ISIC Project

EVOLUTION OF DIGITAL IMAGING IN SKIN LESION DIAGNOSIS

Although skin lesions are visible to the naked eye, early-stage melanomas may be difficult to distinguish from benign skin lesions with similar appearances. This has led to many missed melanomas despite an epidemic of skin biopsies. The number of unnecessary biopsies varies by clinical setting, the expertise of the examiner, and the application of technology. For example, in children in whom melanoma rates are low and changing moles are common, there are over 500,000 biopsies a year to diagnose approximately 400 melanomas.

Dermatologists who specialize in skin cancer routinely employ total body photography and dermatoscopy as diagnostic tools for the detection and diagnosis of melanomas. Total body photography permits the early detection of changing lesions and avoidance of biopsy of stable lesions. Dermatoscopes, simple hand held devices that eliminate surface glare and magnify structures invisible to the “naked eye”, significantly improve the distinction of melanomas from other skin lesions. When used by skin cancer specialists, total body photography and dermoscopy make it possible to detect melanoma very early in its evolution, while decreasing the number of unnecessary biopsies and improving recognition of atypical lesions. In clinical trials, training in dermoscopy or sequential imaging led to improvements in early detection of melanoma for both non-specialist dermatologists and primary care physicians. Specialized systems for image acquisition, storage, and retrieval have been developed for physicians to facilitate total body photography assisted follow up and digital dermoscopic monitoring.

The adoption of technological aids for melanoma detection by dermatologists in general practice and primary care physicians — who constitute the front line in melanoma detection — has been slow due to cost and inconvenience. This is changing due to the mobile revolution as smart phone based digital cameras and dermatoscopes enter the professional market.

In addition, there has been a proliferation of apps for the public. While the potential of consumer apps to educate and aid in melanoma detection is great, the first generation apps have evolved without regulation or oversight. The availability of inaccurate self-diagnosis” apps may lead some patients to delay a consultation with a clinician. Indeed, a small study of the accuracy of some of these apps endorses this concern. As of February 9th 2015, the FDA (Food and Drug Administration) has assumed responsibility for regulation of consumer diagnostic apps and on February 23, 2015 the FTC (Federal Trade Commission) fined app makers for false advertising.