Digital photography may improve quality of life in patients with atypical mole syndrome

Key Points

"On average, in patients who completed follow-up surveys, there was an improvement in all the instruments suggesting that TBDP may have a positive impact on QOL and cancer worry. Further studies with control groups are necessary to demonstrate the benefit from TBDP," Dr. Pressley tells Dermatology Times.

A larger number of patients will be necessary to provide power to detect statistical significance for the all instruments, explains Dr. Pressley, who is working with Laura DeLong, M.D., M.P.H., and directed by Suephy Chen, M.D., M.S., director, Emory DCOR Unit, as well as Clara Curiel-Lewandrowski, M.D., of Arizona University, Tucson, for the ongoing study.

Localized photography has long been used in dermatology to monitor individual pigmented lesions.

"This monitoring tool could catch changes in progressing lesions early, thereby catching early melanoma. As of late, a number of academic and industry investigators have developed a more formal way of looking at not only each lesion, but the skin overall," Dr. Pressley says.

TBDP is increasingly used by dermatologists in following patients with AMS. While there currently are no data confirming the impact of this tool, the researchers set out to assess whether it has an impact on QOL and cancer worry in AMS patients.

"We hypothesized that TBDP probably decreases the rate of unnecessary biopsies. Furthermore, if there was a need for a biopsy because of changing morphology compared to baseline photography, that biopsy potentially would result in diagnosing melanoma at an earlier, more curable stage. However, an alternate hypothesis may be true. Dermatologists may start doing more biopsies that are pathologically benign because they see subtle, not clinically relevant changes in nevi in comparison to photos," Dr. Pressley says.

The study

From June 2005 to June 2006, about 30 patients with AMS - with or without a history of melanoma seen in the pigmented lesion clinics at Emory and Arizona University - were given survey instruments at baseline and three to six months after TBDP that measured QOL and cancer worry. About 53 percent, or 16, were female. TBDP was obtained after initial baseline instruments. Enrollment now has expanded to about 60 patients.

The instruments administered included: 1) SKINDEX-16, a skin-specific Quality of Life (QOL) scale; 2) Revised Impact of Events Scale (RIES) I and II, measuring subjective distress in response to life events; and 3) Breast Cancer Worry Scale, modified to be melanoma-specific (MWS), measuring worry about cancer. For all scales, lower scores indicated less of the measured construct.

DigitalDerm Inc., a dermatology digital photography company in Columbia, S.C., was used for photography. Patients had one baseline photo session in which 16 images were taken. One CD-ROM was given to the patient, and one is being kept at the dermatology clinic.

"Patients have the ability and are encouraged to use their CD-ROM during their monthly skin exams. If they see any worrisome, changing lesions, then it is recommended they come in sooner than their next scheduled visit," Dr.Pressley says.

Early results

The mean Skindex-16 total score for all patients (n= 30) was 18.6 ± 15.8. The mean RIES I total score was 13.3 ± 15.9, and the mean MWS total score was 9.4 ± 3.4.

At this time, 13 patients have completed follow-up instruments. For these patients, the mean scores for all three instruments decreased, indicating a decrease in the impact of QOL and cancer worry [Skindex-16: at baseline 22.7 ± 13.4 in comparison to follow-up 17.7 ± 8.9 (p= 0.16); RIES: 15.5 ± 16.5 to 13.3 ± 14.9 (p= 0.97); MWS: 10.8 ± 3.0 to 9.6 ± 2.6 (p=0.048)].

"The results of the study are still preliminary. There is no comparison control group that has not had TDBP. However, our data seems to suggest there is a benefit in having TBDP in terms of QOL and cancer worry," Dr. Pressley says.