~ By Professor H. Peter Soyer and Professor Monika Jander , The University of Queensland
The potential for 3D photography to improve melanoma early detection is a topic of increasing interest in the medical community.
With skin cancer rates rising globally, there is a push to develop more advanced and efficient diagnostic tools. One such tool is 3D total body photography, which is a machine that contains 92 cameras and conducts a full photograph of the skin surface area. It has the potential to improve how we look for melanoma and other skin cancers, particularly in high-risk populations.
In a first-of-its-kind study , we looked into the potential benefits and drawbacks of adding 3D imaging to conventional skin cancer checks.
A randomised controlled trial compared how effective 3D total body photography was when added to routine skin checks people were already receiving.
We monitored 315 high-risk patients over 2 years and looked at how this technology worked in a tele-dermatology environment, where a dermatologist reviews images remotely.
Patients in the study's intervention group underwent 3D total body photography in Brisbane, which created a digital 3D avatar of their skin surface. Lesions detected were added to their profile. A senior dermatologist remotely reviewed these images and would refer any suspicious lesions to the patient's treating physician for further treatment.
Tele-dermatology is becoming an essential tool for remotely monitoring patients, and it was important for us to test whether this new technology could fit into that model to improve health outcomes.
What the study found
By introducing 3D total body photography as an add-on to usual care, we ensured that patients in both the control and intervention groups had access to traditional, trusted methods of skin cancer monitoring.
- Non-melanoma skin cancer
Patients who underwent 3D imaging in addition to their regular skin checks recorded a higher number of non-melanoma skin cancers such as basal cell carcinomas and squamous cell carcinomas than patients in the intervention group.
This is not what we expected, but on further analysis, we concluded that the enhanced technology meant more health professionals (including junior clinicians and tele-dermatologists) were analysing the images, in addition to the usual care, which led to more lesions being identified.
The 3D photography technology allows health professionals to track new moles or any changes in size or colour over time. As doctors, if there are changes we tend to err on the side of caution and recommend excision.
Rates of keratinocytes - which are a non-melanoma skin cancer - in the Australian population are very high, due to their link to UV exposure. Approximately 69% of Australians will be diagnosed with a keratinocyte skin cancer in their lifetime. This is why this type of technology and improving skin cancer monitoring is crucial.
- Melanoma
Interestingly, despite the increased number of excisions, the researchers did not observe a significant difference in the number of melanomas detected between the intervention and control groups.
There may be some concerns that this extra technology could lead to overdiagnosis and skin procedures, but it is important to note that the benign-to-malignant removal rates were the same between the invention and control groups.
This means that 3D total body photography didn't necessarily lead to a higher number of incorrectly diagnosed cases, but resulted in more thorough examinations and more skin cancers being found.
What this means for future skin cancer screening
The study findings suggest that while 3D total body photography could be useful in identifying more suspicious lesions, more research is needed on its role in the diagnostic pathway.
We now have some valuable insights into the use of 3D imaging in tele-dermatology. Further research is needed before 3D total body photography can be widely recommended as part of routine skin cancer screening. This further research includes longer and larger clinical trials, along with studies involving larger, more diverse populations. This study also opens the doors to research into the role artificial intelligence (AI) could play in skin cancer monitoring and treatment.
AI has the potential to improve skin cancer screening by automatically identifying suspicious lesions, tracking changes over time, and helping clinicians prioritise the highest-risk cases. Incorporating AI could reduce clinician workload and lower the rate of unnecessary excisions, but this needs to be tested in larger, prospective studies.
What needs further work
This study had some limitations. The patients' healthcare providers ultimately decided the further management of the patient, but we did not provide the 3D skin cancer images to track changes over time to them.
We see a need for 3D total-body photography to be incorporated directly into a patient's regular care, rather than being offered as an additional service. Further studies into this will help us more accurately assess the impact of this new technology.
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