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detection with algorithm-based and dermatologist-based smartphone - - PowerPoint PPT Presentation

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The current state of melanoma detection with algorithm-based and dermatologist-based smartphone applications: Towards improved healthcare access in the Hawaiian Islands Michael Tee MD, PhD University of Hawaii April 4, 2019 Disclosures No

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The current state of melanoma detection with algorithm-based and dermatologist-based smartphone applications: Towards improved healthcare access in the Hawaiian Islands

Michael Tee MD, PhD University of Hawaii April 4, 2019

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Disclosures

  • No financial disclosures
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Outline

  • Skin cancer
  • Hawaiian Islands
  • Aim
  • Method
  • Results
  • Summary
  • Current state of implementation
  • Take home points
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Introduction: Skin cancer 101

*SEER = Surveillance, Epidemiology, and End Results American Cancer Society

  • 3 Main types: Basal, Squamous,

Melanoma

  • the incidence of skin cancer (in Aus) is
  • ne of the highest in the world
  • two to three times the rates in Canada,

the US and the UK

  • 5.4 million cases (US) NMSC, 959,243

(Aus)

  • 96,480 (US) new melanomas, 15,229

(Aus)

  • 7,230 people (US) die of melanoma, 1,725

(Aus)

  • Merkel cell cancer 2000 a year

https://melanoma.canceraustralia.gov.au/statistics

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Hawaiian Islands

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Island, Population, Dermatologist, 2018 Oahu 943,207 20-40 Hawaii 186,738 2 Maui 144,444 4-5 Kauai 66,921 1 Molokai 7,345 none Lauai 3,135 none Niihau 170 none Kahoolawe (unpopulated) none

Hawaiian Islands

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Aim: Access to dermatological expertise

  • Hawaiian Islands
  • geography greatly encourages the use of virtual care
  • Meaningfully embed virtual care into clinical care
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  • 43 dermatological apps related to melanoma detection

in 2018

  • Teledermatology store-and-forward platforms
  • Dermatologist-based (DB) mobile examination
  • Internal algorithm-based (AB) apps

Aim: Access to dermatological expertise Via smartphone applications

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Method

  • Meta-analysis to assess the association between

melanoma detection and smartphone screening.

  • comprehensive literature review through December

2018.

  • case-control and cross-sectional studies that compared

the detection abilities of melanomas with smartphones compared to face-to-face (FTF) dermatologist screening with histopathological diagnoses confirmation.

  • calculated pooled odds-ratio (OR) with 95% confidence

intervals (CI) and I2 statistics using a random effect model.

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Results

  • Nine studies with sixteen smartphone apps

Favors no melanoma detection benefit compared to FTF Favors melanoma detection benefit compared to FTF

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Summary

  • FTF examinations are still superior to both the current AB

and DB apps.

  • As algorithms and processes improve, continued

scrutiny and transparency is needed.

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Applications in the Hawaiian Island

  • Little to no uptake
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Take Home Points

  • Much work to be done before implementation in

Hawaii’s healthcare system

  • Quality verification issues
  • Reimbursement issue
  • Integration, usability
  • Access issues continue to be an issue
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References

  • 1.Ngoo, A., Finnane, A., McMeniman, E., Soyer, H. P. & Janda, M. Fighting Melanoma with Smartphones: A Snapshot of

Where We are a Decade after App Stores Opened Their Doors. Int. J. Med. Inf. 118, 99–112 (2018).

  • 2. Dorairaj, J. J., Healy, G. M., McInerney, A. & Hussey, A. J. Validation of a Melanoma Risk Assessment Smartphone

Application: Dermatol. Surg. 43, 299–302 (2017).

  • 3. Maier, T. et al. Accuracy of a smartphone application using fractal image analysis of pigmented moles compared to

clinical diagnosis and histological result. J. Eur. Acad. Dermatol. Venereol. 29, 663–667 (2015).

  • 4. Kroemer, S. et al. Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic

image tele-evaluation using cellular phones: Mobile teledermatology for skin tumour surveillance. Br. J. Dermatol. 164, 973– 979 (2011).

  • 5. Boyce, Z., Gilmore, S., Xu, C. & Soyer, H. P. The Remote Assessment of Melanocytic Skin Lesions: A Viable Alternative to

Face-to-Face Consultation. Dermatology 223, 244–250 (2011).

  • 6. Börve, A., Terstappen, K., Sandberg, C. & Paoli, J. Mobile teledermoscopy—there’s an app for that! Dermatol. Pract.
  • Concept. 3, (2013).
  • 7. Börve, A. et al. Smartphone Teledermoscopy Referrals: A Novel Process for Improved Triage of Skin Cancer Patients. Acta
  • Derm. Venereol. 95, 186–190 (2015).
  • 8. Wolf, J. A. et al. Diagnostic Inaccuracy of Smartphone Applications for Melanoma Detection. JAMA Dermatol. 149, 422

(2013).

  • 9. Chadwick, X., Loescher, L. J., Janda, M. & Soyer, H. P. Mobile Medical Applications for Melanoma Risk Assessment: False

Assurance or Valuable Tool? in 2014 47th Hawaii International Conference on System Sciences 2675–2684 (IEEE, 2014). doi:10.1109/HICSS.2014.337

  • 10. Ngoo, A. et al. Efficacy of smartphone applications in high-risk pigmented lesions. Australas. J. Dermatol. 59, e175–e182

(2018).

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Questions