Akron, Ohio, dermatologist Gary Lichten, M.D., has developed a downloadable smart phone application that helps patients monitor their moles and other skin problems. The app, he told Dermatology Times, can be used to complement dermatologists’ surveillance of melanoma and more.
Launched in August 2015 and available on iTunes for $1.99, the MoleMapperPlus app helps users capture total body or individual nevi images and, in time, compare those images side-by-side or as an overlay. Patients and their dermatologists can also use the app for closer monitoring of how inflammatory diseases, such as psoriasis, might be responding to treatment or how an ulcer is healing.
MoleMapperPlus is a technology for consumers, and images can be emailed, but it is not recommended unless through a secure network. Dermatologists, he says, use the technology to help patients avoid unnecessary biopsies and detect what could be skin cancer earlier than with skin exams, office-based technologies and follow-ups. Dermatologists, for example, can follow the image of a nevus taken on a patient’s smart phone with dermoscopy, or use it as a record of areas biopsied.
“How often does a question arise as to the original location of the biopsy site?” Dr. Lichten says.
There is a need for easy-to-use, convenient mole mapping technology, given that dermatologists might not always take the needed photographs of patients at risk for skin cancer and the documented overuse of biopsies.
“The truth is, in private practice, generally speaking, dermatologists don’t take enough photographs. Taking photos is invaluable,” Dr. Lichten says.
Mole mapping and sequential serial dermatoscopic images in high-risk skin cancer patients work and are critical, according to a study published August 2014 in JAMA Dermatology. Researchers studied the impact of full-body examinations every six months, supported by dermoscopy and total-body photography, as well as sequential digital dermoscopy imaging, when indicated, on primary melanoma detection in 311 extreme-risk patients. Among the 75 primary melanomas they detected in an average 3.5 years of follow-up, 38% were found using total-body photography and 39% with sequential digital dermoscopy imaging.
“Hypervigilance for difficult-to-detect thick melanoma subtypes is crucial,” according to the study authors.
Putting the app to practice
When caring for his melanoma patients, Dr. Lichten says he starts with a full-body exam.
“If patients are at high risk for melanoma, and they agree to professional images, we only charge $125 and have a professional photographer take them. (Those images can cost the patient between $150 and $400.) Then, we follow patients at four-month, six-month or one-year intervals. I have them physically stand next to a screen, and I look to see if there are changes and employ dermoscopy,” Dr. Lichten says.
For patients who opt out of the professional photo taking and have atypical nevi or a family history of skin cancer, Dr. Lichten says he recommends they download the app. He tells patients it takes less than 20 minutes to take the photos (and there’s a guideline for how). The images are password protected.
“If they have any concerns, or they think it has changed, [I tell them] bring in your smart phone, we’ll look at it and review it,” he says.
Dr. Lichten says having patients monitor lesions with the app between appointments often saves him from biopsying lesions that don’t look quite right but have not yet been flagged with dermoscopy. And rather than bring those patients back in four months, he might tell them to use the app to monitor for any changes and, if everything looks good, to come back to see him at six months. If there’s a change, they should come in earlier, according to the dermatologist.
The MoleMapperPlus does not replace a dermatologist’s exam, and images taken by a patient or patient’s loved one might not be as clear as those taken by a professional photographer. Still, adding the phone app to other preventive and skin cancer monitoring approaches offered at dermatologists’ offices should lead to earlier detection and fewer unnecessary biopsies, according to Dr. Lichten.
“Present limitations of the app are first ensuring the image quality and then the ability of the user and physician to see changes,” Dr. Lichten says. “A major limitation is the user’s motivation in taking and following the images.”
Helen M. Torok, M.D., medical director, Trillium Creek Dermatology and Surgery, Medina, Ohio, told Dermatology Times that she would recommend MoleMapperPlus to her patients but admitted the limitation is patient compliance.
“In our practice, we routinely take photographs of any suspicious lesions, acne severity, rashes and patch testing results. Our patients often will bring pictures on their smart phones when lesions or eruptions are acute, and their appointments are one to two weeks after the occurrence,” Dr. Torok says. “So in this case, I believe the app is very timely, and it was developed by a dermatologist. There are mole mapping sites already in existence but this one goes beyond in that you can track the changes in lesions.”
Today’s MoleMapperPlus was designed as an easy-to-use technology for consumers, which allows them to gather, organize and compare skin images. It is not yet a technology that allows patients to send the data to their physicians via a secure network or incorporate into an electronic medical record. But that day is coming, according to Dr. Lichten.
“We cannot, with 100% certainty, identify melanoma with this technology yet,” he says.
But future combinations using the at-home surveillance capabilities of the MoleMapperPlus app, along with artificial intelligence computer technology being developed to diagnose images and information, and the use of dermoscopy and confocal microscopy, will make diagnoses possible and accurate, reducing the number of unnecessary biopsies from 15:1 to 2;1, he says.
“I think, personally, what I’ve done putting this software together with imaging, reproducibility, the viewing of the images and aligning the images, is a small step forward. Next, you’ll look at the images and the computer will tell you if there is change and the computer will tell you what it is,” Dr. Lichten says.
Disclosures: Dr. Lichten developed and owns the app. Dr. Torok reports no relevant disclosures.
 Moloney FJ, Guitera P, Coates E, et al. Detection of primary melanoma in individuals at extreme high risk: a prospective 5-year follow-up study. JAMA Dermatol. 2014;150(8):819-27.