I’m compelled to use this platform to sound an alarm and draw added attention to something that has been of great concern to me personally. Today, CBS News published an article that reviews the accuracy of a growing number of smartphone apps that are designed to diagnose skin cancer and other dermatologic conditions. The article cites a January study, also reported by CBS, that appeared in JAMA Dermatology. Researchers tested four different smartphone skin cancer apps. One of the apps sends photos to board certified dermatologists for review. In the research study, that particular app was, as you might expect, quite good. It missed diagnosing just one of 53 pictures of melanoma that were used to test its accuracy. However, taken together the accuracy of all four smartphone apps was determined to be just 33 to 42 percent.
I’ve personally observed people using these dermatology apps. While I applaud them as a way to engage consumers on the importance of skin cancer prevention and knowing the warning signs of skin cancer, I worry that they may be giving people a false sense of security. Worse yet, they might delay treatment by providing a false negative diagnosis of a suspicious skin lesion.
Let me tell you, I know first hand about the prevalence and significance of skin cancer. While still in my 20’s I had my first episode of basal cell skin cancer. Since then I’ve had the unfortunate experience of being diagnosed multiple times with all three of the most common types of skin cancer; basal cell, squamous cell and melanoma. Basal cell and squamous cell generally don’t kill you. They just disfigure. Melanoma skin cancer does kill. Thankfully, my melanoma was caught very early and removed at an “in-situ” stage of development.
I religiously see my dermatologist every six months, and even more often if I have as much as a nuance that something is changing on my skin. I know from experience that skin cancer is often hard to diagnose even for the most skilled and experienced dermatologists. I’ve had some of the best experts look at lesions on my skin and tell me that I had nothing to worry about. Only by my own insistence that a skin biopsy be performed and examined under a microscope have we learned that, in fact, the lesion was an early cancer. When it comes to skin cancer, a biopsy is still the gold standard for diagnosis. And trust me, you can’ t get a biopsy from a smartphone app.
Over the years, treatment options for skin cancer have improved. Some kinds of skin cancer can be treated with topical medications. Some still require surgical excision. But in all cases, early diagnosis will provide the most optimal results.
So, if you want to educate yourself about the signs and symptoms of skin cancer by using a smartphone app, please have at it. However, please don’t use a smartphone dermatology app as a replacement for being seen by a board certified dermatologist. If there is anything that concerns you about changes on your skin, see a doctor. Even though I am myself a physician, I don’t leave fate to chance. I get examined by my dermatologist. I certainly wouldn’t trust the health of my skin to an app on a smartphone.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft
Apps or kinect can help scan and track moles. Making it easier to follow more patients. It can even help track changes and alert them to go see the dermatologist. We as physcians need to embrace technology and use it to our benefit.
I am a total believer in consumer health apps. As you say, apps that can help patients map or track worrisome lesions are beneficial. I just don't want patients to get a false sense of security that an app on a smartphone can replace a visit to their dermatologist. A biopsy is still the gold standard for diagnosis, and you're not going to get a biopsy (at least not yet) from a smartphone. At best, smartphone apps for monitoring changes on the skin are an adjunct to regular medical visits, not a replacement for them.
Bill Crounse, MD