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Skin Cancer and Self-Exams: Increasing Thoroughness through Skin Surveillance

This content was created by Miiskin — A proud sponsor of Dermnet NZ. April 2019. 


Patients are Recommended to Check their Skin for Changes

Melanomas are notoriously difficult to discover and diagnose. After years of education through skin cancer awareness campaigns, patients or their close relatives are, nonetheless, often the ones to sound the early alarm about a concerning lesion. However, many patients are still surprised when the lesion they presented to the doctor, and in many cases another lesion, actually turn out to be a melanoma. The simple fact is that there is no typical appearance of a melanoma that is easily detected by the naked eye [1].

The result of this is the recommendation to the general public that they should present any concerning lesion to their physician as soon as possible.

Another recommendation is to look out for changes to the skin’s appearance. Changes in asymptomatic (atypical) moles and the appearance of any new lesions on the skin for those over 35 years of age are warning signs that should not be ignored.

Studies have shown that the average person may not be very proficient at looking out for any change to their skin, particularly when the change occurs over an extended period of time or in an area of the skin that is not easy to see. Patients and their partners may also not be very comfortable with being tasked to perform regular skin checks to look out for subtle changes [2].

Unlike the pattern for the more prevalent carcinomas, the anatomical distribution of melanoma, albeit highly correlated, is also not only on skin exposed to UV rays, which makes the task more challenging [3]. Even so, an extensive culture for full-body tanning in the summer means that especially western populations have had extensive full-body exposure to UV-light in their lifetime - a tanning culture that is still very prominent today. Continued efforts to ban UV tanning beds and educate populations about sun protection are warranted, but perhaps not sufficient, and an increased focus on secondary prevention of skin cancer may also be needed.

Given the difficulties identified here, there is a concern that patients may not have sufficient awareness of their skin’s appearance and so may only catch any suspicious skin changes at a belated stage. Thorough total-body skin self-examinations, ideally assisted by a partner, should be more prevalent in consumers’ minds [4]. Some campaigns have already been launched such as a campaign from the American Academy of Dermatology focusing on partner-assisted self-examinations [5].

Additionally, as 71% of nevus-associated melanoma show up as new lesions on the skin and not in existing moles, the need to also be aware of any new lesions is critical and may be quite unmanageable for patients with a large amount of nevi [6].

Skin Surveillance Offered to Address the Challenge of Catching Skin Changes

Given the need to closely inspect for changes to the skin, photographic skin surveillance, such as digital dermoscopy of individual lesions and full-body photography to capture images of the skin, have emerged. Many healthcare providers now offer clinical photography for melanoma patients and some consumers also spend out-of-pocket on surveillance programs in private clinics. This is encouraging. The more skin that can be recorded with photography, the higher the likelihood of catching any future skin change at an early stage. For this reason, the Melanoma Institute Australia actively recommend the use of photos in the skin self-examination process [7].

There are, however, a few challenges that should be addressed; 1) Clinical photography does come at a cost given the requirement of clinical equipment and personnel, 2) Some patients have reported uncomfortableness with non-physician photographers and different sex photographers [8] and, 3) There’s a need for ensuring patient consent and secure storage of the photos - especially if images are to be given to the patient [9].

Some of these challenges are already addressed in some countries, such as New Zealand and Australia, where the problem of skin cancer is greatest. In other areas of the world, healthcare systems still need to address if and how they should best meet the requirement and challenge of photographic surveillance of patients.

Technological Advances in Patient-Led Skin Monitoring

Apps for skin self-examination are being investigated and introduced as part of the solution. As well as providing reminders to perform regular skin self-exams, they can be a convenient cost-effective photographic aid for patients to remember the appearance of their moles and overall skin in-between or after medical consultations. They can also be key in facilitating full-body, thorough, skin self-examinations especially if they allow for more holistic photographies to cover larger areas of the skin in addition to individual lesions.

Miiskin is one of the apps that facilitates thorough skin self-examinations. It does so by letting its users:

  • View a video-walkthrough explaining how to perform a full-body skin self-exam
  • Enable the users to capture four “full-body” photos of their skin and individual lesions
  • With Miiskin’s Skin Mapping the user gets a visually engaging “skin map” of the photographed area.

The Skin Mapping solution is powered by an intelligent algorithm, which identifies the moles and marks on the skin, that it can find, and so may help its user identify new moles or marks on the skin. It is not intended to take away the user’s responsibility for identifying changes to their skin. It is a way of making the experience more engaging for the user. Miiskin does not facilitate a diagnostic process - the focus is on the patient’s skin awareness and identification of skin changes.

Miiskin is now the leading global skin surveillance app with over 300,000 downloads.

Read more about Miiskin.

High-Tech Technology to Empower Patient Monitoring Programmes

A solution like Miiskin holds further potential for the future. An ever increasing number of healthcare providers are reaching out to hear how the application may be able to help their patients. In addition, patients enrolled in other photographic surveillance programs and clinical follow-up programs want to use Miiskin as an integrated part of their existing programme.

Some clinicians also advocate the benefits of physicians being able to view their patient’s Miiskin images together with the patient’s medical history. Efforts are being undertaken to investigate how such a teledermatological solution can safely be implemented in a clinical setting.

If you are running a patient follow-up programme or are offering patient photographic surveillance reach out to Miiskin on [email protected] to hear how Miiskin may integrate with and help your programme.

Miiskin are also offering free educational leaflets for those interested in educating their patients about secondary prevention of skin cancer. Request leaflets for your clinic here.

See smartphone apps to check your skin.
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References

  1. Walter FM, Birt L,Cavers D, et al. ‘This isn’t what mine looked like’: a qualitative study of symptom appraisal and help seeking in people recently diagnosed with melanoma. Available at: https://bmjopen.bmj.com/content/4/7/e005566.
  2. Hanrahan PF, Hersey P, Menzies SW, Watson AB, D'Este CA. Examination of the Ability of People to Identify Early Changes of Melanoma in Computer-Altered Pigmented Skin Lesions. Arch Dermatol. 1997;133(3):301-311. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9080890.
  3. Publication: "Anatomical distribution of sites of malignant melanoma including non-sun exposed sites - incidence and trend". Available at: http://www.ncin.org.uk/view?rid=1224.
  4. Melanoma Early Detection With Thorough Skin Self-Examination Weinstock, Martin A. et al. American Journal of Preventive Medicine , Volume 32 , Issue 6 , 517 - 524. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17533068.
  5. Check Your Partner. Check Yourself. Available at: https://www.aad.org/public/spot-skin-cancer/programs/skin-cancer-awareness-month/check-your-partner-check-yourself.
  6. A meta-analysis of nevus-associated melanoma: Prevalence and practical implications Pampena, Riccardo et al. Journal of the American Academy of Dermatology , Volume 77 , Issue 5 , 938 - 945.e4. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28864306.
  7. How do I check myself for melanoma? Melanoma Institute Australia. Available at: https://www.melanoma.org.au/preventing-melanoma/how-do-i-check-myself-for-melanoma/.
  8. C Leger, Marie & Wu, Timothy & Haimovic, Adele & Kaplan, Rachel & Sanchez, Miguel & Cohen, DE & Leger, Elizabeth & Stein, Jennifer. (2014). Patient Perspectives on Medical Photography in Dermatology. Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al.]. 40. 10.1097/01.DSS.0000452632.22081.79. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25099296.
  9. Nielson, Colton & West, Cameron & Shimizu, Ikue. (2015). Review of digital image security in Dermatology. Dermatology online journal. 21. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26632792.

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