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Smartphone diagnosis of skin cancer: there's not yet an app for that

Mobile health technology is growing at such speed that it is difficult to regulate. Mobile applications that seek to serve as diagnostic tools without the input from qualified medical professionals are rightfully scrutinized because of concerns for patient safety. While companies producing the large number of health apps that are designed to assist consumers to track their own health information, share information with health professionals or interact with electronic health records are not required to list their apps with the U.S. Food and Drug Administration (FDA), the FDA does regulate the development of all apps that are intended for diagnostic, treatment or prevention purposes. Dermatology is an obvious speciality for health-related app developers to explore, because the skin is so easily visible and smartphones with high-quality in-built cameras are becoming commonplace. Melanoma and skin cancer have received particular attention from the commercial sector, with a large number of apps currently available. The potential of such devices and apps to speed up consultation processes, triage lesions more effectively and facilitate early detection of skin cancers is both exciting and appealing. Considering the majority of melanomas are found by patients or their partners, any technology that can improve the ability of the general population to identify suspicious or changing lesions early could have enormous benefits. However, until these apps have been rigorously tested and found to have high sensitivity and specificity, it remains inappropriate to support their use. It is possible that such apps could contribute to dangerous, false reassurance in patients and/or increases in unnecessary excisions. Researchers and clinicians have previously submitted images of lesions to a number of individual apps, and these studies have confirmed the limited sensitivity and in some cases very low specificity for diagnosing melanoma. In this issue of the BJD, Kassianos and colleagues review the 39 available apps that aim to improve detection of melanoma. The authors evaluate the content of the apps as well as the evidence used to support their development. The apps varied significantly in their purpose, with some focusing on the provision of information and prevention advice, and others offering assessment of lesions either using an in-built algorithm or sending images to a specialist. Perhaps of greatest concern is the finding that none of the apps appeared to have been validated for diagnostic accuracy or utility using established research methods. However, the authors conducted their evaluation using the information provided by app developers in their app description and did not download the full versions of the apps. It is possible the app developers neglected to include such information in their app description, even if the research had been done. The improved prognosis when melanoma is detected early provides enough reason to continually improve these new technologies, rather than resist them. The International Skin Imaging Collaboration (ISIC) Melanoma Project is bringing together experts in dermatology and bioinformatics who are committed to keeping up with the pace of technology development in medicine. The establishment of a large, publicly available archive of skin images, as well as efforts to standardize the terminology, technology and imaging techniques used in the clinical imaging of skin lesions are the focus of ISIC, and will support the development and subsequent testing of high-quality mobile medical applications. Ongoing comparison of these apps with the current gold standard of face-to-face assessment by dermatologists and store-and-forward teledermoscopy using carefully designed studies is necessary and important research. In our estimation, this technology is a disruptive innovation and has the potential to save clinician time, reduce patient burden, reduce healthcare costs and potentially enable more effective triage and earlier detection of skin cancers.