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SMARTPHONE APPLICATION

SHOULD SMARTPHONE APPLICATIONS REPLACE DERMATOLOGISTS IN THE DIAGNOSIS OF SKIN CANCER?



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  • - SOLOMON BENDAYAN
  • - M.D.C.M CANDIDATE
  • - MCGILL UNIVERSITY

Technology is advancing at faster rates than ever before and access to technology has increased exponentially over the last 5 years. It is estimated that one quarter of the world’s population has access to smartphones. Applications (apps) exist for all fields of work and the medical field, particularly dermatology, is no exception.
Dermatology apps that are designed for the general public usually fall into one of three categories: teledermatology, self-surveillance and education, or diagnosis. Teledermatology allows patients to connect with a physician remotely, often via video conference. Although there are several issues with teledermatology, such as patient confidentiality and picture quality, the field of teledermatology continues to expand at record pace – in part due to the COVID-19 pandemic. It is worth mentioning some of the benefits of teledermatology. Patients do not have to take time off work to see the doctor. Appointments are conducted from a remote location and patients, especially those living in rural areas, who may not have had access to a dermatologist are easily able to consult one. Although teledermatology comes with challenges, it will continue to grow and improve several aspects of the patient-physician encounter.

Apps for self-surveillance and education have also become more and more popular. They provide instructions on how to self-examine one’s skin, information about skin cancers and melanoma, as well as recommendations regarding sun protection. Although these apps may theoretically serve as a powerful tool for people who want to educate themselves and be proactive with their skin health, there are several cons that must be considered.

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Only a small minority of these applications have actual input from a dermatologist. Additionally, most applications do not reveal where they are getting the information from nor do they disclose authorship; making the information largely unreliable and possibly incorrect. Additionally, only few studies have evaluated the efficacy of these applications, and the studies that have been published have generated disappointing results.

Diagnostic apps are automated and require the person to upload images of a suspicious skin lesion. These photos are then analyzed by the apps’ algorithm and a risk assessment or diagnosis is given, without the involvement of a dermatologist. Although the diagnosis of skin cancer usually requires a skin biopsy, these apps try to quantify the risk that a lesion is cancerous based on data derived from past images. Diagnostic apps are unregulated, and the algorithms used are unreliable and not validated. Often people use these apps to try and replace the patient-physician encounter. In doing so, people may think that dangerous skin lesions are benign, causing delayed diagnosis and worse prognosis in the end. On the other hand, people may believe that benign lesions are in fact cancerous, causing unnecessary stress and anxiety. Dr. Ivan Litvinov, a dermatologist and director of dermatology research at McGill University, advises against the use of automated diagnostic apps in dermatology. “The only apps that could be useful are directly connected to a certified dermatologist evaluating the images on the other end”, he explains. The algorithms are unsound, and they give the patient a false sense of comfort.

To conclude, teledermatology continues to expand and shows promising potential. Dermatology apps designed to educate the patient have the right idea, but the information is generally unreliable with no proven clinical efficacy. Finally, automated diagnostic apps in dermatology are questionable and should not be used in the diagnosis of skin cancer as they may cause unintended harm by providing false sense of security. “In Canada dermatologists receive on average ~13 years of university training, five of which is just dedicated to the study of the skin and seeing patients. This is not something that you can replace with an app”, highlights Dr. Litvinov.