SALT LAKE CITY — Skin cancer mortality rates are directly related to how early the disease is diagnosed. Now, a number of new smartphone apps claim to be able to analyze photos of moles and marks and tell individuals whether changes in the skin warrant a visit to a dermatologist for further testing.
But as the summer heat draws more people out into the sun's harmful ultraviolet rays, a number of doctors are warning patients not to rely on the apps for diagnosis.
“I would not want patients to think that using an app is a replacement for a visit to a dermatologist,” Diane Berson, a dermatologist practicing in New York City and a spokesperson for the American Academy of Dermatology, told Parade.
Apps that look for skin cancer are part of a growing list of health monitoring tools that do everything from counting people's steps to keeping track of their blood pressure. Some professionals say skin cancer apps could save lives by encouraging more people to seek a second opinion about abnormalities they discover.
"There's no question these apps will raise awareness and encourage people to point out moles or unusual skin findings to their doctors — even if they are going in for a routine exam," said Gary Doolittle, an oncologist at the University of Kansas Health System and medical director for the Center for Telemedicine and Telehealth at the University of Kansas Medical Center.
Skin cancer is the most common cancer in the United States, and approximately one in five Americans will develop skin cancer in their lifetime, according to the American Academy of Dermatology. Melanoma, the deadliest form of skin cancer, claims 20 American lives every single day.
The American Academy of Dermatology encourages everyone to perform regular skin self-exams to check for signs of skin cancer. Skin cancer warning signs include changes in the size, shape or color of a mole or other skin lesion, the appearance of a new growth on the skin, or a sore that doesn't heal.
A number of smartphone apps including Miiskin, UMSkinCheck, Mole Detective, MoleScope and SkinVision are designed to look at a person's skin and tell them if they're likely to have cancer. Users can take photos of individual moles or large areas of skin. The apps then analyze skin marks for things like size, shape, asymmetry, bumpy or blurred borders and color. They can also help users track changes in moles or lesions over time, according to CNET.
Each application uses different technology. Molescope involves a specialized device that attaches to your smartphone camera and allows users to send a magnified photo to an actual dermatologist for an online checkup. And SkinVision uses a machine learning algorithm that can pick up on risk patterns doctors might not be able to see, CNET reported.
Depending on the app you choose, the results might range from "problematic" to "low, medium or high-risk" to "OK" or "atypical."
And there are often disclaimers. If you use Miiskin for example, you’ll get a warning saying the app “does not diagnose skin cancer,” Parade reported. It also warns that using the app “should not replace any recommended preventive skin checks and medical consultation.”
"If used the right way, skin cancer detection apps could be key to finding melanomas early and saving lives," said Daniel Aires, director of dermatology at the University of Kansas Health System.
The concern among some health professionals is that the smartphone tests are not always accurate, and people could experience a false sense of security if an app tells them they are low-risk.
"When there is a suspicious lesion, it's important to get a biopsy of that lesion. Don't be overly confident in the app's diagnosis and miss something dangerous," Aires told the University of Kansas Health System news service. A biopsy is a procedure that involves a doctor cutting and removing a small sample of skin to have it tested for cancer.
Studies testing the accuracy of skin cancer detection apps have shown they are helpful but not completely reliable.
In a study published in the Journal of the European Academy of Dermatology and Venereology in 2014, researchers tested the accuracy of SkinVision through the analysis of 195 pictures of skin lesions. The app was 81% accurate in detecting melanoma.
"The smartphone application ... might be a promising tool in the pre‐evaluation of pigmented moles by laypersons, while it is to date inferior to the diagnostic evaluation by a dermatologist," concluded the researchers.
In a 2013 study published in JAMA Dermatology, Joel A. Wolf and colleagues from the University of Pittsburgh analyzed four smartphone apps that detect skin cancer, without disclosing the names of those apps. Even the most accurate app missed almost 30% of melanomas, diagnosing them as low-risk lesions, the researchers found.
More recently, a 2018 Cochrane review of research found that artificial intelligence-based skin cancer detection has "not yet demonstrated sufficient promise in terms of accuracy, and they are associated with a high likelihood of missing melanomas."
However, much of this research was conducted several years ago and the technology has likely improved since then.
In 2017, a team of researchers at Stanford University announced that they developed an algorithm that can classify skin lesions as benign or malignant. They tested their computer program against 21 board-certified dermatologists and found it was just as accurate as the doctors. At the time, they said they hoped to make the program smartphone compatible in the future.
“We realized it was feasible, not just to do something well, but as well as a human dermatologist,” Sebastian Thrun, an adjunct professor in the Stanford Artificial Intelligence Laboratory, told Stanford News. “That’s when our thinking changed. That’s when we said, ‘Look, this is not just a class project for students, this is an opportunity to do something great for humanity.’”
Aires and Doolittle said smartphone apps should be used as a way for patients to "start a conversation" with their doctors about skin cancer, the University of Kansas Health System news service reported.
"For now, smartphone apps have the potential to save lives — but only if people follow through with a visit to their doctor," said Aires.
Because exposure to harmful ultraviolet rays is the most preventable risk factor for skin cancer, the American Academy of Dermatology recommends people avoid tanning beds and protect themselves from the sun by staying in the shade, wearing protective clothing and using sunscreen with an SPF of 30 or higher.
A dermatologist can make individual recommendations as to how often a person needs a skin exam from a doctor based on individual risk factors, including skin type, history of sun exposure and family history. Individuals with high risk should have a full-body exam by a doctor at least annually and perform regular self-exams to check for new and changing moles, according to the American Academy of Dermatology.