While we look forward to time in the sun this summer, we know we need to protect ourselves against the risk of melanoma. In this article, published in January 2022, Nicky Pellegrino discovered AI is helping with the early detection of skin cancer, but it isn’t without flaws.
The earlier a melanoma is spotted, the more chance that surgery will have a successful outcome, so there is a great deal of interest in the potential of smartphones to help us identify suspicious moles and have them treated faster.
A number of AI-based apps have been designed to flag suspicious lesions, but the general consensus has been that they shouldn’t be relied on as there is a high likelihood of them missing melanomas. One problem is those AI systems that have been trained on banks of images showing mostly people of European descent are less helpful for those with darker skins.
There is some encouraging news, however, from a small trial led by the University of Sydney. It involved 100 people who had previously been diagnosed with melanoma and found that tele-dermatology helped participants identify skin cancers between scheduled doctors’ visits.
“We’ve been researching in this area for a few years and found that often it was a patient or one of their family members who was the first to notice that a mole had changed, but then they would wait because they had a routine check coming up,” says Katy Bell, a public health researcher at the university. “We thought there was an opportunity to empower people to check the change themselves first and have it attended to straight away.”
Self-checking with a smartphone requires a special lens, known as a dermatoscope, that fits over the device. Before embarking on a larger study, researchers wanted to know whether people would be able to attach it correctly and take good-quality, clear images.
“Patients have to learn about new technologies and so it is definitely something you need a period of training and practice to do,” says Bell. “Another issue is that it takes time and some people had difficulty finding a skin-check partner who was willing to help them.”
There was also a concern that having to check their skin more often might spark anxiety, but most participants felt reassured to have some control in the management of their health.
Melanoma is a cancer that develops in the skin’s pigment cells and can occur even in areas that receive little or no sun exposure. People who have already had one are at increased risk of developing more, even if it was a Stage 0 melanoma in situ – in other words, the cancer cells were all contained in the area in which they started to develop and hadn’t grown into deeper layers of the skin. While staying vigilant is important for everyone, those with any history of skin cancer need to be especially careful.
Once they had photographed any moles that were concerning them, the participants in the MEL-SELF project sent the images, via an app, to a dermatologist for examination. Five new melanomas were picked up this way, before the people concerned were due for a routine visit to the doctor, suggesting it is a practical and useful approach to earlier detection.
“It’s a small number,” says Bell, “but it still seems to be a strong signal.”
In New Zealand, at least 6000 people a year are diagnosed with melanoma and it is responsible for nearly 80% of all skin-cancer deaths. There is a shortage of dermatologists working in public health and there can be long waiting times. Telehealth has the potential to take some pressure off the system as well as benefit patients.
“Dermatologists may be able to reduce some of the routine skin checks,” says Bell. “If they were confident a patient was doing a thorough skin examination, taking good photos and choosing the right lesions to image, they might be happy for them to drive the surveillance, and that would free up some of their time to focus on higher-risk people who definitely have to come to a face-to-face clinic.”
More study is being done, with researchers recruiting 600 participants for a larger MEL-SELF trial, titled “Can smartphone technologies help patients to detect melanoma early?” and Bell reports there has been strong interest.
“Since the pandemic, people are much more familiar with telehealth, and both doctors and patients are really keen to try it out.”
This article was originally published in the NZ Listener on January 15, 2022.
