Skin cancer phone apps aren’t very accurate: study

Carrying on with regard to previous discussions about Apps, this has come out this month. I can email the article which is free online to anyone (




Skin cancer phone apps aren’t very accurate: study

(Reuters Health) – Smartphone applications that use algorithms to analyze skin lesions may not be very good at determining which ones are cancerous, a new study suggests.

The apps are marketed as educational only and so aren’t covered as medical devices under the Food and Drug Administration’s regulations.

But that may not stop some people from relying on the inexpensive toolsinstead of going to see a dermatologist, researchers said – which could mean slower diagnosis of potentially dangerous lesions.

“There’s no substitute, at this point, for a complete skin exam performed by an expert dermatologist for picking up melanoma as well as other skin cancers,” said Dr. Karen Edison, a dermatologist from University of Missouri in Columbia who wasn’t involved in the new study.

“Just sending a picture to someone you don’t know anywhere in the world can be reassuring if it’s very clear that (the lesion) is benign, so that’s a good thing,” she told Reuters Health, “but it’s kind of fraught with other issues that we haven’t grappled with adequately, I don’t think.”

For example, even if an app makes a correct diagnosis of melanoma, that doesn’t necessarily help if the patient doesn’t know where to get a biopsy or doesn’t have insurance to pay for it, Edison said. “We’re all for technology, but we need to keep it in perspective, and make it a tool.”

For the new study, researchers used photos of 188 pre-diagnosed lesions – 60 melanomas and 128 benign lesions – to check the accuracy of four Smartphone apps made to look for melanoma in previously-taken images.

Three of those apps, which cost under $5 to own, use algorithms to determine whether a lesion is likely to be cancerous or not. The fourth sends images to a certified dermatologist for evaluation, at a price of $5 per lesion.

Of the three algorithm-based apps, the most accurate still missed 18 of the 60 melanomas, mistakenly classifying them as lower-risk, Dr. Laura Ferris from the University of Pittsburgh Medical Center in Pennsylvania and her colleagues reported Wednesday in JAMA Dermatology.

App users “need to know that that’s a pretty big risk to take,” Ferris said.

“If you delay removal or evaluation for your melanoma, it gets deeper, and the chance of it spreading and getting deadly really increases with time,” she told Reuters Health.

The dermatologist consultation app did better than the others, misdiagnosing just one out of 53 evaluable images of cancerous lesions.

All but one of the apps classified more than half of the benign, non-cancerous lesions as problematic.

The researchers said they chose not to release the commercial names of the apps evaluated because their purpose was to determine the accuracy of this type of tool, in general.

The website of a similar company that markets an app for skin lesion analysis using real-time photos, SkinVision, cautions customers to, “Never disregard professional medical advice, or delay in seeking it, because of something you have read on SkinVision. Do not rely on information from SkinVision instead of seeking professional medical advice.”

Likewise, the website for the Mole Detective app says, “Always defer to a medical professional if you feel that a mole looks suspicious. Mole Detective’s intent is not to diagnosis but to help you better track the symptoms of melanoma at home.”

Ferris said there are certain dermatology apps that can help patients.

“There are apps that will do things like teach you about melanomas,” she said. “There are ones that will remind you to do your own skin check – that’s great.”

Both researchers said teledermatology – giving people who live in rural areas, for example, the chance to consult with a dermatologist through photos or video – can be useful. Edison, for example, once used it to diagnose a farmer living hours away with melanoma during harvest season.

But they agreed that for now – and probably for the foreseeable future – machines and apps can’t beat in-person exams when it comes to checking for skin cancer.

Pain and skin cancer

I discussed this with a few people last year and came across this article during the holidays.  I do not believe their pain figures for BCC and SCC as they seem far too high. It’s probably because it is a hospital setting and they see more advanced cases.




Pain and Skin Cancer

Pain is a significant predictor of squamous cell carcinoma compared to basal cell carcinoma, according to results of a recent study.

