While dermatascopes and the analyses used at MoleSafe are the most effective in detecting skin cancers and Melanoma, being vigilant by starting with your own naked eye exam is important, too.  AND it’s important for doctors to mandate that as well.  Shockingly, only 59.6 percent of family practitioners and 56.4 percent of internists conduct regular full-body skin exams, compared to 81.3 percent of dermatologists. (We would like to know why it is not 100% of dermatologists, though.)

According to a story in Bloomberg Businessweek last month,

“The most common reasons for not performing this type of examination were patient embarrassment/reluctance, time constraints, and other patient illnesses.”

About half of the internists and family practitioners cited time constraints as an impediment to conducting the naked eye exams.

I find all those reasons unacceptable since taking five minutes is nothing compared to a diseases that takes lives.

Our post in 2009 here on Melanoma Updates publicized the suggestion that not only should medical students be trained in naked eye exams no matter their ultimate specialization, but asking your doctor to keep an eye open while checking your lungs and seeing your back, or seeing your legs while checking your reflexes.

So, show the love this year and start by checking yourself, check your mate, and check with your doctor.

The Right View

“View” lets physicians examine images WHILE the patient is in the office for an exam, which enables not only a more thorough exam by the doctor, but more information back to patients in real-time. [Read more in my post from November, when View was unveiled at the International Dermoscopy Society Conference.]

Previously, even with a dermatoscope, doctors reviewed only a few moles and could never be fully confident that their naked eye scrutiny discerned some of the finer, or questionable moles. For dermatologists who refer patients to MoleSafe for a comprehensive and state-of-the-art screening, this software is available for use in their offices at no charge. We just feel it is imperative to bring the opportunity for the best options for melanoma detection to as many patients as possible…and View enables a more clear, super enlarged view of all moles for doctor review, with the ability to pause on any questionable areas and compare the patient’s actual skin along side the macro images that have been delivered to the screen.

Based on the feedback we’ve gotten, this looks to be revolutionizing doctor/patient relationships and the very process of screening for earlier detection of melanomas, especially among high risk patients.

We encourage all of our readers to review the MoleSafe web site FAQs, and to take advantage of the increasing ways and places to get the most efficacious skin cancer examination… and help us make early, accurate detection a team effort among patients, their doctors, and technology.

To Top it Off: Sun Safety

FYI, at these fairs it’s easy to negotiate for a discount if you buy more than one, so consider a hat for yourself, too!

Another good thing to do for yourself and a loved one is to have regular skin cancer screenings.

What topped off my weekend though was also the opportunity to share this story about digital dermoscopy and MoleSafe’s thorough melanoma screenings, thanks to recent press on AssociatedContent.com.  Please share this info with all your friends and relatives as we enter into the season of “fun in the sun.”

Just don’t forget your hat.

Note: This blog post may be a little more formal and "scholarly” than my usual posts. I thought it was important to convey this compelling information accurately and as objectively as possible, so I’ll be including longer sections of quotes from the BJD paper.

The study, hoped to determine if patients could be screened for melanomas and other skin cancers effectively with the use of a teledermatology system (which includes the use of epiluminescence microscopy and macrophotograhy and forwards results to dermatologists) as triage (screening and prioritization) by general practitioners and lesion diagnosis clinics when using proper screening equipment, compared to face-to-face examinations by dermatology specialists.

Conducted in New Zealand, this was particularly valuable to that location since NZ suffers from one of the "highest reported incidence of melanoma and nonmelanoma skin cancers in the world” ¹ while at the same time being challenged by an undersupply of dermatologists. In addition, some 15% of the population there lives more than an hour’s drive from a dermatologist. It’s not just essential to confirm the value of teledermatology in that country, but also in all places where "the technology could be used as a triage tool to reduce waiting lists and thus improve access to the public hospital lesion diagnosis clinic.”

As a matter of fact, this was reported in the British Journal of Dermatology because of the interest in determining if this would be a good solution in Great Britain where current U.K. National Institute for Health and Clinical Excellence (NICE) guidelines dictate that all suspected skin malignancy should be seen face to face, and the use of teledermatology for pigmented lesions remains controversial.

