its structure and color become visible in a way that it isn’t to the naked eye or regular magnification. Dermatologists utilize dermoscopy to improve identification of lesions prior to biopsy or excision, which is still the gold standard for diagnosis of a skin lesion.  Through utilization of a dermatoscope, earlier identification of malignant skin lesions is possible, as well as more accurate diagnosis of benign skin lesions without biopsy.

Mole-Mapping

If you see your dermatologist utilize a device that looks like this, they are performing dermoscopy. This will provide your doctor with more information about the lesion.

If you see your dermatologist utilize a device that looks like this, they are performing dermoscopy. This will provide your doctor with more information about the lesion.

Mole-mapping or digital total body imaging, utilizes a single-lens camera and imaging software that compares lesion changes over time and identifies new lesions. In a patient with many moles, a personal or family history of melanoma, or rare genetic disorders that increase one’s risk for melanoma, this type of imaging and mole-tracking can be beneficial in identifying early melanomas and may improve patient outcomes. However, for most individuals extensive full body imaging is time consuming, costly, and generally not covered by insurance. Your dermatologist may perform a simpler type of mole mapping when photographing some of your moles for comparison at future skin exams.

MelaFind®

MelaFind® has been developed by MELA Sciences as a new diagnostic tool to aide in earlier diagnosis and detection of melanoma and decrease the number of unnecessary biopsies, while improving accuracy of lesion categorization. MelaFind is one of the newest technological devices in dermatology. However, a recent study found that if physicians rely too heavily on the findings of MelaFind®, some melanomas may be missed. MelaFind is specifically used to assess pigmented skin lesions with one or more atypical characteristics, in deciding whether or not to perform a biopsy.  MelaFind® differs from dermoscopy in that it utilizes 10 different wavelengths of light to examine lesions up to a depth of 2.5mm beneath the skin’s surface and then compares that lesion to a database of malignant lesion photographs. While this tool has been shown to aide in identifying atypical lesions, it is not a replacement for a thorough skin examination by a dermatologist, is time consuming, costly, and not covered by insurance companies.

There are also limitations to the use of MelaFind® as it does not aide in identifying non-melanoma malignancies (such as basal cell and squamous cell carcinoma) and the lesion must meet specific criteria to be analyzable by the device. It is also important to note that out of the 1831 lesions analyzed in the clinical study performed by MELA Sciences, 1702 of the lesions were identified as “cannot be excluded as melanoma,” a majority of the cases. While MelaFind® should not be discounted completely and may be appropriate for a certain patient, the evidence-base for this tool is from a study funded solely by the manufacturer of the product and thus presents a potential conflict and bias. There is currently insufficient evidence to support that its use improves patient outcomes, decreases the amount of inappropriate biopsies, or that it should be used by dermatologists or non-dermatologist physicians in the routine skin examination of patients.

Conclusion

Technology is important in dermatology and is changing rapidly.  We hope you find this review helpful in caring for your skin.  Do not use any app that promises to tell you from a photo whether your mole is a melanoma.  But do use digital photography, whether using UMSkinCheck or your digital camera, to help you monitor your moles and identify changing skin lesions.  When in doubt, see your dermatologist!

Kalei Ensminger, RN, Krauss Dermatology

Family Nurse Practitioner Student, Regis College

Madeline Krauss, MD

Dermatologist Krauss Dermatology


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