Investigators with Wake Forest University Baptist Medical Center conducted an institutional review board-approved study, analyzing data on 576 nonmelanoma skin cancers (NMSC) from 478 patients with a mean age of 68.8, . Of those patients, 353 had basal cell carcinoma (BCC) and 223 had squamous cell carcinoma (SCC). The patients used a visual analogue scale to rate the pain and itch they experienced.

For both types of NMSC, itch was the most reported symptom, at 43.5% in SCC and 33.4 % in BCC. The pain prevalence was 39.8 % for patients with SCC, compared to 17.7 % of patients with BCC.

With each one-point increment in visual analogue scale for pain, the odds of having SCC rather than BCC increased by 30 %, according to the study. There was nearly a fourfold increase in the likelihood of a patient having SCC versus BCC when the score for pain was greater than two (odds ratio=3.94; 95 % confidence interval, 2.49-6.23).

“With an increasingly aging population, patients often present with numerous BCCs and SCCs, and it is often difficult for the clinician to prioritize lesion biopsy and removal,” the study authors wrote. “Thus, there is a need for better clinical tools to aid the physician in selecting lesions most likely to be SCCs.”

The study was published in the December issue of JAMA Dermatology, formerly Archives of Dermatology.


Study: Risk for skin cancer involves numerous genetic factors

Have a look at this comment and the original article in Genetics:

We will hear a lot more about this in the future I think


It’s common knowledge that excessive UV exposure from sunlight raises your chances for skin cancer, but predicting whether someone will actually develop skin cancerremains difficult. In a new research report, scientists from the University of Alabama at Birmingham (UAB) and the University of Wisconsin-Madison show that the risk for skin cancer involves numerous genetic factors including family history, ethnicity, and genetic variations specific to each individual. Using these factors, the researchers developed a more precise model for assessing risk, which is published in the December 2012 issue of the journal GENETICS (

“We hope this study will ultimately contribute toward a better understanding of the genetics of complex traits and diseases,” said Ana Inés Vázquez, PhD, lead author of the study from UAB’s Department of Biostatistics. “Such an understanding is essential for the development of methods that can be used for early and improved prediction of genetic predisposition to diseases.”

To make this discovery, the scientists used phenotypic and genetic information from more than 5,000 familial participants in the Framingham Heart Study to develop various models for assessing skin cancer risk. The researchers’ most basic risk evaluation model included standard risk factors such as sex. Additional predictive models were developed by adding information on family history, ethnicity, and data from 41,000 genetic markers across the human genome. The predictive power of each model was evaluated, with the best prediction accuracy obtained from models that include all predictive risk factors — those standard risk factors plus family history, ethnicity and genetic markers.

“Although there is no doubt that sun exposure increases your risk for skin cancer,” said Mark Johnston, Editor-in-Chief of the journal GENETICS, “it isn’t clear how much of a risk it poses to each individual. This new model for assessing risk should prove useful to health care providers and public health officials, who play a crucial role in educating people about preventing skin cancer.”

Skin cancer risk in red-heads

This is quite interesting to a degree. I mean, we already know there is a strong genetic component to skin cancer, independent of sun-exposure.

Redhead Pigment Boosts Skin-Cancer Risk

From Nature magazine

Fair-skinned, red-haired folks know — sometimes through painful experience — that they are more susceptible to the damaging effects of the Sun’s ultraviolet (UV) rays, including sunburn, skin ageing and a higher risk of skin cancers. But a study published today in Nature suggests that in mice, the pigment responsible for this colouring has a role in the development of melanoma.

“There is something about the redhead genetic background that is behaving in a carcinogenic fashion, independent of UV,” says David Fisher, a cancer biologist at Massachusetts General Hospital in Boston, who led the study. “It means that shielding from UV would not be enough.”

Compared to people with darker skin, those with fair, freckly skin and red hair produce a different form of the pigment melanin. This red–yellow form, called pheomelanin, is less effective at protecting the skin from UV damage than the darker form, eumelanin. The difference is caused by a mutation in the gene MC1R.

