THE ROLE OF TOTAL BODY PHOTOGRAPHY IN EARLY MELANOMA DETECTION A literature review

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THE ROLE OF TOTAL BODY PHOTOGRAPHY IN

EARLY MELANOMA DETECTION

A literature review

Student: Ann Praveena Rameshkumar

Supervisor: prof. Skaidra Valiukevičienė

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ABSTRACT

Aim: Cutaneous melanoma (CM) is a malignant neoplasm of melanocytes. The goal of the study is to deduce if the total body photography method can be a standard diagnostic tool for CM, by analyzing recent scientific articles to establish its advantages and disadvantages.

Materials and Methods: Studies were collected from PubMed, NCBI and research Gate &

google scholar in between 2010 to 2020. Articles were excluded during screening and eligibility due to non-English, non-human, last 10 years, age less than 19 years, leaving 4 articles to be included. 5 Articles were further added after google scholar search. The search through Medline was conducted using Key words: total body photography, melanoma skin cancer, and screening. Initial search on PubMed (Medline) gave 49 articles. After the addition of filters (free full text, human, 10 years) 11 articles were identified for analysis. Then, 4 articles were chosen after a full text screen and a further of 5 articles, on a Google Scholar search, were included to write this literature review, giving a total of 9 articles for review.

Results: There were 4 prospective, 2 retrospective, and 1 cross-sectional studies that proved

higher accuracy in diagnosing melanoma using total body photography, an increased rate of melanoma detection, and a decrease in biopsy rates. The remaining 2 retrospective studies discussed the role of total body photography in combination with sequential digital

dermatoscopy imaging and found that it’s highly efficient and has a higher sensitivity compared to using total body photography alone. Sequential digital dermatoscopy imaging allows us to compare images in two different time-lapse but particularly of suspicious lesions, unlike digital dermatoscopy where it instantly captures the lesion for a better vision than naked eye.

Conclusion: Total body photography method has met the criteria to be a standard diagnostic tool

for cutaneous melanoma. However, it did not pass as a screening program due to a few

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SANTRAUKA

Tikslas: Odos melanoma (CM) yra piktybinis melanocitų navikas. Tyrimo tikslas - išsiaiškinti,

ar viso kūno fotografavimo metodas gali būti standartinė CM diagnostikos priemonė,

analizuojant naujausius mokslinius straipsnius, siekiant nustatyti jo pranašumus ir trūkumus.

Medžiaga ir metodai: Tyrimai buvo surinkti iš „PubMed“, NCBI ir „Gate & google“

mokslininko 2010–2020 m. Straipsniai buvo atmetami atrankos ir tinkamumo kriterijais dėl ne angliškų, ne žmonių, paskutinių 10 metų, amžiaus jaunesnių nei 19 metų, paliekant 4 straipsnių įtraukimą. 5 straipsniai buvo papildyti po „google“ mokslininkų paieškos. Paieška per „Medline“ buvo atlikta naudojant raktinius žodžius: viso kūno fotografavimas, melanomos odos vėžys ir atranka. Pradinė paieška „PubMed“ („Medline“) pateikė 49 straipsnius. Pridėjus filtrų (laisvas visas tekstas, žmonėms, 10 metų), analizuoti buvo nustatyta 11 straipsnių. Tada buvo pasirinkti 4 straipsniai po viso teksto ekranu, o dar 5 straipsniai „Google Scholar“ paieškoje buvo įtraukti į šios literatūros apžvalgą, iš viso pateikiant 9 straipsnius.

Rezultatai: Buvo atlikti 4 perspektyvūs, 2 retrospektyvūs ir 1 skerspjūvio tyrimai, kurie įrodė

didesnį melanomos diagnozavimo tikslumą naudojant viso kūno fotografiją, padidėjusį melanomos aptikimo greitį ir biopsijos dažnio sumažėjimą. Likusiuose 2 retrospektyviniuose tyrimuose buvo aptartas viso kūno fotografavimo vaidmuo kartu su nuosekliais skaitmeninės dermatoskopijos vaizdais ir nustatyta, kad jis yra labai efektyvus ir turi didesnį jautrumą, palyginti su viso kūno fotografavimu. Nuoseklus skaitmeninės dermatoskopijos vaizdavimas leidžia mums palyginti vaizdus dviem skirtingais laikotarpiais, bet ypač su įtartinais pažeidimais, skirtingai nuo skaitmeninės dermatoskopijos, kai ji akimirksniu užfiksuoja pažeidimą, kad būtų geresnis regėjimas nei plika akimi.

Išvada: viso kūno fotografavimo metodas atitiko kriterijus būti standartine odos melanomos

diagnostikos priemone. Tačiau dėl kelių apribojimų, tokių kaip finansiniai, privatumo ir logistikos klausimai, jis nebuvo naudojamas kaip atrankos programa. Bendras kūno

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ACKNOWLEDGMENT

I would like to give my sincerest gratitude to my supervisor prof. Skaidra Valiukevičienė for helping me throughout the completion of my master thesis.

