Researchers say people concerned about potential melanoma should visit a doctor for more sophisticated exams.
Share on PinterestThe “A-B-C-D-E” list is used during a visual exam to check for possible skin cancer lesions. Getty Images
A mere visual inspection may not always be sufficient when it comes to a skin cancer diagnosis.
That’s according to a research team from the University of Birmingham in the U.K., led by Jac Dinnes, PhD, a senior researcher in the university’s Unit of Public Health, Epidemiology and Biostatistics.
The researchers reached their conclusion by conducting 11 reviews of existing research on the accuracy of diagnosing skin cancer.
Their review, published earlier this month, concluded that some of the most common ways people check for possible skin cancer — including visual inspection and smartphone apps — aren’t enough to accurately diagnose the disease.
Skin cancer, which is generally caused by exposure to the sun’s ultraviolet rays, is the most common form of cancer in the United States.
According to a Mayo Clinic study published last year, diagnoses of basal cell carcinoma and squamous cell carcinoma, the two forms of nonmelanoma skin cancers, increased 263 percent and 145 percent respectively between 2000 and 2010.
Dinnes says that with this in mind, it was a good time for her and her team to use their expertise in reviewing existing diagnostic tests.
“With increasing rates of skin cancer and an increasing number of more specialized tests becoming available in primary care and specialist settings, it was a perfect fit really,” Dinnes told Healthline.
With a multitude of ways to detect and treat skin cancer — beginning with visual inspection — the researchers set out to identify the most effective ways for medical professionals to diagnose the disease.
Diagnosis can be tricky
While the first signs of skin cancer (usually an abnormality or growth on the skin) can be visible to the naked eye, this visual once-over isn’t sufficient for adequately identifying all of the problem areas.
For those who aren’t sure what to look out for, the Centers for Disease Control and Prevention (CDC) offers a handy A-B-C-D-E technique.
If you have a lesion, growth, sore or mole, keep an eye on the spot’s asymmetry, border, color, diameter, and evolution.
If the spot is particularly large, changing size, or is jagged or asymmetrical, it’s best to talk to your doctor.
Dinnes says that a primary care physician has better tools than the eyeball test.
“A careful clinical assessment and visual inspection of the suspicious area and of the surrounding skin will be carried out, possibly supplemented by use of a magnifying device called a dermatoscope,” she said.
Dermoscopy is better than a visual inspection alone when it comes to diagnosing skin cancer, but it’s most effective when used by specialists — which may necessitate a referral from a primary care physician.
“Ideally, dermoscopy should be carried out by a clinician with a good level of experience of assessing skin lesions and with appropriate training in using a dermatoscope,” says Dinnes. “In the U.K., this would often involve referral to a specialist dermatologist, but in other countries, especially those with higher rates of skin cancer, primary care practitioners can be well practiced in the use of dermoscopy.”
Dinnes pointed out that there are a couple of specialized tests that can also potentially diagnose skin cancer, but more research and evidence is needed in order to optimize them.
One such technique, reflectance confocal microscopy (RCM) allows clinicians to conduct a noninvasive “virtual biopsy” of the skin. While more research is needed, this technology could become an effective part of a physician’s toolbox.
“In the U.K., further testing beyond the use of dermoscopy is not currently recommended,” noted Dinnes. “We have not found sufficient evidence for other available tests to support any widespread introduction, but would certainly see value in further studies of tests such as RCM in a usual practice setting as opposed to be highly experienced clinicians in specialist settings.”
The field of artificial intelligence also shows promise, but comes with some caveats, said Dinnes.
Because computer-assisted diagnosis relies on comparing lesions with images in a database, it’s only effective if a given patient’s lesion matches up well with an image already on file.
However, Dinnes said, since skin cancer symptoms can vary widely from person to person, artificial intelligence systems are hardly a foolproof diagnosis technique.
Some smartphone apps use a variation of this technology.
While it may be tempting to get an all-clear diagnosis from your phone, it’s best not to entrust an app with your skin health.
“Based on current evidence, we would advise against relying on a smartphone application to assess the level of risk of a new or changing mole being a melanoma,” stresses Dinnes. “There is a high chance that these applications will miss melanomas.”
Ultimately, skin cancer is tricky to diagnose — and keeping on top of the situation requires vigilance.
“At the end of the day, unless a biopsy is done, there is no perfectly accurate test for detecting skin cancer,” said Dinnes. “So anyone who gets a benign diagnosis and who later has continuing concerns about a particular skin lesion should always go back to their doctor for a second opinion.”
The bottom line
A visual examination of a mole or lesion may not be sufficient for a proper diagnosis of skin cancer.
Researchers in the United Kingdom say people concerned about potential melanoma should see a doctor for more specialized exams, including skin biopsies.
They add that new technology such as smartphone apps and artificial intelligence programs haven’t been tested enough and shouldn’t be a primary diagnostic tool.