A new skin cancer diagnostic tool promises to make detecting and dealing with skin cancer quicker, reducing invasive surgery and even saving lives.
Rural people stand to be the biggest winners, given their tendency to have high skin cancer rates, and distance from clinicians.
Skin cancer diagnosis company MoleMap was one of many health care companies prompted to re-examine its business model as the covid-19 lockdown saw a slide in patient visits, and a need for more contactless diagnosis.
Chair Jodi Mitchell said the lockdown acted as an accelerator for a virtual skin cancer diagnosis programme the company had intended to roll out in a more measured manner.
“Normally with this sort of technology you might aim to perfect it before going to market, but in two weeks we had a service out there, working off a health booking service,” Mitchell said.
The company was founded on the standard health care model of patients visiting a clinic and getting moles and spots checked by dermatology experts to determine if they may be cancerous.
Its SpotChat service now enables patients concerned about a lesion to use their smartphone to show a remotely located skin cancer nurse any problem moles. The nurse can then ensure priority diagnosis is given to any concerning lesions by a melanoma clinician.
The company typically diagnoses about 400 new cases of melanoma each year in New Zealand and Australia, the global capital for skin cancers, closely followed by NZ.
NZ has the second highest rate of melanoma, with 2500 new registrations of the disease each year, and 400 people dying of it every year.
Rural NZ is hit particularly hard by the cancer, with rural males reporting a rate of 7.7 per 100,000, compared to 6.4 per 100,000 in urban areas.
At the company’s Fieldays site 15% of people seen by a melanographer team had skin cancer. Eighty percent had no idea they had a lesion of concern.
Mitchell says the beta version rolled out over lockdown had strong uptake from patients with 250 using it in the first two weeks.
Out of the first 250 users, 280 lesions were detected and 100 required further personal consultation.
“From this, we identified skin cancers in 12% of the high-risk patients examined,” she said.
The system’s “patient-centric” approach reflects the fact a large proportion of melanomas are initially identified by patients, and the technology enables them to take the initiative more quickly than having to arrange a physical consultation that may be distant from where they live.
Amanda Oakley, associate professor of medicine and dermatology at Auckland University said rapid diagnosis of melanoma is important because the cancer can spread quickly into the bloodstream from the skin lesion.
While it can be deadly, she says prognosis at an early stage is usually very successful, with a 94% five-year survival rate for melanoma less than 1mm thickness at detection time.
“Most stay for a long time, sometimes decades in a slow-growing pre-malignant stage, but some grow from a dot to a dangerous nodule within a few weeks,” Oakley said.
Adding once it has spread to other parts of the body it becomes much harder to treat.
Lockdown delays were fortunately no more than a matter of weeks in NZ, but she said it had caused anxiety to remote clients worried about lesions over that period.
Mitchell said skin cancer nurses did much of the heavy lifting in the sector, arranging initial consults, making assessments and reassuring patients, and the remote system enabled them to work more efficiently. It also helped make better use of dermatologists who, like many health care experts, were thin on the ground.
The potential for collecting an even wider range of skin lesion examples through the remote consultation programme could also pave the way for utilising more Artificial Intelligence (AI) programmes in the future to rapidly assess and diagnose at consultation.
Mitchell was encouraged that people were continuing to use the service even though lockdown was over, and believed it may signal a shift in consultation patterns that is here to stay.
As a sector, health care has been slow to adapt to technology, sticking more with the bricks and mortar of clinical-based care, despite technology’s advancements.
Longer term, she believed NZ needed a melanoma surveillance programme, similar to the bowel, prostate and breast cancer programmes now operating.
“This sort of technology supports a lower cost surveillance system. Melanoma can be dealt with if it is detected early, and it continues to kill 400 people a year, and that rate has not declined over time,” Mitchell said.
