From the Editors

Most experts and policy makers today agree that targeted screening of people at elevated risk for melanoma is valuable and worth the cost. It makes sense, since these individuals have the highest likelihood of developing the disease.

However, it is important to be aware that most melanomas occur in individuals without high-risk phenotypic characteristics. Though the benefits and drawbacks of widespread skin cancer screening continue to be debated, the fact remains that without population-based screening, many of these melanomas may remain undetected until they have reached an advanced stage. Furthermore, even when widespread screening is implemented, its relative infrequency may preclude early detection of rapidly growing melanomas.

So, what can be done in non-high risk populations to bring rapidly growing melanomas and other skin cancers to physicians’ attention in a more timely way?  First, it must be pointed out that patients themselves discover most skin cancers. Thus, engaging and empowering the population at large in skin cancer surveillance may be a key answer.

Educating the lay public about the warning signs of melanoma has been ongoing for some time, but the educational landscape is rapidly evolving. Electronic media are eclipsing print media in conveying information, chiefly through the World Wide Web and smartphones.  New apps geared towards skin cancer are continuously introduced, and the number of users is growing. These apps are designed to educate, send reminders for skin self-examination, analyze lesions or monitor them over time, and make communication with clinicians far easier. They may also bring down health care costs.

In this issue of The Melanoma Letter, Drs. Crew, Tyagi, Miller and Cockburn provide an excellent, comprehensive review and analysis of current apps and their role in both public and professional skin cancer education and detection. Their report makes abundantly clear the need for established standards in this industry. In addition, the authors make a convincing case that apps providing metrics about lesions should ideally be tested against standard sets of images of both benign lesions and skin cancers.

While no standards and no dataset of test images yet exist, efforts are under way to create them. The ISIC (International Skin Imaging Collaboration) Melanoma Project is attempting to define standards for digital images and is in the process of building an annotated, vetted image dataset of both benign and malignant lesions.  Once assembled, this dataset will be made accessible to industry and app designers for use in testing new products and analytic algorithms.

In the very near future, with the help of such efforts, apps and telemedicine will transform the very essence of how skin cancers and countless other conditions are detected, diagnosed, and treated. If not a brave new world, it may at least be one in which patients everywhere can participate in their own health and readily avail themselves of lifesaving professional care.

Allan C. Halpern, MD • Editor-in-Chief                                   

Ashfaq A. Marghoob, MD • Associate Editor