"However, the incorporation of high-quality teledermoscopic images in addition to macroscopic images may challenge this view.”²

Indeed, the researchers comment in their conclusion that:

Teledermoscopy offers considerable potential to reduce patient travel costs and waiting time, and thus to increase access to specialist care. …We hope to integrate this technology into the public health service as it is already in use in NZ and Australia within the private sector (MoleMap programme).¹

We read the results of this clinical study with great interest, and some pride, since our sister [parent?] company, MoleMap New Zealand, was selected to supply the quality equipment and trained technicians. That is significant is because lesser quality methods and equipment used in earlier studies to compare diagnoses done via face-to-face exams vs preliminary screenings with teledermoscopy led to lesser consensus:

The use of a melanographer skilled in digital and dermoscopic imaging ensured consistently high image quality. Earlier trials have been hampered by inconsistent digital images and often required the general practitioner to obtain the image. Image quality depends on training, experience and time, which may not be practical for a busy general practitioner.¹

This also supported of the value of including Dermoscopy, which is an essential component of any MoleSafe exam, over just macro-photography, as used by some physicians:

"Concordance of teledermoscopy to face-to-face diagnosis in this study was much higher than that reported in earlier trials. This in part reflected the greater specificity that Dermoscopy has over simple macro photography in the triage of lesions.”¹

How It Was Conducted:

First, the study set out to "assess the accuracy and reproducibility of teledermatology including dermoscopic images (teledermoscopy) compared with face-to-face assessments by dermatologists.” Some two hundred patients with a total of 491 lesions were seen by a dermatologist, and also screened with same methods used by the MoleMap/MoleSafe program with the results sent to the doctors for review.

All patients were seen face to face by two out of three dermatologists, and after a period of 4 weeks the same lesions were reviewed anonymously by two using a standardized history, macro digital images and corresponding dermoscopic images.²

The results were that there was excellent agreement between teledermoscopy and face-to-face diagnosis.

We have shown that 136 of 200 patients (constituting 74% of lesions) could have been spared a face-to-face consultation through using teledermoscopy as the preliminary assessment.¹

The agreement in assessment of more significant lesions was an even better 83% for both face-to-face and teledermoscopy. But what was particularly interesting is that the type of scanning and review done by MoleSafe — including histological examination of suspected malignant lesions — showed the teledermoscopic diagnosis to be more accurate than face-to-face diagnosis.

"This seemingly unlikely observation may relate to the ability to enlarge and contemplate images on a computer screen which is simply not possible during examination of the patient with a hand-held dermatoscope.”²

It’s also important to note that reproducing the study’s results are contingent on the training and experience of the dermatologist, both of whom in the trial were experienced in tele-dermatology and dermoscopy. And when done in conjunction with a whole-body exam, again, as we do at MoleSafe, and as done in a naked eye exam by your dermatologist, results should be even more significant:

"…this store-and-forward form of teledermoscopy provided only images of the lesions of concern and did not permit a whole-body examination. The use of a whole-body teledermoscopy service may overcome this limitation, and a recent analysis of 100 consecutive melanomas diagnosed by MoleMap NZ showed that 37% of patients were unaware of their melanoma.”¹

Here’s the takeaway…

In the future, general practitioners may be able to refer a patient with suspicious skin lesions to a ‘virtual lesion clinic’ for triage. Perhaps there will soon be mobile clinics since "the technology is portable, easy to operate and images can be transmitted via a virtual private network to the teledermoscopists – overcoming geographical barriers and delivering service to remote areas.”

What does this study add?

• Teledermoscopy approximated 100% sensitivity and 90% specificity for detecting melanoma and nonmelanoma skin cancers.

• Importantly, 74% of all lesions were determined to be manageable by the general practitioner without needing to be seen face-to-face by a dermatologist.

• This use of teledermoscopy as a triage tool offers the potential to shorten waiting lists and thus improve healthcare access and delivery.¹

Simply put, this is a clarion call for the value and effectiveness of the kinds of screenings that are conducted by MoleSafe and MoleMap and we are proud to be at the leading edge of skin cancer detection and awareness.

¹Source: British Journal of Dermatology, 12/09: "Successful triage of patients referred to a skin lesion clinic using teledermoscopy (IMAGE IT trial)” by E. Tan, A. Yung, M. Jameson,* A. Oakley and M. Rademaker  Journal Compilation ©2010 British Association of Dermatologists • British Journal of Dermatology 2010 162, pp803–811

²Commentary: British Journal of Dermatology – "Does teledermoscopy validate teledermatology for triage of skin lesions?” S. M. Halper 2010

In all seriousness, Melanoma Updates has also noted back in October that Harvard School of Public Health wanted to encourage more primary care physicians be trained in looking out for melanomas while they happened to be examining other parts of the body. Makes sense to me. So, it makes sense to me that if you’re at all uncomfortable having a full body skin-exam that you could at least start by having your loved one give you a naked eye once-over for spots and dots you can’t see yourself. As the Skin Cancer Foundation’s post points out, “patients themselves detect about half of all melanomas.” They also have a terrific self-exam how-to posted on their site.

As they also note, it doesn’t replace a doctor’s examination, especially one trained in the use of a dermatoscope.

image of dermatoscope

But we are all about moving skin cancer prevention forward, and keeping loved ones around for as long as possible.

