While getting your picture taken in a hospital gown is not most people's idea of a flattering photo shoot, especially when it includes unusual poses, but it could be a life saver.

If you’ve been reading this blog, you may also have recognized our own Maddie Pallamary, RN, from the MoleSafe Millburn location, who conducted the patient examination. I’m very proud of the calming, professional and informative style that Maddie clearly exhibits, as do all of our staff clinicians and physicians around the country, and which is so reassuring to new patients.

It is truly exciting to have such an esteemed institution as NYU Langone Medical Center as MoleSafe’s first U.S. hospital partner. But whether it is there in New York City, or Albuquerque, Savannah…or any of our now 6 locations, please consider getting this potentially lifesaving screening for you and your loved ones.

We truly hope future news coverage about Melanoma will be about its decline vs our ongoing battle to raise awareness and skin cancer prevention.

While getting your picture taken in a hospital gown is not most people's idea of a flattering photo shoot, especially when it includes unusual poses, but it could be a life saver.

If you’ve been reading this blog, you may also have recognized our own Maddie Pallamary, RN, from the MoleSafe Millburn location, who conducted the patient examination.  I’m very proud of the calming, professional and informative style that Maddie clearly exhibits, as do all of our staff clinicians and physicians around the country, and which is so reassuring to new patients.

It is truly exciting to have such an esteemed institution as NYU Langone Medical Center as MoleSafe’s first U.S. hospital partner. But whether it is there in New York City, or Albuquerque, Savannah…or any of our now 6 locations, please consider getting this potentially lifesaving screening for you and your loved ones.

We truly hope future news coverage about Melanoma will be about its decline vs our ongoing battle to raise awareness and skin cancer prevention.

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

Maddie Pallamary, RN, Melanographer - MoleSafe Millburn

Maddie has worked with us from the beginning, and often provides me with insights and recommendations for patient comforts and considerations that have further enhanced their MoleSafe experience.

Here’s her perspective:

I have seen a number of patients, as you can imagine, that have either had a personal melanoma scare or are very high risk and lots of atypical moles.

They tell me of the extreme fear, anxiety, dread and stress they feel every time they visit their dermatologist. This is because they know every time they see their Dermatologist they ALWAYS get cut and have moles excised, sometimes as many as 2 and 3 moles at a time. And to add to the insult, more often than not, the results come back negative/benign. Because of this, some patients don’t always keep their regular MD appointments, which is a bad thing and something potentially deadly could be missed.

After they have had the MoleSafe procedure and understand its benefits, they express to me their utter sense of relief and calm and peace of mind that it will no longer be the case of ‘when in doubt cut it out’ and they will be on the receiving end of no more unnecessary cuts and ugly scaring. Finally, there is an alternative way to manage these high risk patients and monitor their moles over time.

This is why people like me go into nursing: one of its biggest rewards, the sense of fulfillment and to be able to make a difference, to help people and enhance their quality of life.

Thanks, Maddie – and thanks to all our excellent staff who provide considerate and efficient care at all our MoleSafe locations.

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.

Yesterday morning, Charles Osgood interviewed Dr. Alan Geller of Harvard’s School of Public Health about something MoleSafe has been passionately promoting: the need for more doctors to be better trained in skin cancer screening.

Dr. Geller said,

We’re finding that about three-quarters of primary care residents from our four programs were not trained at all in the skin cancer examination during their residency program.

Since too many Americans don’t keep skin cancer in mind because its symptoms can be more easily overlooked compared to the more obvious symptoms of other diseases, we need to be our own patient advocates and ask for check ups.

Dr. Geller told Mr. Osgood that if your primary care doctor is, for example, listening to your lungs then "there’s no better activity that could complement that than by just looking at the back of the skin for moles.”

I was pleased that Dr. Geller also pointed out, however, that even if a primary care physician is not trained to perform a thorough skin exam, "they could at least refer the patient to somebody better equipped.”

So, the point is it probably doesn’t take an awful lot to get the ball rolling on at least being able to do an adequate examination — and if one sees something unusual, to make sure that the resident or the physician refers that person to a dermatologist or someone who has a real strong expertise in the skin to follow through appropriately.

– Dr. Alan Geller, Harvard School of Public Health as told to Charles Osgood

So, here are our reminders of the options we encourage:

DO keep an eye out ON yourself (look for changes) and FOR yourself: ask your primary care doctor to be mindful of your skin at every exam.

BETTER: Make sure you have annual exams with a dermatologist who takes his or her time doing a careful once-over, from head to BETWEEN the toes!

EVEN BETTER: Find a dermatologist who goes beyond the "naked eye” exam and also uses a Dermatoscope for more finer observation of moles.

BEST: DO come in for your baseline screening at MoleSafe and have a thorough review done by a melanographer, complete with digital photography, total body dermoscopy, and a map of your body’s moles for future comparisons. We’ll share your results with you and with your dermatologist so you’re better armed with information.

Knowledge is the best line of defense.

Yesterday morning, Charles Osgood interviewed Dr. Alan Geller of Harvard’s School of Public Health about something MoleSafe has been passionately promoting:  the need for more doctors to be better trained  in skin cancer screening.

Dr. Geller said,

We’re finding that about three-quarters of primary care residents from our four programs were not trained at all in the skin cancer examination during their residency program.

Since too many Americans don’t keep skin cancer in mind because its symptoms can be more easily overlooked compared to the more obvious symptoms of other diseases, we need to be our own patient advocates and ask for check ups.

Dr. Geller told Mr. Osgood that if your primary care doctor is, for example, listening to your lungs then “there’s no better activity that could complement that than by just looking at the back of the skin for moles.”

I was pleased that Dr. Geller also pointed out, however, that even if a primary care physician is not trained to perform a thorough skin exam, “they could at least refer the patient to somebody better equipped.”

So, the point is it probably doesn’t take an awful lot to get the ball rolling on at least being able to do an adequate examination — and if one sees something unusual, to make sure that the resident or the physician refers that person to a dermatologist or someone who has a real strong expertise in the skin to follow through appropriately.

– Dr. Alan Geller, Harvard School of Public Health as told to Charles Osgood

So, here are our reminders of the options we encourage:

DO keep an eye out ON yourself (look for changes) and FOR yourself: ask your primary care doctor to be mindful of your skin at every exam.

BETTER: Make sure you have annual exams with a dermatologist who takes his or her time doing a careful once-over, from head to BETWEEN the toes!

EVEN BETTER: Find a dermatologist who goes beyond the “naked eye” exam and also uses a Dermatoscope for more finer observation of moles.

BEST: DO come in for your baseline screening at MoleSafe and have a thorough review done by a melanographer, complete with digital photography, total body dermoscopy, and a map of your body’s moles for future comparisons. We’ll share your results with you and with your dermatologist so you’re better armed with information.

Knowledge is the best line of defense.