Dr Paul Charlson argues that mole apps should never replace a full consultation or be used to change clinical diagnosis
Melanoma is a deadly and increasingly common skin cancer. In fact, in 2012, there were reports of more than 100,000 new cases of malignant melanoma.1It is often curable if detected and removed in the early stages so an early diagnosis is extremely important.2 Increasing public awareness of this disease, prevention and diagnosis are key elements in reducing morbidity and mortality.3
Generally, publicity about melanomas is positive, but it can have negative effects. It can make some patients anxious resulting in frequent consultations. It can also result in patients being referred on the ‘two-week rule’ (the time within which a GP must refer a patient with a suspected melanoma to a specialist) by primary care clinicians even though they are very likely to be benign, whilst melanomas in less anxious patients may be referred routinely with lengthened waiting times.4
Mobile apps have the potential to increase the quality and efficiency of healthcare, allowing patients to have quick and easy access to advice and information. They are a relatively new way for patients to be able to monitor their skin changes at home, in a user-friendly way, without having to visit their GP or dermatologist.
Although I believe mole apps are a relatively good thing, it is important that both practitioners and patients understand their limitations. I also stress that they do not, by any means, replace a consultation, proper medical skin assessment and diagnosis, and should not be used to sway clinical judgement.
The purpose of melanoma apps
NICE recommends that patients that have a low degree of suspicion should monitor pigmented lesions by photography with a review at eight weeks.5 However, one of the key problems with photographing lesions is ensuring that photos are consistent so that change can be monitored effectively.
Many mole apps aim to allow the user to take more accurate photographs by recognising the position of the lesion, so to take the same image every time. They can also map out malignant patterns and set reminders to take the photographs regularly. Some apps provide useful information about melanomas, and others allow you to assess melanoma risk through question and answer-based interactive functions.
There are some obvious advantages of having an accessible app that enables patients to do these things:
Raises much needed awareness of melanoma risks
Monitors skin changes or non-changes over time by photographing lesions
Allows practitioners to monitor moles and engage patients in the process
Empowers patients to take responsibility for their health
Allows patients to understand their probable risks of developing melanoma
Reassures the ‘worried well’ who are frequently visiting their GP or dermatologist for mole checks
Of course, anything that is helping to create public awareness of the importance of detecting melanoma is a good thing. When it comes to melanoma apps however, there are a few concerns that both patients and practitioners need to be aware of.
The first thing to note is that mole apps are not necessarily put through rigorous assessment. According to Pro-Cal Powertrain Development Ltd, its app Mole Monitor is the only available mole app currently approved by the NHS,6 while SkinVision, by SkinVision VV, claims to be the only mole app that is CE certified.7 Although I have seen many apps that appear to be just as good as these two, I have also seen some that are poorly designed and are extremely unhelpful to patients, providing images of mole types that might be misleading or wrong. When it comes to taking standard photographs, this is not so much of a concern. It becomes a concern when the apps are providing medical information and advice to patients, such as what a melanoma looks like and the point at which they should seek medical attention. The sheer number of apps available is also worrying – I was able to download more than 10 in just a few minutes. How is an individual to know which app to use when there are so many to choose from? I personally would recommend one that has been approved, or otherwise been developed by a dermatologist, which is usually stated in the app bio, because there is no sure-fire way for patients to tell whether the apps are providing the correct information.
Another issue, and probably the biggest concern, is that patients using mole apps could mistake this as an alternative to professional assessment. Although mole apps can be useful in determining skin changes, if a patient does not notice a difference in a few weeks, it does not rule out the possibility of a skin cancer. As well as this, if patients do not provide accurate responses to the app’s questions assessing their risk of developing moles, they might be misled into thinking that they do not have a high risk, and hence might not be diligent at applying sunscreens or monitoring their moles at all.
It is my belief that mole apps, if used correctly, can be a useful resource for patients to monitor and track the changes of their skin as most people do not know if their skin has changed or not. However, mobile apps do not replace a consultation. These apps and their photographs are an adjunct to clinical decision-making. It is our responsibility as healthcare professionals to educate and advise our patients about the limitations and to encourage those at high risk to get their skin checked by a professional as well as tracking their moles with an app.
Upgrade to become a Full Member to read all of this article.