Perspective from Sanjiv S. Agarwala, MD
April 14, 2015
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Speaker: Screening, diagnosis of melanoma has become increasingly reliant on technology

Perspective from Sanjiv S. Agarwala, MD
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NEW YORK — Technology is increasingly being used to screen for and diagnose melanoma, according to a presenter here.

“The amount of moneys being spent on treatment of advanced melanoma is, to some extent, fueling this interest in primary and secondary prevention,” Ashfaq A. Marghoob, MD, an attending physician at Memorial Sloan Kettering Cancer Center, said at the HemOnc Today Melanoma and Cutaneous Malignancies meeting.

During his presentation, Marghoob discussed leveraging technologies for the screening and diagnosis of melanoma.

“Over the past 30 to 40 years, we have gotten quite good at [what to look for] from the clinical standpoint,” he said with regard to screening for suspect lesions.

There are many faces to finding early malignant melanoma, according to Marghoob. These include analytical recognition, with an example being the “ABCD” mnemonic of melanoma; differential recognition, or cases in which a mole that looks different is of concern; and comparative recognition, or recognizing change in a lesion over time.

When physicians utilized visual examination alone, sensitivity was 70% and specificity was 75%, with 12 to 15 benign nevi being removed for every melanoma found, according to various research, he said.

Patients at high risk for melanoma frequently have many moles that are atypical in appearance; therefore, the challenge is finding new or changing lesions in this group of individuals, according to Marghoob. This, however, is where technology can be leveraged to assist, he said.

Photography and imaging allow physicians to compare patients’ older and more recent photos; however, learning to look for changes in nevi can sometimes be a challenge in itself, he said.

Total body photography (TBP) helps find thinner melanomas and can be utilized in both 2-D and 3-D formats. Additionally, a computer-assisted program can assist physicians in finding melanoma lesions using TBP, according to Marghoob.

Another available technology, dermoscopy, overlaps between screening and diagnosis, with sensitivity at 90%, specificity at 86% and a benign to malignant ratio of 4:7, according to Marghoob. Some studies have even demonstrated a ratio of 4:1 when using dermoscopy.

However, dermoscopy is time consuming, and the human factor comes into play, leaving room for improvement in terms of sensitivity and specificity, he said.

A newer technology — reflectance-mode confocal microscopy (RCM) — is a virtual-based pathology that allows physicians to see the cellular structure of the skin. RCM is available in a hand-held device and allows for in-vivo diagnosis, and the benign to malignant lesions ratio is 2:1 for RCM, according to research, Marghoob said.

Despite all the available technology, however, most melanomas are still being found by patients, according to Marghoob.

“We still need to harness the ability of patients to find their own melanoma,” he said.

Multiple companies now produce scopes that can be attached to cellphones, as well as apps through which patients can compare changes in a specific lesion. Patients then have the ability to take those images with them when they see their physician, or they can communicate electronically with their physicians.

“All technologies come at a cost,” Marghoob concluded. “Although the overall impact is improvement, there is a problem when technologies take over … as we get better and better at being able to use technology, our own expertise will suffer to some extent. — by Bruce Thiel

References:

Marghoob AA. Leveraging Technologies for Melanoma Screening and Diagnosis. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies. April 10-11, 2015; New York.

Disclosure: Marghoob reports no relevant financial disclosures.