Smartphone Applications for Melanoma Detection
Smartphone Applications for Melanoma Detection
Smartphone health applications ('apps') are widely available but experts remain cautious about their utility and safety. We reviewed currently available apps for the detection of melanoma (July 2014), aimed at general community, patient and generalist clinician users. A proforma was used to extract and assess each app that met the inclusion criteria, and we undertook content analysis to evaluate their content and the evidence applied in their development. Thirty-nine apps were identified with the majority available only for Apple users. Over half (n = 22) provided information or education about melanoma, ultraviolet radiation exposure prevention advice, and skin self-examination strategies, mainly using the ABCDE (A, Asymmetry; B, Border; C, Colour; D, Diameter; E, Evolving) method. Half (n = 19) helped users take and store images of their skin lesions either for review by a dermatologist or for self-monitoring to identify change, an important predictor of melanoma; a similar number (n = 18) used reminders to help users monitor their skin lesions. A few (n = 9) offered expert review of images. Four apps provided a risk assessment to patients about the probability that a lesion was malignant or benign, and one app calculated users' future risk of melanoma. None of the apps appeared to have been validated for diagnostic accuracy or utility using established research methods. Smartphone apps for detecting melanoma by nonspecialist users have a range of functions including information, education, classification, risk assessment and monitoring change. Despite their potential usefulness, and while clinicians may choose to use apps that provide information to educate their patients, apps for melanoma detection require further validation of their utility and safety.
Smartphones are rapidly evolving from being solely devices for communication and entertainment to include specialized applications ('apps') that are intimately involved in many aspects of daily life. A vast range of health apps is now available to assist users (> 13 000 in a 2012 report), for example to monitor their pulse and blood pressure, or to track their food intake and exercise undertaken to manage weight loss. Furthermore, two out of three U.S. clinicians already use smartphone health apps in their practice to manage a range of conditions. Some apps have been evaluated, such as those to assist in managing diabetes and pain, and to aid monitoring of anticoagulation therapy and epilepsy, but such evaluation is not common among apps aimed at general community users, probably due to the rapid evolution and commercial drivers of this field. While smartphones have been hailed as 'new clinical tools in oncology', many experts remain cautious about the utility of the thousands of apps currently available, either free or at a small charge, for the prevention, detection and management of cancer. It has also been suggested that apps for detecting cancers tend to lack scientific and specialty input, and the use of technology to deliver cancer follow-up has only begun to be studied for safety and utility: a recently published systematic review found only two randomized studies that had used smartphone technology.
A number of dermatology-specific apps have been developed which aim to help previously unaffected individuals or those previously diagnosed with a skin cancer to decide if they should seek medical review for a skin lesion, and to assist nonspecialist clinicians such as general practitioners (GPs) to make decisions about whether to reassure the patient that their lesion is benign or to refer for specialist assessment. However, a recent comparison of the accuracy of four smartphone apps in assessing melanoma risk demonstrated wide variation in performance and utility. Furthermore, smartphone apps for the identification or management of cancer including melanoma have not been subject to any sort of validation or regulatory controls in the U.S.A., the U.K. or elsewhere. Therefore, while they have the potential to improve patient and nonspecialist clinician assessment and patient–clinician communication about potential skin cancer there is the risk that these apps could actually harm users. The advice could be inaccurate or misleading, apps could be used as a substitute for a clinical consultation, and they could even delay melanoma diagnosis. This risk is particularly concerning for melanoma compared with other cancers as the majority are detected by the patient rather than their clinician, and the time taken to present to a clinician from first noticing a skin change or symptom is longer than for all other cancers except those of the head and neck.
In this paper we report a review of currently available smartphone apps for the detection of melanoma aimed at general community, patient or generalist clinician users, evaluating their content and the evidence applied in their development.
Abstract and Introduction
Abstract
Smartphone health applications ('apps') are widely available but experts remain cautious about their utility and safety. We reviewed currently available apps for the detection of melanoma (July 2014), aimed at general community, patient and generalist clinician users. A proforma was used to extract and assess each app that met the inclusion criteria, and we undertook content analysis to evaluate their content and the evidence applied in their development. Thirty-nine apps were identified with the majority available only for Apple users. Over half (n = 22) provided information or education about melanoma, ultraviolet radiation exposure prevention advice, and skin self-examination strategies, mainly using the ABCDE (A, Asymmetry; B, Border; C, Colour; D, Diameter; E, Evolving) method. Half (n = 19) helped users take and store images of their skin lesions either for review by a dermatologist or for self-monitoring to identify change, an important predictor of melanoma; a similar number (n = 18) used reminders to help users monitor their skin lesions. A few (n = 9) offered expert review of images. Four apps provided a risk assessment to patients about the probability that a lesion was malignant or benign, and one app calculated users' future risk of melanoma. None of the apps appeared to have been validated for diagnostic accuracy or utility using established research methods. Smartphone apps for detecting melanoma by nonspecialist users have a range of functions including information, education, classification, risk assessment and monitoring change. Despite their potential usefulness, and while clinicians may choose to use apps that provide information to educate their patients, apps for melanoma detection require further validation of their utility and safety.
Introduction
Smartphones are rapidly evolving from being solely devices for communication and entertainment to include specialized applications ('apps') that are intimately involved in many aspects of daily life. A vast range of health apps is now available to assist users (> 13 000 in a 2012 report), for example to monitor their pulse and blood pressure, or to track their food intake and exercise undertaken to manage weight loss. Furthermore, two out of three U.S. clinicians already use smartphone health apps in their practice to manage a range of conditions. Some apps have been evaluated, such as those to assist in managing diabetes and pain, and to aid monitoring of anticoagulation therapy and epilepsy, but such evaluation is not common among apps aimed at general community users, probably due to the rapid evolution and commercial drivers of this field. While smartphones have been hailed as 'new clinical tools in oncology', many experts remain cautious about the utility of the thousands of apps currently available, either free or at a small charge, for the prevention, detection and management of cancer. It has also been suggested that apps for detecting cancers tend to lack scientific and specialty input, and the use of technology to deliver cancer follow-up has only begun to be studied for safety and utility: a recently published systematic review found only two randomized studies that had used smartphone technology.
A number of dermatology-specific apps have been developed which aim to help previously unaffected individuals or those previously diagnosed with a skin cancer to decide if they should seek medical review for a skin lesion, and to assist nonspecialist clinicians such as general practitioners (GPs) to make decisions about whether to reassure the patient that their lesion is benign or to refer for specialist assessment. However, a recent comparison of the accuracy of four smartphone apps in assessing melanoma risk demonstrated wide variation in performance and utility. Furthermore, smartphone apps for the identification or management of cancer including melanoma have not been subject to any sort of validation or regulatory controls in the U.S.A., the U.K. or elsewhere. Therefore, while they have the potential to improve patient and nonspecialist clinician assessment and patient–clinician communication about potential skin cancer there is the risk that these apps could actually harm users. The advice could be inaccurate or misleading, apps could be used as a substitute for a clinical consultation, and they could even delay melanoma diagnosis. This risk is particularly concerning for melanoma compared with other cancers as the majority are detected by the patient rather than their clinician, and the time taken to present to a clinician from first noticing a skin change or symptom is longer than for all other cancers except those of the head and neck.
In this paper we report a review of currently available smartphone apps for the detection of melanoma aimed at general community, patient or generalist clinician users, evaluating their content and the evidence applied in their development.
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