But for a number of years there have been hints that UV exposure alone might not account entirely for the risk of melanoma in redheads. Fisher and his team wanted to investigate the molecular backdrop for this increased risk.

The researchers looked at how melanomas develop in mouse models of olive-skinned, ginger and albino colouring. The last group had the same genetic background as the dark-skinned mice but lacked the enzyme needed to synthesize melanin. The researchers also tweaked each group’s genes to be more susceptible to developing benign moles, which Fisher says is a probable first step in the development of melanoma.

No sunlight needed
The researchers planned to expose the mice to UV light and monitor differences in melanoma development. But before they got to that part of the experiment, about half the ginger mice had developed melanomas. Fisher says that he and his team were shocked. “The first thing we needed to do was bring a UV meter into the animal room to be sure there wasn’t some inadvertent UV being radiated out of the light bulbs or something,” he says. “And it turned out there was not.”

The result suggested that the pigment itself was a cause of melanoma. The researchers suggest that the increased melanoma risk could have something to do with the pigment-production process, or a by-product of it, in melanin-containing cells called melanocytes.

Eugene Healy, a clinical dermatologist at the University of Southampton, UK, says that although the mechanism is interesting, it is probably a less common trigger of melanoma than UV radiation. Indeed, in the UK, 8 out of 10 cases of melanoma are due to UV exposure. In humans, most melanomas develop on skin that sees the sun. “You almost never see melanoma, for example, on the buttocks,” says Healy.

To complicate the picture, one of Healy’s own studies, published in 2010, suggested that pheomelanin was protective against the effects of UV radiation in another type of skin cell, the keratinocyte.

The sun-safety message does not change because of the latest results. “UV is very tightly and convincingly linked to the formation of most non-melanoma types of skin cancer,” Fisher says. “One of the most important messages from this is to avoid an assumption that this takes UV off the hook.” It is possible that UV exposure worsens the carcinogenic mechanism of the red pigment, he adds.

Healy is keen to avoid alarming people with fair complexions. “Whatever risk was there, was always there. But we don’t see lots of spontaneous melanomas in redheads. We shouldn’t be sending out a worrying message for them.”

This article is reproduced with permission from the magazine Nature. The article wasfirst published on November 2, 2012.

Relationship between naevi and BCC

This article, although quite obvious really, has just been published. The interesting thing is how naevi on the back were not associated with increased risk.




J Eur Acad Dermatol Venereol. 2012 Sep;26(9):1092-6. doi: 10.1111/j.1468-3083.2011.04213.x. Epub 2011 Aug 16.

Melanocytic naevi and basal cell carcinoma: is there an association?


Cancer and Population Studies Unit, Queensland Institute of Medical Research School of Life Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.



Melanoma and basal cell carcinoma (BCC) affect similar body sites and share a complex relationship with sun exposure.


To establish the existence and magnitude of association between melanocytic naevi, the strongest predictors of melanoma, and BCC to give possible insights into shared pathways of solar ultraviolet tumourigenesis.


In a community-based longitudinal Australian study, detailed information was collected about sun sensitivity, and dermatologists assessed skin colour and counted naevi on the forearms (1986) and back (1992). The BCC frequency and sites were prospectively monitored until 2007. Multivariate logistic regression was used to assess the association of naevi on the forearms or on the back with the development of BCC, adjusting for other risk factors.


Of 1621 study participants in 1992, 1339 (average age 49) had complete follow-up and 401 (30%) of these had 1202 histologically confirmed BCCs until 2007. After adjustment for age, gender, skin colour, naevi on the back and sun exposure, overall BCC risk increased significantly in those with forearm naevi (odds ratio: 1.5; 95% confidence intervals: 1.1-1.9). Risk of BCC specifically on the back was doubled in those with many (11 or more) forearm naevi compared with no forearm naevi (odds ratio: 2.4; 95% confidence interval: 1.1-4.8). Naevi on the back were not associated with subsequent basal cell carcinoma.


High naevus prevalence on the arms is associated with future BCC development.

