Page 24 - Noninvasive Diagnostic Techniques for the Detection of Skin Cancers

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noncompliant patients is another issue since TBP requires regular followup sessions. Privacy
issues, such as imaging of the perineum, gender preference of photographers, and data storage,
have also been raised. 38

Variations of Technique
• Total body imaging systems. These generally consist of a digital camera for image
acquisition and a computer storage and retrieval system. They include the MIRROR™
DermaGraphix, FotoFinder BodyStudio LITE, and MoleMap surveillance program.
• Photography with automated image analysis. Several devices like MoleMax 1 Plus,
®
DermAssist™, Molemax 3 and Melanoscan have built-in software that allow real-time
comparisons of total body baseline and followup pictures, automatic mole counting to
detect new lesions, and diagnostic algorithms. 32,39,40 Other techniques utilize 3D
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differential forms of skin surfaces to “realize automatic recognition of melanoma” or
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computer-based algorithms to evaluate pigmented skin lesions.
• Total body photography combined with devices for lesion evaluation. 16,34,43-45 An
example of such a device is a dermoscope/camera combination (see Dermoscopy section

for further details).
• Teledermatology. In this technique, acquired digital images are transmitted virtually
through the Internet via mobile devices, such as 3G phones and personal digital
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assistants, and e-mail or specific Web applications. The images are transferred either
from other practitioners (teleconsulting) or directly from the patient to the clinician
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(telediagnosis). Description of the use of digital photo images in developing
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dermatological diagnosis and medical management is available. This technique confers
the advantages to both physicians and patients by eliminating the need for clinic
appointments or reducing long waiting lists for the receipt of results while maintaining
expert management, although data privacy and physician training issues have been raised.
• The use of ultraviolet light photography, (e.g., Canfield Visia System), is discussed under
Photodynamic Diagnosis, as it relies on the photodynamic properties of melanin in the
skin.

Clinical Context of Use
TBP is recommended for screening patients at high risk of skin cancer (specifically
melanoma). 48,49 High-risk patients are defined as those with more than 10 dysplastic nevi, a
previous history of melanoma, a family history of melanoma in a first degree relative (parent,
sibling, or child). However, the age of onset and frequency at which photographic surveillance
should be performed is unclear.
In terms of setting, our technical experts also suggested that these techniques may be useful
in the primary care setting and in rural areas with no access to specialists. Although TBP is
widely used by dermatologists and oncologists in the U.S., it is not routinely used by primary
care practitioners. The literature describes a wide range of practices of TBP. While some clinical
practices have dedicated professional medical photographers, others depend on existing
dermatologists, oncologists, or general practice physicians to use these devices. Various training
modules on the use of specific devices are available on the manufacturers’ Web sites.

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