Standards needed to guide technology’s role in skin imaging
NEW YORK — Mobile technologies will continue to play a larger role in melanoma detection due to increased access and ease of use, but a lack of oversight and quality assurance remain formidable challenges, according to a presenter at the HemOnc Today Melanoma and Cutaneous Malignancies meeting.
“We live in an amazing moment in time when you look at what has happened from a technology perspective: It’s faster, cheaper and more robust,” Allan C. Halpern, MD, chief of the Dermatology Service at Memorial Sloan Kettering Cancer Center and a HemOnc Today Editorial Board member, said during a presentation. “Even in expert clinics, most melanomas are found by patients themselves between visits … so the opportunities for direct-to-consumer apps are enormous.”
Allan C. Halpern
More than 50 apps available for the iPhone evaluate images of lesions, rashes and other abnormalities to help diagnose melanoma and/or instruct patients whether to seek medical attention.
“One big problem is, we’re all using off-the-shelf technology,” Halpern said. “The cameras are getting better and better, but they’re also getting smarter. If someone takes a picture with an iPhone, it already does a lot of on-camera processing to try to make the skin look better. It gets rid of red eye and other features that may be critical to diagnosing a skin lesion.”
Two attempts to develop Digital Imaging and Communications in Medicine (DICOM) standards for imaging techniques and the technology needed to process, store and transmit the images have been unsuccessful. The lack of those standards raises questions about quality and consistency.
“How good can these apps be and, equally important, how do we know if they’re good?” Halpern said.
The International Skin Imaging Collaboration: Melanoma Project — a collaboration of skin cancer specialists, imaging technology developers and informatics experts — focuses on digital imaging standards related to skin lesion diagnosis. The effort also includes the creation of a public, international archive of standardized clinical and dermoscopic images of skin lesions.
“By developing some standards — and by creating large image archives — it will empower people to do a better job developing these kinds of apps, and also give us a yardstick with which to begin testing and validating them,” Halpern said. “The hope is that we can use that to both formulate the standards, test the standards and promulgate the standards among centers that specialize in melanoma.”
Until standards are formulated, Halpern urged clinicians who use images in their practice to be cautious.
“If you are acting on a picture you received in an email, it probably belongs in the patient’s medical record,” he said. “If it’s in the medical record, you want to make sure it is an image of reasonable quality and that you’ve ensured the privacy of it so it doesn’t pop up at the patient’s next dental appointment.”
For more information:
Halpern AC. Existing technologies: do we need to establish standards for skin imaging? Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; April 11-12, 2014; New York.
Disclosure: Halpern reports consultant fees from Caliber ID, Canfield Scientific, DermTech and Quintiles.