Parkinson’s disease and melanoma

I had previously heard of this but have never really come across a lot of patients with both Parkinson’s and melanoma. Has anyone?


Parkinson Disease and Melanoma May Share a Genetic Link

Reciprocal predispositions of parkinsonism and cancer demonstrate a strong association between these conditions.

Persons with Parkinson disease (PD) have a lower than expected prevalence of most cancers, but melanoma is an exception. Several studies have found an elevated risk for malignant melanoma in PD patients. A reciprocal increased risk for PD has been reported in melanoma patients and their first-degree relatives, suggesting a common genetic or environmental link. Researchers used the Utah Cancer Registry and the Utah Population Database, which contains birth, death, and family relationship data of more than 2 million individuals, dating back in some instances 15 generations, to assess associations between PD and cancer subtypes.

Among 388,221 individuals with a recorded cause of death and at least three generations of genealogic data, 2998 had PD as a cause of death, and 48 of these had melanoma, versus an expected rate of 24.6 (relative risk, 1.95; 95% confidence interval, 1.44–2.59). Statistically significant excess risk for melanoma was found in the first- and second-degree relatives of those with PD-related deaths. Among 7841 individuals with a melanoma diagnosis and at least three generations of genealogy, the researchers found significantly increased risk for PD-related death in the melanoma cases (RR, 1.65; 95% CI, 1.22–2.19) and in their first-, second-, and third-degree relatives. Prostate cancer was the only other cancer observed in excess in those with PD-related death. Among those with PD-related deaths, men had significantly fewer than expected lung, pancreas, and stomach cancers, and colon cancers were significantly decreased in women. The authors conclude that the findings in this study strongly support the hypothesis of a common genetic link between PD and melanoma.

Comment: This study adds further genetic evidence of a link between Parkinson disease and melanoma. The strength of this association is indicated by the finding of an increased risk in both directions: an increased risk for melanoma among PD patients and vice versa. I personally have several patients who have been diagnosed with both conditions, and the question of Sinemet treatment invariably surfaces at some point. Because PD patients tend to be older, quality of life becomes a real issue for them. I typically balance the risk of their melanoma with disability if Sinemet is discontinued. If they remain on the drug, careful melanoma follow-up is certainly indicated.

— Hensin Tsao, MD, PhD

Published in Journal Watch Dermatology September 28, 2012


Kareus SA et al. Shared predispositions of parkinsonism and cancer: A population-based pedigree-linked study. Arch Neurol2012 Sep 3; [e-pub ahead of print]. (

The rate of melanoma transection with various biopsy techniques and the influence of tumor transection on patient survival.

This is interesting. Survival does not change due to biopsy technique (but there does seem to be a trend). But I wonder how many melanoma diagnoses are missed due to sub-optimal biopsy technique?




J Am Acad Dermatol. 2012 Sep 8. [Epub ahead of print]

The rate of melanoma transection with various biopsy techniques and the influence of tumor transection on patient survival.


Baylor College of Medicine, Houston, Texas.



Depth of melanoma invasion is critical because it dictates patient treatment and prognosis. Recent reports indicate melanoma transection with initial biopsy does not impact patient survival; however, tumor transection can lead to misdiagnosis and inaccurate staging.


This study assessed the rate of melanoma transection with various biopsy techniques and the impact of tumor transection on patient survival.


We conducted a retrospective review of all melanoma cases at our institution between 2000 and 2008. Of the 490 melanoma cases identified, 479 met inclusion criteria for the study. The transection rates of biopsy techniques were determined. Cases of transected tumors were matched with nontransected cases in a retrospective case-control fashion to evaluate survival.


The rate of melanoma transection was 1.5% for excisional biopsies, 4.1% for punch biopsies, and 9.0% for saucerization biopsies. The means of disease-free survival for the control and transected groups were 911 days and 832.7 days, respectively (P value .67). Overall survival for the control group was 1073.7 days versus 1012.4 days for the transected group (P value .72).


