Participation of older males in a study on photography as an aid to early detection of melanoma

Enhancing Skin Self-Examination with Imaging: Evaluation of a Mole-Mapping Program

Background:

To enhance early detection of melanoma with thorough skin self-examination, we have enrolled patients in a mole-mapping program that uses digital imaging of the skin.

Objective:

The goal of our study was to evaluate the impact of participation in the mole-mapping program on performance of thorough skin self-examination.

Methods:

The study was carried out by telephone survey of 64 program participants, using self-report to assess impact.

Results:

Participants were generally satisfied and found the program useful and effective; 97% would recommend it. Almost half (45%) of those who were not performing thorough skin self-examination before participation reported performing it after receiving their images. After participation, a partner such as a spouse or friend was more commonly assisting in these examinations. We also noted a correlation (of borderline statistical significance) between sun protection and performance of self-examination, and differences among different definitions of thorough skin self-examination.

Conclusion:

Interventions centered around imaging have the potential to substantially enhance and encourage the performance of thorough skin self-examination for the early detection of melanoma.

Total body photography for skin cancer screening

BACKGROUND

Total body photography may aid in melanoma screening but is not widely applied due to time and cost. We hypothesized that a near-simultaneous automated skin photo-acquisition system would be acceptable to patients and could rapidly obtain total body images that enable visualization of pigmented skin lesions.

METHODS

From February to May 2009, a study of 20 volunteers was performed at the University of Virginia to test a prototype 16-camera imaging booth built by the research team and to guide development of special purpose software. For each participant, images were obtained before and after marking 10 lesions (five "easy" and five "difficult"), and images were evaluated to estimate visualization rates. Imaging logistical challenges were scored by the operator, and participant opinion was assessed by questionnaire.

RESULTS

Average time for image capture was three minutes (range 2-5). All 55 "easy" lesions were visualized (sensitivity 100%, 90% CI 95-100%), and 54/55 "difficult" lesions were visualized (sensitivity 98%, 90% CI 92-100%). Operators and patients graded the imaging process favorably, with challenges identified regarding lighting and positioning.

CONCLUSIONS

Rapid-acquisition automated skin photography is feasible with a low-cost system, with excellent lesion visualization and participant acceptance. These data provide a basis for employing this method in clinical melanoma screening.

The Australian experience in sun protection and screening for melanoma

Australia has the world's highest incidence of skin cancer. Despite excellent prevention and early diagnosis education programs and an increasing percentage of the population with darker and more UV tolerant skins, skin cancer remains a major and expensive community medical problem. However, primary and secondary prevention programs are now showing positive outcomes, especially in melanoma incidence and survival. Primary and secondary prevention programs are conducted by a variety of non-government organizations such as the Australian Cancer Council, which is comprised of state anticancer groups, with some assistance from State and Federal health agencies. Current and future campaigns are becoming focused on specific community groups, noticeably teenagers and the older population. The role of sunscreens as the primary preventative approach has been superceded by sunlight avoidance campaigns. In light of an increasing rate of early diagnosis, a low and falling morbidity of melanoma, improving general practitioner competence in skin cancer diagnosis and proliferation of skin cancer clinics throughout Australia, it is unlikely a national skin cancer screening program will be implemented. Ozone depletion, a sunlight overloaded environment, increased leisure time and an outdoor lifestyle necessitate continued efforts to minimise the cost and morbidity of skin cancer in Australia.

Adoption of new technologies for early detection of melanoma in dermatologic practice

The identification and diagnosis of early melanoma will reduce unnecessary operations and may be important in reducing mortality from melanoma and impacting cost savings to the health system. New technologies are being developed and used at some specialized centers to facilitate the detection and diagnosis of early melanoma for patients at high risk. These technologies include but are not limited to digital photography, dermoscopy, computerized image analysis systems, and confocal scanning laser microscopy. To most effectively implement these novel approaches, it is important to identify the key factors that influence the adoption or diffusion of new medical technologies. We propose patient-, physician-, and health care system-related factors that influence the diffusion of new technologies for the early detection of skin cancer. Studies involving physicians and patients in a variety of clinical settings need to be conducted to achieve a greater understanding of the barriers to the adoption of these new technologic tools that are intended to aid in skin cancer screening.

Screening for melanoma

This article describes major screening studies of the past two decades, discusses the evidence-based screening recommendations, highlights the need to screen high-risk and previously unscreened populations, and concludes with suggestions for risk assessment and physician-nurse training in the skin cancer examination.