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Advances in Imaging for Skin Checks With Dr Jennifer Stein

Total body photography has been around for decades, said Jennifer A. Stein, MD, PhD, FAAD, at the 2019 American Academy of Dermatology Summer Meeting. It can show marked change in lesions, she added. It does not necessarily require state-of-the-art machinery as old photographs of patients can be used to monitor and compare changes in new and suspicious lesions.

The benefit of total body photos is that it decreases biopsy rates and has been shown to decrease patients concerns about cancer, according to Dr Stein. “I think this is good for those patients who are anxious and who don’t do self-exams,” she said.

One of her recommendations to help patients with skin self-exams was to give them a book or CD with their pictures to help them monitor their skin and lesions for changes. Findings from a study that compared patients who were given a book of photos to those without a book showed patients with the book were better able to identify altered lesions compared with those without, Dr Stein noted.

Dr Stein reviewed currently used automated machines for performing skin checks. 3D body photos see all parts of skin and manually take dermoscopic images to watch for changes. These include sequential dermoscopic imaging, total body scans, gross image, as well as close up of individual lesion. According to Dr Stein, this instrument is best for patients who are on the fence or do not want a biopsy. A photo can be taken at the time of visit and the patient returns for follow up after 3 months, and again after 6 months for slow growing lesions, to catch changes in suspicious lesions.

I by no means do not use total photography for all of my patients, said Dr Stein. Patients’ comfort level, cost, as well as privacy issues are some of the reasons she listed for considering whether or not to do total body photography. “If I do a book, I give it to a patient and I do not keep a copy” she said, adding that electronic images of patients are not included in their electronic medical records but placed in a separate file with a different firewall to ensure privacy and security.

Patients who benefit the most from total body photography are ones where the provider may not be able to easily keep track of moles, she said. In addition, she added that patients do not have to have photographs taken of their entire body. For example, an image of a patient’s back is effective for those where most nevi are localized to that region.

Patients can also take their own images and use apps, such as Molemapper (a free app developed by Oregon Health and Science University) to upload pictures and track their moles, said Dr Stein.

Confocal imaging is another option that can be purchased by dermatologists and has been found to be efficacious. It is able to get into the cellular detail at 30x and goes down to the papillary dermis, which is good for diagnosing melanoma, said Dr Stein. In addition, this imaging lends itself to lentigo maligna and is good for mapping out margins, she added. The cost is $89,000 to purchase and $5000 for annual maintenance, but there are CPT codes so physicians can be reimbursed. According to Dr Stein, clinics can break even with about 2 or 3 patients undergoing confocal imaging.

Dr Stein ended her presentation on advances in artificial intelligence (AI). In a 2017 study that compared the diagnosis of melanoma between dermatologists and AI, AI performed about the same as dermatologists, she stated. Another meta-analysis published in 2019 showed AI programs outperformed dermatologists at diagnosing pigmented skin lesions.

While the focus has in AI research has been on competition between humans and machines, Dr Stein stressed a change towards not looking at it as a competition anymore, but as “humans with machines.” While AI can select the best statistical prediction based on a photograph, physicians can still determine what the best diagnosis is. The computer does not replace judgment but can complement it, she said. There is strength in having more information and giving access to patients in areas with few or no dermatologists to help them decide whether a trip to a dermatology office is worth it to catch melanomas, she added.

Reference

Stein JA. Advances in imaging technology for melanoma diagnosis. Presented at: the 2019 American Academy of Dermatology Summer Meeting; July 25-28, 2019; New York, NY.

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