CONFLICT OF INTEREST

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LIST OF ABBREVIATIONS

• AMS- atypical mole syndrome

• ATR-FTIR- attenuated total reflectance Fourier transform spectroscopy • CDKN2A- cyclin-dependent kinase inhibitor 2A

• CM- Cutaneous melanoma • DBP - Digital body photography • DD - Digital Dermatoscopy

• DELM - digital epiluminescence microscopy • DFU- Digital fotographic Unit

• FAMMM - Familial atypical multiple mole melanoma • FU – follow up

• IM – invasive melanoma • LN – lymph node

• MDN- Melanocytic dysplastic nevi • MIS – melanoma in situ

• MM- malignant melanoma

• PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses • PSE- Physical self-examination

• SCC- Squamous cell carcinoma

• SDDI - Sequential digital dermatoscopy imaging • SDD- Sequential digital dermatoscopy

• SDI – Sequential digital imaging • SSE- Self skin examination

• TBDP – Total body digital imaging • TBDP- total body digital photography • TBP - Total body photography

• TBSI- Total body skin imaging • US- United states

• UV- Ultra-violet

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INTRODUCTION

Cutaneous melanoma (CM) is an aggressive therapy resistant malignant neoplasm of melanocytes.(1) The most challenging task is to make an earlier diagnosis of CM as the prognosis, survival rate, mortality, & treatment strongly depend on the Breslow thickness.(2)

Among other imaging methods, Total body photography (TBP) is a particularly beneficial screening tool for patients at high risk due to their personal or family history, and for those with multiple dysplastic nevus. Skin biopsy and histopathological confirmation are yet to be replaced, but the evolution and combination of photographic techniques seem to be promising for the diagnosis of melanoma in the future.

TBP provides the photographic record of patient’s entire skin surface, which typically includes 12-24 baseline images of entire skin surface. Newness or change in a lesion may be useful, in starting suspicion of lesions that might not otherwise be suspicious for melanoma. TBP and follow ups demonstrates stability which avoids unnecessary biopsies.

This is going to be a literature review on the role of TBP, and its effectiveness to be used as a standard diagnostic tool in diagnosing CM, and to reduce unnecessary biopsies.

Table 1. Non-invasive methods (mainly imaging) & their role for CM diagnosis.

IMAGING METHODS EFFECTIVENESS

ATR-FTIR spectroscopy (attenuated total reflectance Fourier transform spectroscopy)

Useful tool to diagnose different types of melanomas also to identify metastatic potential of cancer cells (3)(4)

Smart phone imaging applications (E.g: Skin scan)

In a single study = 0% sensitivity and 100% specificity for the detection of melanoma

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to 87%) for the detection of malignant or premalignant lesions.

Accuracy was poorly recommended by experts in 3 studies(5)

Mobile teledermoscopy (Smart phone app attached with dermatoscope attachment)

Ongoing study (sensitivity and specificity of mobile teledermoscopy-enhanced SSE versus naked-eye SSE in consumers at high risk of developing melanoma will be determined at the end of this study) (6) Dermoscopy or digital dermatoscopy Gives magnified and Illuminated images. Globally

recognized technique for the assessment of melanocytic tumors (7)(8). However only 39% sensitivity for <6mm lesions(9).

Automated skin photography (mainly based on color & shape geometry #PH2 dermoscopy)

Smart phone based, classifies images as normal, atypical or melanoma. An alert will be sent if not normal.

96% sensitivity & 80% specificity was recorded. (10) DELM photography (digital epiluminescence

microscopy)

Lower biopsy rates & lower nevus-to-melanoma ratios using TBP detected. (11)

Effectiveness is lesser compared to TBP.

SDDI (sequential digital dermoscopy imaging) Allows detection of melanoma in the absence of dermoscopic evidence of melanoma in four level 2 studies(12). Suspicious lesions are imaged, stored and retrieved for time-lapse comparison.

TBP Includes the whole body. Usually performed in high

risk pts, additionally increases SSE rates. Highly recommended by many studies (13)(14)

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AIMS AND OBJECTIVES

Aim: This literature review aims to get an overview of the total body photography

method and its role in CM diagnosis.

Objectives:

o Analyzing recent data about role of total body photography in diagnostic methods of Cutaneous Melanoma.

o Drawing a brief comparison about diagnostic accuracy of total body photography for early detection of CM.

o Deducing if total body photography can be a standard diagnostic tool in screening high-risk CM patients.

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1. LITERATURE REVIEW

1.1Cutaneous Melanoma

1.1.1 Epidemiology

CM is one of the often-occurring cancers in light skinned population. However, researches continually show that people with dark skin die more from this curable

disease(15)(16). Currently it’s the 6th most common cancer in women, and 5th most common in men in U.S, where the incidence has been rising since 1973 to 2002 by 270% which is 6.8 per 100,000 to 20.1 per 100,000 (17). Colored people often feel that their skin is fully protected against sun rays, which is a wrong conception that leads to late stage diagnosis of melanoma and increase in mortality(18)(19). Australia, Queensland, as well as in New Zealand, have the highest CM incidences recorded during the period of 1998 to 2002.

