Can An App Spot Skin Cancer?

Is that a benign freckle or a cancerous mole?

Mole-scanning apps differ in quality and approach. Some, such as MelApp and Skin Scan, have algorithms to detect growth and enable users to photograph and track moles over time, as well as locate a doctor.  Other apps allow users to map the parts of the body where moles are located.  With Mole Detective, users take a photo of a mole, which the app then analyzes by the “ABCDE” method, which examines factors such as asymmetry and diameter.  In a separate category is an app called SpotCheck, which allows users in California, New York and New Jersey to photograph a mole and send the photo to certified dermatologists for analysis of potential abnormalities.  The patient receives a response within 24 hours, and, if the mole appears abnormal, the app then recommends a doctor in the patient’s area.To answer that question quickly, a flurry of skin-scanning, smartphone apps has emerged where people can now snap photos of their skin moles for analysis — and let an app decide the danger.

At first glance, a skin-scanning app would seem an unreliable way to form a possible cancer diagnosis. The apps include disclaimers that they don’t replace medical treatment and are not diagnostic tools, but some apps still claim to be a medical device. For example, Skin Scan’s site states it “is a medical application created for you to easily scan and monitor your moles over time in order to prevent skin cancer.”

They’re not currently regulated by the Food and Drug Administration. But because they inhabit a new realm where phones become tools to analyze skin, they’ve made inroads to consumers. Still, not all dermatologists embrace them.

Dr. Laura Ferris, a dermatologist at the University of Pittsburgh Medical Center, said it could be challenging to take an accurate photo or judge a mole without seeing the patient’s entire skin and other moles.  “I think it is hard to look at one lesion out of the context of a patient,” she said. “It’s not always the lesion that sends someone in the door that turns out to be the skin cancer.”

Ferris, who gives her patients a full skin exam, uses a dermatoscope to further examine lesions and will generally biopsy a mole of concern.  While patient-directed apps don’t incorporate dermatological tools, such as hand-held scopes for examining lesions, a dermatoscope can be attached to a smartphone, but those apps are not currently aimed at patients.

Many of the apps focus on melanoma, a type of skin cancer that can be effectively treated with early detection. The Skin Cancer Foundation cites one study showing that the survival rate for patients whose melanoma is detected early, before the tumor has penetrated the skin, is about 99 percent. According to the foundation, another study has shown that the survival rate falls to 15 percent for those with advanced disease. The foundation’s website states that an estimated 8,790 people die of melanoma yearly in the United States.  The American Cancer Society web site recommends self-exams and that people show moles to their doctors.

Despite their disclaimers, the apps’ marketing could blur that distinction and cause potential consumer confusion. The Skin Scan App’s iTunes page states Skin Scan is “the Most Accurate Skin Cancer Detector.” “MelApp is an image-based risk assessment mobile app that assists in the early detection of melanoma,” its website says.

Dr. Barney Kenet, a New York City dermatologist and author of “Saving Your Skin,” considers anything that spurs people to examine their skin as a plus.  “Anything that gets people looking at their skin, ultimately brings patients into dermatologists’ offices,” Kenet says.

But Kenet warned the apps can’t give an exact diagnosis.  He acknowledged that people could possibly decide not to go to a doctor, if the mole is deemed low-risk by the app — a problematic result, if the mole is in fact at greater risk.

Kristi Zuhlke, founder and CEO of Mole Detective, decided to develop the mole-analyzing app based on her experience examining the moles of her boyfriend, a stage 4 melanoma survivor.  In between her boyfriend’s doctor visits, she would check the moles on his back and she realized she needed a tool to help track if they changed.

She said she intends the app to raise awareness of melanoma and motivate people to visit the dermatologist. Even if the app gives a “green” diagnosis that the mole is not showing signs of melanoma, Zuhlke said the app still encourages people to make their annual appointment.  She said that if the user takes a photo in the right lighting, the app is accurate.  The app also has an alarm feature to remind people, who might put it off, to examine their skin. “The intent is by no means to diagnose,” she said, “but to help people understand they need to go to the dermatologist.”

In a different category of analysis is SpotCheck, in which dermatologists analyze photos captured by devices.  Dr. Bobby Buka, founder of SpotCheck, could not be reached for comment regarding his app, but he noted in an ABC News interview that while the average wait time to see a dermatologist is 38 days, dermatologists within the SpotCheck network can see patients within two weeks.

The companies that developed MelApp and Skin Scan also could not be reached for comment.

Dr. Thomas Hornyak, chief of dermatology at the VA Maryland Health Care System and associate professor of dermatology and of biochemistry and molecular biology at the University of Maryland School of Medicine, emphasized that it’s important to fully assess a person’s skin and risk factors.  “Just focusing on the moles isn’t enough,” he said. “That’s why I think, at this stage, the role for remote imaging done from one’s own hand is pretty limited and in its infancy.”