In all seriousness, Melanoma Updates has also noted back in October that Harvard School of Public Health wanted to encourage more primary care physicians be trained in looking out for melanomas while they happened to be examining other parts of the body.  Makes sense to me.  So, it makes sense to me that if you’re at all uncomfortable having a full body skin-exam that you could at least start by having your loved one give you a naked eye once-over for spots and dots you can’t see yourself. As the Skin Cancer Foundation’s post points out, “patients themselves detect about half of all melanomas.” They also have a terrific self-exam how-to posted on their site.

As they also note, it doesn’t replace a doctor’s examination, especially one trained in the use of a dermatoscope.

image of dermatoscope

But we are all about moving skin cancer prevention forward, and keeping loved ones around for as long as possible.

As a "woman of a certain age,” I am used to getting the recommended regular medical tests and checks. But I didn’t know there was more to a skin exam than the occasional inspection done by my dermatologist, when I remembered to even book those check-ups. I was proud of myself for being a little more vigilant than many I know – who had never even done a skin exam let alone been checked between the toes, for example! I felt ahead of the curve by comparison.

Then the experience of two different friends gave me a head’s up about ways to get a better head-to-toe scan. My friend Leslie, who has a lot of "beauty marks,” lives near the Millburn location of MoleSafe and had gotten full body scans and “molemapping” for herself and even her children. (I found out that skin cancers are on the rise among kids – especially teenage girls who have been allowed to use tanning salons.)
(I cringe when I think of us using those sunlamps as kids.)

I was thinking about checking out the place and then I bumped into my friend Carol, who had just gotten back from a follow up exam since her bout with melanoma a few years ago. Her cancer had actually been spotted by a woman standing behind her on a ticket line. Carol had had a sleeveless shirt on, and a woman tapped her on the shoulder and said, "pardon me for intruding, but has anyone ever checked out the mole on the back of your arm?…” Carol was vaguely aware of it, but it wasn’t in a place she could easily see. She decided to see the doctor…and a surgery with 16 stitches inside and 16 stitches outside basically saved her life the next week.

That was enough coincidence to send me to MoleSafe to see for myself…and have someone see ME better than I could myself! I spoke to Dr. Richard Bezozo, who invited me in so I could help share the experience with my readers. Bascially, MoleSafe is a three-prong protocol for screening: "Total Body Photography, total digital dermoscopy and digital sequential monitoring.” Apparently, that’s the gold standard for screenings that most dermatologists in the rest of the world recommend. We’re behind the curve in the good old US of A for being progressive in prevention. And it’s not like this is an invasive protocol.

Anyway, here’s what happens:

First, the place is clean, nice, and comfortable (and right near the train from NY.) You get down to your skivvies (you can keep a paper gown on, but I figured mole mapping is once a year and very important, so might as well go for the semi-full monty.) The exam room has a mat that looks like something from an old-fashioned dance lesson (or these days like a Dance Mat from Wii!)

My very reassuring nurse/"moleographer” had me take a stance with my feet in the position indicated on the mat with hands akimbo (I think that means hands on hip? but I always wanted to be able to use that word in a blog). She took a set of images that way, then a set of images on the otherside, feet in the opposite position.

Then we sat down at her desk while she uploaded the super high res images, then coordinated the pictures to points on a computer image of a body. It was like creating a constellation on paper. I could immediately understand how the consistency of taking the same position on the mat year after year is a lot more efficient than random poses and "eyeballing” things. My molegrapher then carefully did a visual exam of moles that caught her eye and captured those with a dermatoscope – it’s a super magnifying camera with a special light that really shows details of specific moles. She uploaded those images, also correlated on the computer to the ones she’d marked on the figure.
It was fascinating to see super enlargements of my skin on the computer. You might find out that there are some that are "interesting” – and might be reassured about others…but all of them are sent electronically (yes, safe and encrypted) to a sort of radiologist/dermatologist who reviews the dermatascope images professionally.

You get a lovely CD of your body mole images to take home and give to your dermatologist. Then, a week or two later you have a report from the specialist sent to you.

The thing is, MoleSafe doesn’t do any surgeries or removals, so dermatologists are still involved in the whole process. I guess It’s like sending a person for an MRI and having then having them come back to the doctor to get treated for the broken leg or tumor or whatever. We need to be our own patient advocates and seek out MoleSafe on our own…or bring it to the attention of our doctors. You can go get one without a referral, and some insurance will cover it when you submit the receipt for reimbursement. Some won’t. But it’s an investment in your life compared to the approach most dermatologists have been using for the past 50 years.
So, I recommend you get on board. Or, get on mat, I guess.

PS: The good news is that I am a-okay, but have a much better sense of what to look for, where to look for it, and why.

PSS: MoleSafe is opening at NYU on 2/3. That should be the eye-opener a lot of people need about the value and legitimacy of this kind of protocol.

