The role of technology in melanoma screening and diagnosis

Abstract

Melanoma presents challenges for timely and accurate diagnosis. Expert panels have issued risk‐based screening guidelines, with recommended screening by visual inspection. To assess how recent technology can impact the risk/benefit considerations for melanoma screening, we comprehensively reviewed non‐invasive visual‐based technologies. Dermoscopy increases lesional diagnostic accuracy for both dermatologists and primary care providers; total body photography and sequential digital dermoscopic imaging also increase diagnostic accuracy, are supported by automated lesion detection and tracking, and may be best suited to use by dermatologists for longitudinal follow‐up. Specialized imaging modalities using non‐visible light technology have unproven benefit over dermoscopy and can be limited by cost, access, and training requirements. Mobile apps facilitate image capture and lesion tracking. Teledermatology has good concordance with face‐to‐face consultation and increases access, with increased accuracy using dermoscopy. Deep learning models can surpass dermatologist accuracy, but their clinical utility has yet to be demonstrated. Technology‐aided diagnosis may change the calculus of screening; however, well‐designed prospective trials are needed to assess the efficacy of these different technologies, alone and in combination to support refinement of guidelines for melanoma screening.

Etiologies of Melanoma Development and Prevention Measures: A Review of the Current Evidence

“…An unaided total body skin examination is currently the most common screening method. The method uses the “ABCDE” methodology: asymmetry, border irregularity, nonuniform color, diameter greater than 6 mm, and evolution over time [ 149 ]. A physician-performed total body skin examination has been linked with a decreased incidence of thick melanomas, which are typically associated with poorer prognoses.…”

“…New screening methods with higher sensitivities are also under development. Total body photography (TBP) images the entire skin surface at a single time point as a reference for longitudinal monitoring [ 149 ]. TBP typically is performed in imaging booths and captured within minutes.…”

“…Temporal image comparison, or serial imaging, uses digital imaging over time to track the growth of potential cutaneous melanoma to assess their risk. SDDI is one method that is most useful for pre-existing lesions, as, by nature, it tracks them over time [ 149 ]. This method is especially useful for tracking lesions without clear benign or malignant features.…”

Dermoscopy practice guidelines for use in telemedicine

“…However, appropriate dermoscopy training is vital to proper and consistent use. User expertise and training increases diagnostic accuracy, whereas lack of training can pose major barriers to providers 5 , 6 . Teledermatologic modalities of care dramatically increased during the recent SARS-CoV-2 pandemic, yet there were increased numbers of missed melanomas and non-melanoma skin cancers, further necessitating proper dermoscopic provider competency in teledermatology visits 7 , 8 .…”

The Value of Total Body Photography for the Early Detection of Melanoma: A Systematic Review

“…Thus, 3-D TBP may particularly facilitate the localization of lesions for follow-up [13]. Both techniques may aid in the assistance of the early detection of melanoma as they improve the diagnostic accuracy of melanoma in high-risk patients [14][15][16][17]. TBP has the advantage of monitoring the patient's entire skin surface, rather than only a subset of individual lesions.…”