One useful technology for melanoma is serial total body photography to detect dynamically changing and therefore suspicious skin lesions.
"You’d want it if you were the patient. But it’s a logistical nightmare to set it up," Dr. Halpern observed.
Conventional total body photography is two-dimensional. Dr. Halpern and his colleagues are working with industry to develop a 3-D total body imaging system. The prototype takes 1 millisecond to acquire a 360-degree color total-body representation. Although such technology is not practical for the typical office practice, it may be a boon for patient care in high-volume skin cancer centers.
American dermatologists as a whole are about a decade behind their European colleagues in embracing dermoscopy as a tool for enhanced assessment of concerning lesions, Dr. Halpern noted.
"We’re still not as good at it as many of them, because they started on the learning curve earlier. But we are rapidly catching up," he added.
The next major advance in melanoma detection that improves upon dermoscopy will require subsurface imaging that provides cellular detail. Optical coherence tomography and high-resolution ultrasound are among the technologies under development, Dr. Halpern said.
He said he believes that reflectance confocal microscopy holds the greatest promise. "Now there’s a handheld device that runs off of a laptop [VivaNet by Lucid Inc.]. There are clinics in Europe using it routinely. It may or may not play out in clinical practice here," he said.
At present, the only Food and Drug Administration–approved device for melanoma detection is MelaFind, the multispectral imaging system marketed by Mela Sciences. Other diagnostic systems the pipeline for melanoma include the use of electrical impedance spectroscopy and the noninvasive genomic detection of melanoma via RNA analysis of a scraping of stratum corneum off of the lesion.
Dr. Halpern reported serving as a consultant to Canfield Scientific, DermTech, SciBase, Quintiles, and Lucid.
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