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Emerging technologies allow patients, computers to help diagnose melanoma
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NEW YORK — Emerging technologies during the next 5 to 10 years will assist physicians in surveillance of melanoma through advances in imaging, as well as provide new ways for computers and patients to help with diagnoses, according to study results presented at the HemOnc Today Melanoma and Cutaneous Malignancies meeting.
Ashfaq A. Marghoob, MD, a board-certified dermatologist and director of Memorial Sloan-Kettering Cancer Center’s regional skin cancer clinic in Hauppauge, N.Y., discussed these technologies and how they can aid in the challenges of diagnosing melanoma.
Finding a concerning lesion
A challenge to physicians is having “a patient with lots of moles, and now you’re trying to find out which is the lesion that could be a melanoma,” Marghoob said.
Ashfaq A. Marghoob
One option is total body photography. Studies have shown that patients followed by total body photography tended to have thinner melanomas vs. the population at large, as well as fewer biopsies performed on benign lesions.
However, in those who have many moles, the examination time can be much longer than what is required for the average person.
Possible solutions include the “flicker technique” to obtain images of an individual and repeat those images at a later date. The physician then flips back and forth between the images. Anything that “flickers” (changing nevi) would be highlighted as an area to concentrate on.
New technology would combine total body 3-D imaging with computers using registration to help find the changed lesions (flickers). “There are multiple companies that have looked into this,” Marghoob said.
Diagnosing a concerning lesion
“Once you have found this concerning lesion, now what we do we do?” Marghoob said. “The answer is somehow to increase the specificity while maintaining a high sensitivity.”
Studies have shown that the ratio of benign to malignant lesions removed was between 12:1 and 15:1 for visual examination vs. 10:1 for total body photography and approximately 5:1 for dermoscopy.
A more accurate diagnostic tool could be confocal microscopy, basically a laser that allows physicians to see the cellular details of the skin.
He used an example of a 3-mm lesion on the chest. Dermoscopy was fairly nonspecific.
Confocal microscopy showed a nodular melanoma and a superficial basal cell carcinoma.
Prototypes under development include a confocal device that attaches to the skin and allows a physician to see the cellular details on an iPhone screen, as well as confocal microscopy with 3-D imaging of the lesion.
Another option being developed is “tele-confocal” microscopy, allowing a physician to send an image to a center, which would then answer what it is.
Computerized diagnostic systems also are being developed. Clinical trial results for a computer-based imaging instrument (MelaFind) showed a sensitivity of 98.4% for finding melanoma, with a specificity of 9.5%, which was better than the 3.7% rate of physicians enrolled in the study.
Finding rapidly growing melanomas that escape detection
“We tell patients to look at their own skin,” Marghoob said. “We also give patients total body photography to assist them in their examination. Why not … tell them how to use dermoscopy?”
He gave an example of a patient who bought his own dermatoscope and found his own melanoma.
“With very simple rules, it is possible that patients can actually start this,” Marghoob said.
Patients can then communicate with their physicians about the results.
Another idea is that a patient can take the image and “send it off to some other center that can tell them what to do,” he said.
There are companies creating a dermatoscope, planned for $5 to $6, which patients can purchase to take an image and then send it to a center for evaluation.
“Our clinics may end up being more procedure-oriented spaces but … much of the [rest of the diagnoses] will occur in this virtual space,” Marghoob concluded.
For more information:
Marghoob A. Update on new surveillance technologies. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; March 22-23, 2013; New York.
Disclosure: Marghoob reports no relevant financial disclosures.