Skin cancer detection by one click — are we any closer?

To the Editor: Despite cost-effective sun-safety campaigns,1 in 2010, 36% of adolescents and 42% of adults believed a sun-tanned person looks more healthy, and 21% and 13%, respectively, were sunburned during the previous weekend.2 Skin cancer rates in Australia will thus remain high.

Early detection of skin cancers can reduce excess morbidity and mortality, and allows less invasive treatment.3 A number of smartphone apps have been developed that provide analysis of uploaded images of naevi. They could engage consumers to take a more active part and collaborate with their doctors for optimal skin health. However, recent research reported that the sensitivity of four “melanoma early detection” apps ranged from 6.8% to 98.1%.4 The app showing a reasonable level of performance was one that sends the image directly to a board-certified dermatologist for analysis.4 We tested five apps and found a range in sensitivity of 0–80% (data to be presented at the 47th Hawaii International Conference on System Sciences, 6–9 January, 2014; Chadwick X, Loescher LJ, Janda M, Soyer HP. Mobile medical applications for melanoma risk assessment: false assurance or valuable tool?). In the United States, the Food and Drug Administration has drafted guidance for mobile medical applications,5 and similar guidance may be needed in Australia.

In contrast to these apps, mobile teledermoscopy — a form of teledermatology — is designed to assist remote skin cancer detection by a doctor. The dermoscope is attached to the phone, providing magnification and polarised light and optimal distance from the lesion for photo precision; this is combined with an app for recording details (eg, location of lesion on the body, patient’s sex, age and lesion history), storage and transfer. We found that it allows consumers to take and submit excellent clear images of skin lesions. The mobile teledermoscopy process is acceptable to most, but not all, consumers,6 and could in future supplement some face-to-face dermatology encounters in skin cancer care. Barriers may include having many moles, lack of expertise with using smartphones or apps, and not having a partner to help with areas of the body that are difficult for the patient to photograph.

It is likely that Australian doctors will increasingly use apps in their practice, or will be asked about results received through such apps by their patients. It will be important for doctors to inform themselves about the accuracy of such tools and how mobile medical applications can best enhance their practice and patient interactions.