Skin cancer — are apps part of the solution?

This content was created on behalf of Miiskin — A proud sponsor of Dermnet NZ. Medically reviewed by Dr Amanda Oakley. August 2018.


Skin self-examinations

Melanoma survival rates are dramatically improved if a melanoma is detected early, especially when the malignant cells are confined to the tissue of origin — called melanoma in situ or level 1 melanoma.  When melanomas are not caught early, and have invaded into the deeper layers of the skin, the survival rates drop [1].

Many suspicious lesions that turn out to be melanomas are initially identified by the patient [2], so skin self-examination can contribute to early detection. It follows that encouraging skin self-examination and facilitating more effective skin self-examination are both strategies likely to assist in early detection of melanoma.

The majority of moles, spots and bumps on the skin are harmless, but it is not always the case. As well as looking out for any “ugly duckling” that stands out from other moles, people are advised to look for changes in their existing moles and also be aware if any new spots appear within previously normal skin. In adults, 71% of melanomas are new lesions [3].

In order to monitor for changes over time, taking photos of your skin and moles is recommended by many organisations and credible resources [4–8]. Photographs record current and new  moles so that changes can be more easily detected. Photographs of a wider area of the skin can also assist in the detection of new spots.

The Melanoma Institute Australia recommends “The best way to monitor changes on your skin is by taking photographs every few months and comparing them to identify any changes. React quickly if you see something growing and/or changing [8].”

Miiskin (miiskin.com) has created an app to help consumers monitor their skin for changes over time. The app helps its users keep track of individual moles with close-up photographs over time. As part of its premium subscription, it also helps its users monitor their skin as a whole to keep an eye out for new spots. This can be especially useful on a hard-to-see area like the back, although help will be needed to photograph this part of the body.

The Miiskin app is free for the basic version. The premium version of the app costs US$25 per year and it comes with a 30-day free trial for its users to try it out before they are charged anything.

Read more about how you can start using the Miiskin app here.

For a diagnosis — see your doctor.

Home photo-monitoring of skin and moles should not replace a visit to the doctor.

Even though some research [9] has showed promising results with algorithms for melanoma risk assessments of moles when pictures are taken in clinical contexts, there is still a long way to go before consumers can get a diagnosis or even an adequate automatic risk assessment through a smartphone.

The British Association of Dermatologists released a press release in July 2017 stating that apps that aim to detect or diagnose lesions based on smartphone photos should be treated with caution [10].

Teledermatology services have shown more promising results in real-life settings, and can be as good as an in-person examination by a specialist — when the total body examination and lesion selection is initially undertaken by a trained and experienced practitioner [11].

Putting technology to good use

The Melanoma Risk Predictor, developed by Australian researchers (QIMR Berghofer Medical Research Institute) in the Qskin — Sun and Healthy study [12], represents a useful way to take advantage of technology to help users understand their overall risk of melanoma. Note that the results cannot be guaranteed for non-Australians.

The Melanoma Risk Predictor can be accessed within the Miiskin app. It is currently available in the app to all English speaking countries; the Risk Predictor itself is only available in English.

App technology

There is general evidence [13] that smartphone apps have been well received by users when implemented in health interventions in other areas.

When it comes to skin self-examinations, apps like Miiskin have also been positively received by users and professionals because of their usefulness in helping users take pictures of their skin on a regular basis.

Besides helping its users photograph their skin, a bespoke smartphone app can insert a layer of privacy and security around the user’s photos so they aren’t mixed up with other general photographs such as holiday pictures or are lost.

Apps may also help skin self examinations by providing a digital mole map to pinpoint the location of the lesions that have been photographed.  

Some apps can be used to set reminders via push messages for the next skin self-examination.

In addition, apps are able to assist the user in comparing photographs over time by allowing side-by-side viewing and parallel manipulation of the images. This may make it easier for the user to identify differences between photos such as the appearance of a new mole, or a change to an existing mole.

Smartphone apps may also provide general education and information, so people can easily educate themselves about melanoma and examining their skin.