This past week Alfred W. Kopf, MD, conducted was what possibly the last lecture from one of the most incredible careers in the specialty of dermatology. And during this conference, which included the latest updates on malignant melanoma, Dr. Kopf’s topic was teaching physicians.

Much as changed since 1985 when Dr. Kopf and his colleagues wrote an article that helped to teach physicians and thus the public the value of skin self-examinations, promoting at that time, the ABCD concept I’ve posted about before. Yet, per my other recent posts, still not enough has changed in getting more physicians trained and on board to be aware and scrutinizing the skin even during other exams.

But Dr. Kopf also spent the next portion of his career promoting the use of total body photography for the early detection of melanoma, and the advocacy of Dermoscopy as an essential tool. He worked diligently to help prove its effectiveness, even helping to identify important mole patterns necessary to make it most effective.

He battled the slow to change tide of US dermatologists, of whom only 23% practice Dermoscopy, vs. its use by virtually 100% of dermatologists outside our country.

To them it’s perceived as essential to their expertise as a stethoscope is to a cardiologist. In the face of the unacceptably low adoption rate in the U.S., Dr Kopf has truly made it his life work to promote the use of Dermoscopy and the training of physicians in that use. I have no doubt his effort has saved thousands of lives.

Dr. Kopf recently retired from NYU Medical School as Professor Emeritus of Dermatology / Clinical Professor, after one of the most notable careers in our field, spanning more than five decades. He also one of the founders of the Skin Cancer Foundation, the Melanoma Newsletter, and has remained an active participant in the melanoma lecture circuit, continuing to provide excellent training to physicians all around the world. I have consulted with and spoken to him on many occasions over the past several years as I have become more involved in the community of physicians working towards effective early diagnosis of melanoma, and he has always been a gentleman, eager to teach, and eager to promote those tools necessary to promote early detection to help save lives.

What make me particularly happy is the knowledge that MoleSafe incorporates almost all of Dr. Kopf’s lifelong passions and topics he’s worked to promote. Now we have to pick up that gauntlet and continue on his path to grow use of Dermoscopy and help improve survival rates exponentially.

They wrote:

[each year more than 60,000 Americans] will have been diagnosed with melanoma, the most dangerous form of skin cancer, according to the American Cancer Society. When early detection is key to survival, thorough and accurate skin cancer screenings become one’s first line of defense. But what do you do if you discover today’s standard screening isn’t as efficient and reliable as it could be? …you seek out a better way.

Agreed.

They went on to tout their newest technology, in the form of a cordless digital imaging device that uses LED lighting and a fixed-zoom lens to produce consistent, reliable images during skin cancer screenings. I’m happy for them, and happy to have a little competition because that can only help to raise awareness and offer more than just the old “naked eye exams” and improve the prognosis for those with a melanoma diagnosis.

And I also have to say this is what MoleSafe has offered for years – both in New Zealand and Australia, and finally with increasing popularity in the United States. Only MoleSafe takes it farther, by offering the world’s only complete melanoma early detection and surveillance program. In addition, for locations unable to provide the MoleSafe program, or for teaching practices, or even in cases where physicians only have a couple of areas of concern, MoleSafe’s New Zealand partner recently released a streamlined upgraded program.

MoleSafe’s new dermoscopic camera for melanoma screenings offers optimum simplicity, consistency and digital quality.

Really big news?

This new program will be used for the first time in MoleSafe’s newest location opening soon at a University location in New York. (Details to come!)

MORE Big News?

MoleSafe has always been a tireless advocate of ways to better enable physicians to find, analyze and document lesions. And we’ve added another new tool to help do just that. In my last post, I mentioned the recent conference I attended of the International Dermoscopy Society. Well, we’re honored that MoleSafe was considered to be the “gold standard” by so many presenting researchers and physicians. They were, quite honestly, “blown away” by the newest of our products:

We unveiled a brand new touch-screen at the Barcelona conference, a tool that will revolutionize the workflow for dermatologists in their practice.

The screen is ideally mounted on the wall directly over the patient’s exam table. Then, just like sliding images on an iPhone — or like they do on CNN these days! — the doctor simply has to touch the panel to advance images, and can then easily show and educate the patient on what he or she is reviewing, and what the patient should be mindful of keeping an eye on as well.

Plus, by incorporating the MoleSafe proprietary View technology software right into the flat touchscreen computer, it enables the doctor to look at the images, then look directly at the suspect mole, without having to go to a desktop computer and review records. It’s all together, and all there in spectacular, hi-res digital detail…truly helping workflow and patient communication.

We are truly excited by all advances in our field, and only hope to embrace more newcomers, because that’s what it will take to keep opening eyes and demonstrating that there really is a better way to screen for and detect melanoma early.