Use of Smartphones for Early Detection of Melanoma: Systematic Review

Abstract

BackgroundThe early diagnosis of melanoma is associated with decreased mortality. The smartphone, with its apps and the possibility of sending photographs to a dermatologist, could improve the early diagnosis of melanoma.ObjectiveThe aim of our review was to report the evidence on (1) the diagnostic performance of automated smartphone apps and store-and-forward teledermatology via a smartphone in the early detection of melanoma, (2) the impact on the patient’s medical-care course, and (3) the feasibility criteria (focusing on the modalities of picture taking, transfer of data, and time to get a reply).MethodsWe conducted a systematic search of PubMed for the period from January 1, 2007 (launch of the first smartphone) to November 1, 2017.ResultsThe results of the 25 studies included 13 concentrated on store-and-forward teledermatology, and 12 analyzed automated smartphone apps. Store-and-forward teledermatology opens several new perspectives, such as it accelerates the care course (less than 10 days vs 80 days), and the related procedures were assessed in primary care populations. However, the concordance between the conclusion of a teledermatologist and the conclusion of a dermatologist who conducts a face-to-face examination depended on the study (the kappa coefficient range was .20 to .84, median κ=.60). The use of a dermoscope may improve the concordance (the kappa coefficient range was .29 to .87, median κ=.74). Regarding automated smartphone apps, the major concerns are the lack of assessment in clinical practice conditions, the lack of assessment in primary care populations, and their low sensitivity, ranging from 7% to 87% (median 69%). In this literature review, up to 20% of the photographs transmitted were of insufficient quality. The modalities of picture taking and encryption of the data were only partially reported.ConclusionsThe use of store-and-forward teledermatology could improve access to a dermatology consultation by optimizing the care course. Our review confirmed the absence of evidence of the safety and efficacy of automated smartphone medical apps. Further research is required to determine quality criteria, as there was major variability among the studies.

Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies

“…We included an additional two studies2930 that were not included in previous reviews. We also excluded between three42 and five9 studies that reported the development (without independent validation) of new apps that were included in the other two reviews because such studies are likely to overestimate accuracy.…”

Current state of melanoma diagnosis and treatment

“…Several smartphone applications, such as SkinVision, UMSkinCheck, and MoleScope, have been developed with purported goals of wide-spread accessibility, cost-effective screening, and ultimately increased early detection for patients. However, multiple studies have shown that these applications are often inaccurate: 36,37 one study found that 3 out of 4 applications incorrectly classified upwards of 30% of melanomas as low-risk lesions. 37 These applications could be a very useful tool for melanoma diagnosis if accuracy could be improved and if strict regulatory oversight was ensured, 37,38 however, experts caution that reliance on these applications as they are currently available has the potential to harm patients through a false sense of security, potentially resulting in delayed diagnosis.…”

Will applications on smartphones allow a generalization of telemedicine?

“…An expense of around 30 euros has just saved a few hundred euros in expenses and a lot of unnecessary stress for both the patient and the care staff in charge of organizing a transfer. There are a large number of published examples of smartphone-based telemedicine demonstrating both its clinical effectiveness and costeffectiveness in fields as varied as geriatrics [21], psychiatry [22], neurology [23], dermatology [24], and cardiology [25].…”