GRAND CAYMAN ISLAND – Smartphones and other digital technologies could provide clinicians – and patients – the tools to greatly improve melanoma and other dermatology outcomes, but how might they change actual practice?
“Ten years from now, what is going to distinguish the app world from the dermatology community?” That was the question Dr. Allan C. Halpern, chief of the dermatology service at Memorial Sloan Kettering Cancer Center, New York, posed at the meeting, sponsored by Global Academy for Medical Education.
Dr. Allan Halpern
Many clinicians already use dermatoscopes, which Dr. Halpern said “significantly improves diagnostic accuracy for melanoma by making available to us visual cues that would not be available through routine naked-eye examination.” However, he said, a rapid digital evolution in dermoscopy is already underway, allowing clinicians to use mobile devices that store images and perform short term monitoring of any areas of concern.
“For suspicious lesions, rather than do a biopsy, one of the options is that you can take a dermoscopic image of it, then do so again in another couple of months. If it hasn’t changed, then the data are very convincing that you’re dealing with something other than melanoma,” Dr. Halpern said.
What gives him pause is that there are an increasing number of consumer-based smartphone medical products, including more than 250 for dermatology alone.
“For about 100 dollars or less, patients can purchase their own dermatoscope and attach it to their smartphone” and take images of their own lesions, Dr. Halpern said.
As a result, he believes that the field has reached the “tipping point” for successful teledermatology, where companies can accept and interpret these data.
Because of the exponential growth of mobile medical applications, the Food and Drug Administration issued guidance for their use in 2015, he noted.
Although he said that the FDA is overwhelmed by the task – and that the medical app marketplace is akin to the Wild West – medical apps are here to stay and will continue to develop quickly.
“For one thing, big players are now entering the field,” he said, alluding to a recent Apple initiativeto collect data uploaded by consumers to the Cloud, which can then be parsed by medical researchers. In addition to melanoma, Apple is currently focusing on autism and epilepsy.
“Apple is trying to make the iPhone a conduit for medical research,” Dr. Halpern said.
Over the next 5-10 years, there will be a race to see who can perfect this kind of data analysis. There is even an ongoing competition that pits melanoma researchers around the world against one another to see who can most accurately interpret images uploaded to the archives. The hope, he said, is that it will help dermatologists to develop and agree upon international standards for melanoma diagnosis.
With this kind of standardization, medical apps can help both consumers and practitioners triage care.
“I don’t know when it will happen, but there is no doubt we’re going to reach a point at which these apps are going to be as good as the average dermatologist is today when it comes to looking at a single spot,” Dr. Halpern said.
Aside from some cancer centers’ ability to create three-dimensional images of lesions, another distinguishing technology for dermatologists could be reflectance confocal microscopy.
“As dermatologists, we are trained well enough in pathology that we can use this technology, we will be able to do even better than with dermoscopy alone,” he said. This kind of technology captures images at the cellular level similar to histological examinations, but without the actual biopsy.
In an interview, Dr. Halpern said that while dermatologists have nothing to fear from apps in daily practice, there are some issues to be aware of. “The first is the one we’re most concerned about – automated diagnosis, before we know for certain that the apps work.”
Another issue is that these apps raise awareness among consumers about their individual risk for melanoma, which will “invariably help drive more people in the door,” but there may not be enough clinicians to manage these patients.
The group Dr. Halpern expects will be the most frequent users of personal dermatology technologies initially are “ultra–tech savvy young people motivated to avoid melanoma,” although he expects that over time, this could change as technologies become easier to use.
He disclosed financial relationships with Quintiles, Canfield Scientific, DermTech, SciBase, and Caliber ID.
Global Academy and this news organization are owned by the same parent company.
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