The future is bright for devices in dermatology. The advances made recently in the use of devices for diagnosis and treatment of serious disorders, such as melanoma and other forms of skin cancer, demonstrate that technology may at last have become non-optional for a practicing dermatologist. Melanoma detection is arguably the single most important function of a dermatologist, and one that cannot be compromised. With the advent of current technologies in melanoma detection, established through well-designed large clinical trials, have we reached the tipping point where devices may become standard of care?
Standard of care in medicine is defined as that which is established by authority, custom, or general acceptance as a model.Up until this point, laser and light-based technologies have been employed mainly to treat elective concerns, such as pigmented benign lesions, telangiectasia, tattoos and wrinkles, the exception being photodynamic therapy (PDT) for actinic keratosis, acne, and non-melanoma skin cancers. However, even in the case of PDT, the application of technology was largely relegated to specialists within dermatology and such procedures were not considered mandatory for all dermatologists to offer. The choice to bring such technologies into dermatologic practice has mainly been considered optional. The patient demand and pressure for the general dermatologist to offer state of the art treatments for medical disorders such as rosacea, lentigines, or scars, has certainly been present, but not necessarily perceived as sufficient to make lasers and light-based devices mandatory in a medical dermatology practice - that is until now.
With the advent of hand-held technologies in melanoma detection, devices have advanced so dramatically in providing diagnostic tools in dermatology that it may have reached a tipping point wherein it should be considered standard of care.1 An apt comparison, perhaps, would be to consider the stethoscope as a diagnostic tool, which took years until a point was reached when it was universally adopted by internists. An example of such a technology providing increased diagnostic accuracy for our most important challenge, melanoma, is the advent of hand-held, multispectral, digital dermoscopy.2,3,4,5 A recent hand-held version of such a device, called Mela-find®, rapidly employs multispectral data capture and computer algorithms to automatically acquire and analyze lesion data from under the skin surface. The device uses a series of ten different specific wavelengths (between 430nm and 950nm) including near infrared bands to image the skin within seconds and to generate a positive (recommended for biopsy) or negative (no biopsy) result based on predefined image analysis algorithms. The data is obtained from beneath the surface of lesions by a lens system composed of nine elements and a photon sensor that captures the multi-spectral data of light scatted back from the lesions. A number of rigorously executed clinical trials have used the data obtained from a hand-held device to calculate the degree of disorganization of melanocytic nevi and to define criteria for biopsy, boosting sensitivity of melanoma detection to over 98% and tripling specificity of diagnosis as compared to visual inspection.2,3,4,5 In addition, the device is one of the lowest cost technologies on the market, is rapid to use, and will likely be developed into a portable version in the future. Prior melanoma-detecting technologies were hampered by the cumbersome setups, higher costs, and time-intensity for analyzing lesions. With reproducible data accumulating and demonstrating increased sensitivity, specificity, and positive and negative predictive values of this device as compared to routine examination, and given its speed, low cost, and ease of use, are we at a tipping point when a dermatologist today may not be able to afford functioning without such a melanoma-detecting technology in their clinical practice? Due the rigor of the evidence available to support its use, the tipping point may soon be upon us if not already.