One of the most important peer-reviewed journals in the field of dermatology, JAMA Dermatology, published a study that evaluated several mobile apps that claim to be able to detect lesions at risk for being melanoma. The conclusion? Some apps are better than others. Melanoma is a deadly form of skin cancer that dermatologists are recognizing in patients at ever younger ages and at increasing frequency. There are many risk factors for melanoma, but sun exposure and tanning are at the top of the list. Early detection can be a matter of life and death, because as the melanoma grows deeper in the skin, chances for long term survival become much lower. For this reason, dermatologists welcome every effort to increase early detection.
Dermatologists used to detect melanoma just by looking at a “mole” and judging whether it is suspicious based on its features to the naked eye. Specifically, asymmetry, border irregularity, color variation, large size, and change over time are considered risk factor for melanomas. Now, a technique called dermoscopy (which is similar to a handheld microscope) allows dermatologists to avoid biopsying benign lesions while highlighting otherwise innocuous appearing lesions as suspicious. Based on this, if a lesion is suspicious, a biopsy is taken and this is the gold standard for melanoma detection.
So, how do mobile apps fit into this model? Three of the four apps reviewed in JAMA Dermatology use a computer algorithm to simulate what a dermatologist wound do: i.e., look for asymmetry, border and color irregularities, etc. These apps performed very poorly. One of these apps missed 93% of real melanomas, and another app was wrong 33% of the time when it said something was melanoma. Some of these apps were free, or very inexpensive, which could be appealing to underprivileged people who believe that they can’t afford to see a dermatologist. This is unfortunate, because they are not getting the level of care they deserve and their health could suffer as a result. The fourth app, however, performed better because the images were sent to an actual board-certified dermatologist for review.
This app missed less than 2% of melanomas. Although First Derm was not studied in this article, it also sends all images for review by board certified dermatologists. Dermatologists agree that teledermatology is an exciting and promising way to triage patients. It can be hard for an individual patient (or even a non-dermatologist physician) to know whether any given rash or bump is serious or worrisome. With apps like First Derm, a dermatologist can triage your rash or bump in a matter of hours. This study from JAMA Dermatology confirms that algorithms can’t replace the dermatologist. First Derm, however, brings the dermatologist to you.
Written by: Dennis A. Porto, MD
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The Specialist doctor from the University Hospital in Gothenburg, alumnus UC Berkeley. My doctoral dissertation is about Digital Health and I have published 5 scientific articles in teledermatology and artificial intelligence and others.