The study used a select population. The sample size of transected biopsies was limited, in turn limiting the power of the study. Residents performed the majority of biopsies.


Punch and saucerization biopsies were more likely to transect tumors than excisional biopsies. The transection of melanoma did not affect overall disease-free survival or mortality in the population studied.

A couple of interesting abstracts

A couple of interesting abstracts. Obviously the first one may just be that melanomas from certain parts of the body may be discovered later and deeper but this is still very relevant



Melanoma Res. 2012 Aug 23. [Epub ahead of print]

The prognostic impact of the anatomical sites in the ‘head and neck melanoma’: scalp versus face and neck.


aDepartment of Dermatology bDivision of Pathological Anatomy, Department of Critical Care Medicine and Surgery, University of Florence cClinical and Descriptive Epidemiology Unit, ISPO, Florence, Italy.


Cutaneous melanoma is a malignant neoplasia with several demographic and histopathological prognostic factors. Many studies stress that the head and neck region has a worse prognosis compared with other localizations, but the reasons for this worse prognosis are unclear. Therefore, the aim of our study is to analyse the poor prognosis of head and neck melanoma (HNM) with respect to the other anatomical sites, considering the face and neck (F&N) and the scalp separately. We carried out a retrospective analysis of 757 melanoma patients. In particular, we studied the prognostic impact of different melanoma skin localizations (head and neck, trunk, upper extremities and lower extremities). Afterwards, we divided HNM into two subgroups, F&N and scalp, to evaluate their impact in the HNM prognosis. Data showed a significantly lower 5-year overall survival probability for HNM (78.9 versus 93.1% for other body sites; P=0.05). Moreover, on analysing the two anatomical areas considered among HNM, we observed a 5-year overall survival of 81.8% for F&N and 66.7% for scalp. HNM has different and worse prognostic features with respect to other sites, but this trend is not only because of scalp melanoma but is also determined by F&N melanoma, which we believe to be underestimated until now.


Melanoma Res. 2012 Jun;22(3):252-6.

Features of small melanocytic lesions: does small mean benign? A clinical-dermoscopic study.


Department of Dermatology, Division of Pathological Anatomy, University of Florence, Florence, Italy. [email protected]


The use of dermoscopy is known to increase the sensitivity and specificity in the clinical diagnosis of cutaneous pigmented melanocytic lesions compared with naked-eye examinations. However, small pigmented melanocytic lesions with maximum clinical diameters of 6 mm remain the most significant diagnostic challenge to the clinician, particularly in the diagnosis of small melanoma, both in naked-eye and in dermatoscopic examinations. The aim of the present study was to analyze the clinical and dermatoscopic features of small pigmented melanocytic lesions, focusing on more frequently occurring features in small melanoma to identify them earlier. A total of 103 pigmented melanocytic lesions with diameters less than 6 mm were analyzed. On histopathological examination, 34 of these lesions were diagnosed as melanomas and the remaining lesions (n = 69) were diagnosed as benign, melanocytic lesions. Images of cases were independently and blindly administered to three dermatologist experts in dermoscopy, who were asked to examine the clinical and dermatoscopic images of melanocytic skin lesions separately and to fill out a printed questionnaire to rate the images according to the ABCD clinical criteria and according to typical dermoscopic pattern analyses. The results of the questionnaires were then analyzed and crossed in order to rate the clinical and dermoscopic features of small pigmented lesions. Our study proved that the clinical criteria for diagnosing melanoma are not as reliable in the diagnosis of pigmented lesions of less than 6 mm diameter. However, the use of dermoscopy, even if not nullifying, allows a better classification of small, melanocytic lesions through pattern analysis.


Genital skin cancer

This comment is from:

The most interesting point (which is not referenced) and I would think does not apply to Australia is the bit about half of all deaths from skin cancer other than melanoma being due to skin cancer of genitalia.

I have never heard such a statement, even from the USA……






Not all skin cancers are from sun exposure. Viruses such as human papilloma virus(HPV), the virus that causes genital warts, also cause skin cancer. Skin cancer from HPV develops on genital skin in both men and women. It is rarely talked about, but it’s important and can be deadly.

