As dermatologists, we are trained to look for irregularity in skin, to continually find what is new or changing in the search for atypical moles and the early signs of skin cancer. But what if this process—the very backbone or our field—was imperfect, and very often led to unnecessary mole biopsies and scarring? As a physician, causing needless ‘harm’, even in the pursuit of the greater good—to detect melanomas or other skin cancers—goes against the very principles of my vocation, and commitment to always do better by my patients.¹ The current state of screening for skin cancer is imperfect, and the goal should always be to find ways to perfect the science, and the screening methodology to exponentially enhance the procedure for better overall care and better diagnosis.²
Irregular moles and how they are managed today:
The current process of skin screening is to look for the existence of dysplastic nevi (DN), also called atypical moles or Clark nevi because they carry clinical and histological markers for an increased risk of melanoma. The challenge however, remains a diagnostic one. Through a combination of visual screening and the use of dermoscopy (hand held microscopic scopes), a trained physician is likely to pick up 80-90% of melanomas, or at least potential melanomas. These atypical moles are biopsied and shared with a skin pathologist who, while assessing slices of tissue, will again make an estimate (albeit a very accurate one) about whether these moles are malignant, benign or benign with some features of malignancy. The final decision becomes a judgment call: based on the level of atypia and dysplasia (irregularity) how likely is it that what was left behind from the biopsy will grow back into melanoma, or already is a melanoma?
How can this process be improved?
The most promising answer today is high-resolution full-body digital photography that can help us set a baseline for skin examination so that we can more accurately and subjectively track critical skin change over time, determining which sites need to be viewed by dermoscopy or confocol microscopy for biopsy and evaluation, and which can be left alone. The biggest potential lies with the vast pools of image-data these forms of technology can generate and will bring to the field: a deep learning and artificial intelligence capable of answering the questions we can currently only guess at: what parts of the skin are really at risk, and what parts are not?
At Kline Dermatology we’re determined to be a part of this breakthrough research, investment and data-capture with DermSpectra, the first total body digital imaging system. Not only are we able to bring our own patients a level of unprecedented skin screening for long term tracking, monitoring and assessment, but we are able to join the Mayo Clinical, Oregon Health and Science University and other leading institutions to bring indispensable skin data to the industry at large with the hope of improving the lives of patients around the country. I am reassured that with these strides towards more accurate and advanced technological imaging, the future looks a little brighter for the field of skin cancer research and diagnosis.
To learn more about skin cancer, our expertise and DermSpectra, visit here.