In 2015 the global incidence of melanoma was 315,000 cases with almost 60,000 deaths [1]. Melanomas are thought to arise either de novo or adjacent to pre-existing pigmented lesions. These pigmented lesions, called naevi, are several magnitudes more common than melanoma and share some genetic mutations. Few studies have assessed the evolution of naevi in detail, for example there were only 2 longitudinal studies in healthy adults that counted changes in the number of naevi over time [2].

Cutting-edge imaging technology is changing the dermatology landscape and improving the way we detect melanoma and other common skin cancers, as well as how we monitor naevi, other precursor lesions as well as conditions including psoriasis and atopic dermatitis over time. Focusing on the early detection of melanoma the field is moving strongly towards innovative surveillance using total-body 3-dimensional (3D) photography and sequential digital dermoscopy imaging, supported with periodic imaging by consumers as part of their skin self-examinations (SSE), alongside traditional clinical skin examinations.

Total-body 3D photography constructs a digital 3D avatar of the person that can be used to view and monitor skin lesions over time. This advanced technology has an added capability of automated analysis that can be used to objectively measure important parameters, including size (area, diameter), colour, and symmetry of skin lesions. Automated analysis of skin lesions can also assist in the monitoring of any changes in skin lesions over time, which can help minimise the risk of unnecessary excisions or treatments of lesions. Total-body 3D imaging can play a pivotal role in telemedicine, particularly in rural settings.

Despite these advances in dermatological imaging in the clinic, the majority of melanomas are still detected by the patients themselves or their partners [3]. Therefore, it is encouraged that consumers conduct regular SSE or, better yet, partner-assisted skin examinations, in addition to total-body 3D photography. Incorporating digital dermoscopy imaging into the partner-as-sisted process may facilitate the earlier detection of melanoma. Consumers can be provided with a der-matoscope attachment for their smart phone and a corresponding mobile health application (app). The dermatoscope attachment utilises the camera of the smart phone for consumers to capture dermoscopic images of any suspicious lesions for review and monitoring between clinician visits or in some cases may replace the in-person visits. These images are stored within the password-protected app and can be sent to a dermatologist or skin cancer specialist for telediagnosis. Mobile teledermoscopy has shown comparable diagnostic accuracy and agreement to in-person diagnoses for the lesions that the consumers elected to submit [4, 5]. It has the potential to reduce waiting times and increase access to dermatologists [6-9].

In this issue of Dermatology,Koh et al. highlight the perspectives of consumers on mobile teledermoscopy-enhanced SSE for sequential imaging of suspicious skin lesions. This study assessed consumer acceptability and expectations of this proposed technology for the selection and imaging of their own lesions for telediagnosis or monitoring of changes in skin lesions identified by their medical practitioner. This technology was well accepted, with consumers stating that mobile teledermoscopy would be convenient, reduce anxiety, and provide an objective record of their skin lesions. However, consumers questioned the reliability of the telediagnosis and voiced concerns about their ability to accurately select suspicious skin lesions. While previous studies have assessed the feasibility and acceptance of consumer mobile teledermoscopy, the benefit compared to SSE alone has not been assessed. Janda et al. therefore present in this issue of Dermatology a protocol for a proposed randomised controlled trial of mobile teledermoscopy-enhanced SSE. This trial will assess the sensitivity and specificity of mobile teledermoscopy-enhanced SSE versus naked-eye SSE in consumers at high risk of developing melanoma. Along with assessing diagnostic accuracy, this study will determine whether consumers can select their own suspicious lesions using mobile teledermoscopy-enhanced SSE and consumer satisfaction with this technology. Mobile teledermoscopy-enhanced SSE, if coupled with total-body 3D photography, may help increase consumer trust in telediagnoses.

Selecting the best approach of monitoring by clinicians and consumers themselves can be challenging. Current guidelines differ between countries, ranging from close 3-monthly monitoring for very high-risk patients to a generic recommendation for skin monitoring for the general population. Germline genetic information sequenced from blood or saliva is becoming increasingly accessible, which can assist clinicians to better stratify monitoring services for their patients. Moreover, since naevi are the closest simulators of melanoma, a greater understanding of their genomic make-up is needed to elucidate the mechanisms for naevus formation. Indeed, in some cases early melanomas can arise form a pre-existing naevus. In this issue of Dermatology, Tan et al. review the current literature and summarise recent findings relating to targeted gene and whole-exome (all coding genes) analysis of dermoscopic patterned naevi and matching adjacent normal skin.

In summary, based upon genomic information, naevus formation is strongly influenced by UV-induced mutations but importantly most naevi do not have the propensity to transform into melanoma due to “balancing” of genomic events. Since naevi mimic the appearance of melanoma, it is reassuring that skin cancer monitoring is moving away from the somewhat archaic “one medical practitioner looks at one person’s skin at one point in time” to a sophisticated interplay of sequential whole-body imaging incorporating artificial intelligence, supported by intermittent imaging by the consumer.

H. Peter Soyer is a shareholder of e-derm consult GmbH and MoleMap by Dermatologists Ltd Pty. He provides teledermatological reports regularly for both companies. He is also Advisor of First DermTM.

This research is funded by a research grant awarded to M.J. from the National Health and Medical Research Council APP1113962 and APP1099021. M.J. is funded by a TRIP Fellowship APP1151021. H.P.S. is also funded by the Medical Research Future Fund – Next Generation Clinical Researcher’s Program Practitioner Fellowship APP1137127.

1.
International Skin Imaging Collaboration (ISIC): Skin lesion analysis towards melanoma detection, 2018.
2.
Plasmeijer EI, Nguyen TM, Olsen CM, Janda M, Soyer HP, Green AC: The natural history of common melanocytic nevi: a systematic review of longitudinal studies in the general population. J Invest Dermatol 2017;137:2017–2018.
3.
Hamidi R, Peng D, Cockburn M: Efficacy of skin self-examination for the early detection of melanoma. Int J Dermatol 2010;49:126–134.
4.
Manahan MN, Soyer HP, Loescher LJ, Horsham C, Vagenas D, Whiteman DC, Olsen CM, Janda M: A pilot trial of mobile, patient-performed teledermoscopy. Br J Dermatol 2015;172:1072–1080.
5.
Wu X, Oliveria SA, Yagerman S, Chen L, DeFazio J, Braun R, Marghoob AA: Feasibility and efficacy of patient-initiated mobile teledermoscopy for short-term monitoring of clinically atypical nevi. JAMA Dermatol 2015;151:489–496.
6.
Snoswell CL, Caffery LJ, Whitty JA, Soyer HP, Gordon LG: Cost-effectiveness of skin cancer referral and consultation using teledermoscopy in Australia. JAMA Dermatol 2018;154:694–700.
7.
Tensen E, van der Heijden JP, Jaspers MWM, Witkamp L: Two decades of teledermatology: current status and integration in national healthcare systems. Curr Dermatol Rep 2016;5:96–104.
8.
Watts CG, Cust AE, Menzies SW, Mann GJ, Morton RL: Cost-effectiveness of skin surveillance through a specialized clinic for patients at high risk of melanoma. J Clin Oncol 2017;35:63–71.
9.
Janda M, Loescher LJ, Banan P, Horsham C, Soyer HP: Lesion selection by melanoma high-risk consumers during skin self-examination using mobile teledermoscopy. JAMA Dermatol 2014;150:656–658.

This article is part of the Nevi Article Series

© 2018 S. Karger AG, Basel
2018
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