Did you know that half of all deaths from skin cancer other than melanoma are from genital skin cancer? You probably also didn’t know that women are more likely to die from genital skin cancer as they are from skin cancer that developed from sun exposure (again, excluding melanoma).

We dermatologists are inexhaustible when it comes to warning people about the dangers of sun exposure, but we should also be warning people about the dangers of genital warts. HPV protection, which includes HPV vaccines, is as important as sun protection in preventing death from non-melanoma skin cancer.

Genital warts can lead to deadly skin cancer. If your dermatologist has not checked your genital skin, then be sure your primary care physician or gynecologist does. This is especially important, because unlike other STDs which often have symptoms, HPV or genital warts often don’t. It may be embarrassing, but it could save your life

BCC and risk of another.

The below study does not really add anything new to what we know  but reaffirms that the most important thing for patients to know is that if you have had a basal cell carcinoma, you have a 44 percent chance of getting another.

There are also some other interesting findings eg ACE inhibitors increasing risk





A new study affirms that basal cell carcinoma, the most common form of skin cancer, should be viewed as a chronic disease.

That’s because once most people have a single occurrence, they are at risk of getting another.

“Basal cell carcinoma has generally been viewed as something that comes up, is treated and cured,” said Dr. Martin Weinstock, a study co-author and professor of dermatology at the Warren Alpert Medical School at Brown University in Providence, R.I. “For someone with an isolated lesion, that’s a reasonable way of looking at it. But most people are constantly at risk of this and will be getting more.”

The study confirmed what was commonly understood about the disease: a prior history of basal cell carcinoma is the greatest risk for another lesion. But the research found that eczema may also predict a recurrence among those at high risk for the disease. Those with a family history of eczema had a 1.54 times greater risk than those without.

Older age, sun sensitivity, intense sun exposure before age 30, and use of certain blood pressure-lowering medications (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) were also associated with increased risk.

Why would eczema, a chronic skin disorder that involves scaly and itchy rashes, be associated with basal cell carcinoma? Weinstock said it’s unclear. “There may be some differences in these people’s immune systems compared to people without eczema,” he said, noting that other investigators need to confirm the findings.

Having other types of skin cancer or actinic keratoses (scaly or crusty growths caused by sun damage) did not appear to raise the chances for basal cell carcinoma.

The study was published online July 19 in the Journal of Investigative Dermatology and funded by the U.S. Department of Veterans Affairs. It involved more than 1,100 people, nearly all men, all veterans, with a median age of 72.

On average, each participant had more than three instances of basal cell cancer or squamous cell cancer (another type of skin cancer) before participating in the research. During the study period, 44 percent developed new basal cell cancers, and those with the most basal cell cancers in the five years before the study had the most recurrences.

Study participants with more than five prior basal cell cancers were nearly four times as likely to develop a new one as those with one or no prior skin cancers. And their risk was twice as high as those with three previous skin cancers, the study found.

Now the most common cancer in the United States, basal cell carcinoma begins in the outer layer of the skin, often as a small white or flesh-colored bump that grows slowly and sometimes bleeds. While these cancers rarely spread, they must be removed or treated, usually in a physician’s office with local anesthetic.

Weinstock said researchers are eager to find a preventive medication to guard against the recurrence of basal cell carcinoma. Last year a team he led concluded that topical tretinoin did not prevent new basal cell cancers in high-risk patients. Now he is involved in a study looking at whether 5-Fluorouracil, a compound used to treat actinic keratoses, may prevent basal cell cancer when given intravenously.

Dr. Jean Tang, an assistant professor in the department of dermatology at Stanford University School of Medicine who is familiar with the study, said the most important thing for patients to know is that if you have had a basal cell carcinoma, you have a 44 percent chance of getting another.

“This study doesn’t change any clinical guidelines or recommendations,” she added. Current advice still stands: “Get an annual skin assessment by your dermatologist,” she said.