Apps Aim to Detect Skin Cancer

By Christopher Weaver The Wall Street Journal Smartphone apps are inching onto the turf of doctors and medical-device makers, promising to measure heart rates, display X-ray images and detect skin cancer. They also are prompting concerns about how well they work and whether consumers may rely on their smartphones and skip seeing a doctor. The accuracy of such apps can vary significantly, according to a study published Wednesday. Researchers at the University of Pittsburgh Medical Center evaluated four smartphone apps meant to determine whether moles have morphed into cancerous melanomas. The best-performing app accurately identified cancerous moles 98.1% of the time, while the worst picked them up only 6.8% of the time, according to the study. Two scored in the neighborhood of 70%. That’s far worse than trained dermatologists with modern equipment, who can accurately spot about 90% of melanomas on the first try, according to other studies, though it compared well with the detection skills of unspecialized family doctors. The study, published online by JAMA Dermatology, used the four unidentified apps to analyze images of 188 moles, including 60 melanomas, that had already been evaluated by a dermatologist. Three of the apps—priced at $5 or less—used algorithms to analyze moles. The worst performer suggested dozens of swollen, discolored cancers were benign. The app with the best results relied on doctors, forwarding images to board-certified dermatologists for review at a cost of $5 per mole. “If people have a way to feel better about delaying care, it’s only a matter of time before” a patient is harmed, said Laura Ferris, a UPMC dermatologist who co-wrote the study and has consulted for MELA Sciences Inc., a maker of skin-cancer detection device for doctors. She said she conceived the study when a patient asked about mole-examining apps. The research was funded by the National Institutes of Health. The new study arrives as consumers are broadly adopting mobile health technology, app makers are quickly becoming more sophisticated and gaining more financial backing, and expectations for relationships between patients and doctors are fast changing. “Health is following every other industry that we track,” said Susannah Fox of the Pew Research Center’s Internet & American Life Project. “The opportunity to educate yourself to make a decision has exploded.” A Pew survey published Tuesday found about one-third of adult Americans used online resources, including apps, to diagnose a health problem. About 41% of those people said the diagnosis was later confirmed by a medical professional. In a traditional exam, physicians check the shape, color and edges of a mole. Melanoma signs include a mole that is asymmetrical, has changed shape, has jagged edges or has darkened. Lab tests confirm diagnoses. “If patients are using one of these [apps] to say ‘melanoma’ or ‘not melanoma,’ they’re going to get in trouble,” said Ken Beer, a West Palm Beach, Fla., dermatologist who wasn’t involved in the study. “This can’t be a person’s only dermatologist.” Health-app makers include disclaimers warning patients that they don’t mean to diagnose anything. “We’re not saying this replaces a practitioner,” said Avi Lasarow, co-founder of the Mole Detective app, which uses algorithms to gauge mole risk but plans to add a physician-referral feature. “We’re saying, this is a way you can look to determine whether you might have a problem,” he said. Another app maker, SkinVision, says it “is not a diagnostic but provides tools that promote awareness,” such as its location-based information about exposure to ultraviolet light. Still, executives recognize the demand for more information about the apps’ effectiveness. SkinVision’s chief executive, Roel van Summeren, said the company is preparing a clinical trial in Europe that will compare its app with traditional diagnostic tools by studying 200 patients. Unlike medical devices, which need to be approved by the Food and Drug Administration, most apps haven’t yet been required to demonstrate their safety and efficacy. The FDA has begun approving certain apps that help physicians make diagnoses, but consumer apps have largely avoided scrutiny. The FDA said in a statement that the UPMC study results “reinforce the importance of consumers talking with a health care professional before making any medical decisions” because of the seriousness of melanoma, and that addressing mobile apps is a top priority at the agency. Some FDA-approved apps that measure heart rhythms and allow doctors to review medical images, along with a slew of apps for tracking health conditions from urinary incontinence to weight loss, are considered low-risk and are unlikely to lead to harmful misdiagnoses. One limitation for apps that use dermatologists may be that doctors are reluctant to say a mole they haven’t seen in person is safe, said Bobby Buka, co-founder of the app SpotCheck. “It’s got to be 100% reassuring for me to make that leap,” he said. Dr. Buka said he believes SpotCheck was reviewed by the UPMC researchers. Like the study’s top performer, it charges $4.99 per mole examined and sends mole pictures to board-certified dermatologists, and received an unusually heavy number of submissions during the study period, Dr. Buka said. Dr. Ferris declined to identify the makers of apps she reviewed. Jamison Feramisco, a San Francisco-area physician and co-founder of DermLink, an app that connects patients with dermatologists who review the images online for $70, said that with a high-quality photograph, he and other dermatologists would feel “pretty confident” in making a diagnosis.