If you want to try out one of these apps, you can download Miiskin. Of course, Miiskin is very clear to their users that the app does not provide any diagnoses or risk assessments on the photographs.

The basic features of Miiskin are free and you also get a 30-day free trial to try out the Premium version. Find out more about the Miiskin app.

Are you a health professional? Please contact the Miiskin team on [email protected] to request free leaflets that describe the use of the Miiskin app and help educate about primary and secondary prevention of skin cancer.

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References

  1. Survival rates for melanoma skin cancer, by stage. American Cancer Society. Available at: https://www.cancer.org/cancer/melanoma-skin-cancer/detection-diagnosis-staging/survival-rates-for-melanoma-skin-cancer-by-stage.html. Accessed 15 August 2018.
  2. Avilés-Izquierdo JA, Molina-López I, Rodríguez-Lomba E, Marquez-Rodas I, Suarez-Fernandez R, Lazaro-Ochaita P. Who detects melanoma? Impact of detection patterns on characteristics and prognosis of patients with melanoma. J Am Acad Dermatol. 2016 Nov;75(5):967-974. doi: 10.1016/j.jaad.2016.07.009. Epub 2016 Sep 16. PubMed PMID: 27645105. Journal. PubMed.
  3. Pampena R, Kyrgidis A, Lallas A, Moscarella E, Argenziano G, Longo C. A meta-analysis of nevus-associated melanoma: Prevalence and practical implications. J Am Acad Dermatol. 2017 Nov;77(5):938-945.e4. doi: 10.1016/j.jaad.2017.06.149. Epub 2017 Aug 29. Review. PubMed PMID: 28864306. PubMed.
  4. Moles and Skin Cancer Screening. WebMD. Available at: https://www.webmd.com/melanoma-skin-cancer/screening-moles-cancer#2f. Accessed 15 August 2018.
  5. How to check your skin for skin cancer. Queensland Health. Available at: https://www.health.qld.gov.au/news-alerts/news/how-to-check-your-skin-for-skin-cancer. Accessed 15 August 2018.
  6. Check your skin now. TJEK DIN HUD NU. Available at: https://tjekdinhud.nu/. Accessed 15 August 2018.
  7. UpToDate.com.
  8. How do I check myself for melanoma? Melanoma Institute Australia. Available at: https://www.melanoma.org.au/preventing-melanoma/how-do-i-check-myself-for-melanoma/. Accessed 15 August 2018.
  9. Esteva A, Kuprel B, Novoa RA, Ko J, Swetter SM, Blau HM, Thrun S. Dermatologist-level classification of skin cancer with deep neural networks. Nature. 2017 Feb 2;542(7639):115-118. doi: 10.1038/nature21056. Epub 2017 Jan 25. Erratum in: Nature. 2017 Jun 28;546(7660):686. PubMed PMID: 28117445. PubMed.
  10. Untested skin cancer apps endangering the public. British Association of Dermatologist Press release, Jul 5th 2019. Available at: http://www.bad.org.uk/media/news#. Accessed 15 August 2018.
  11. Finnane A, Dallest K, Janda M, Soyer HP. Teledermatology for the Diagnosis and Management of Skin CancerA Systematic Review . JAMA Dermatol. 2017;153(3):319–327. doi:10.1001/jamadermatol.2016.4361. Journal.
  12. Olsen CM, Green AC, Neale RE, Webb PM, Cicero RA, Jackman LM, O'Brien SM, Perry SL, Ranieri BA, Whiteman DC; QSkin Study. Cohort profile: the QSkin Sun and Health Study. Int J Epidemiol. 2012 Aug;41(4):929-929i. PubMed PMID: 22933644. PubMed.
  13. Payne HE, Lister C, West JH, Bernhardt JM. Behavioral Functionality of Mobile Apps in Health Interventions: A Systematic Review of the Literature. Eysenbach G, ed. JMIR mHealth and uHealth. 2015;3(1):e20. doi:10.2196/mhealth.3335. PubMedCentral.

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