In Europe, the incidence varies depending on the region. Highest rates have been recorded in Scandinavian countries, meaning its higher in well off countries when compared to the data from Baltic countries (Latvia, Lithuania, Estonia, Belarus, Serbia) (17)(20).

Figure. 1 Estimated age-standardized worldwide incidence of CM in both men and women in

2012

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1.1.2 Risk factors

Sunlight -Ultraviolet (UV) radiation is the main exogenic risk factor in CM development. Its closely connected with the UV level, specifically, to the UV-B spectrum(22).

Additionally, sun exposure patterns and timing have been linked in many studies in association with increased risk of melanoma (1)(23)(24).

Intense and intermittent sun exposure, typically an individual with a history of sun burn, is prone to a greater risk, compared to a chronic continuous moderate pattern which is more frequently associated with actinic keratosis and non-melanoma cutaneous malignancy.(25)

Figure 2. Normal melanocyte to malignant melanoma transformation

As adapted from Leonardi GC (1)

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There is a mixed interaction of exogenous and endogenous [including genetic] risk factors in the development of CM. About 8–12% of familial melanomas fall under the category of mutation in CDKN2A gene that encodes p16 in a familial setting. The CDKN2A gene is also linked between melanoma and other malignancies (e.g. pancreatic cancer)in many studies (28)(29).

Different studies have shown that CM incidence is also correlated with gender. Females are more likely to develop CM compared to men, by approximately 1.5 times according to Markovic et al (30), whereas according to other different studies, prevalence in both sexes must be analyzed in relation with age; where prevalence rate higher in women compared to men until the age of 40 years, yet by the age of 75 years incidence is 3 times higher in men compared to women (31).

Figure 3. Estimated Lifetime risk of cutaneous melanoma in the US from 1930 to a projected

risk in 2020.

As adapted from Prado et al (32)

1.1.2 Histopathological classification

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involvement (N stage), and presence of metastasis (M stage). Majority of melanomas are

diagnosed before LN biopsy or distant metastases occur (N0 and M0 stage). Breslow thickness is a crucial criteria for prognosis assessment and further treatment, including required safety

margins and sentinel lymph node biopsy. Ulceration is another applicable histopathological marker that is independently associated with poor prognosis and is also incorporated in the T staging (35)(36).

1.1.3 Diagnosis

Most often, patients discover their own lesions either by accident or during a deliberate self-skin examination (SSE) by themselves or by their partners(37). In general dermatology practice, clinical evaluation and histopathological confirmation are the most commonly used tools for CM diagnosis. Even though it has been recognized that the clinical diagnosis of CM is often found difficult by naked eye examination(38).

Once a diagnosis is confirmed, since early 1990’s, lymphatic mapping and sentinel lymph node biopsy has been used in the staging of CM patients which is now routinely used as a staging procedure(39).

The successful diagnostic ABCD criteria rules (Asymmetry, Border irregularity, Color variation, large Diameter), clinical examination of the patient skin, and after care follow ups, are routinely utilized by dermatologists around the world for CM diagnosis. However definitive confirmation is only made after histopathological confirmation. A screen study in Schleswig-Holstein, Germany, found that 20 to 55 excisions were performed to diagnose one CM (40). For the past 5 years, TBP and Sequential Digital Dermatoscopy Imaging (SSDI) usage as

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1.2 Total body photography

TBP is an advancing technology that increases patients access to dermatologic care which help in diagnosing melanoma at an early stage, therefore decreasing overall treatment costs(41). Furthermore TBP method will decrease large number of excisions with significant morbidity and nevertheless unnecessary costs(42), while also being proven to be safe in pregnant

women(43)(44).

Patient selection for TBP should reflect the potential benefits of the procedure, including: A) higher sensitivity to diagnose new/changing lesions B) lowering the biopsy rates C) decrease patient anxiety while promoting patient compliance to routine FU and SSE.

Patients who are most likely to benefit from the procedure are those at a greater risk for developing CM (patients at increased risk for CM include those with a personal history of

melanoma, strong family history of melanoma, large numbers of common nevi, and/or dysplastic nevi) those with complex nevus patterns, and those with significant anxiety about their

nevi(45)(46). Like mentioned earlier, patients who refuse to comply with the recommended follow-up are poor candidates for TBP. Not only is it improbable that they will reap the benefits of TBP, they also run the risk of having reduced sensitivity for melanoma detection on the part of their physician at the time of initial evaluation because of conscious or subconscious reliance on the efficacy of follow-up.

Diagnosing CM in patients with multiple or atypical nevi can be challenging even for most skilled dermatologists. Mole mapping is a noninvasive technology used to monitor new or changing melanocytic lesions. TBP & SDDI together are the known digital follow ups.(47)(48)

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TBP are 4 basic poses that capture anterior, right lateral, posterior and left lateral sides of the body.(49)

Figure 5. proposed standard poses for total body photography to optimize whole body surface,

shown by a model

As adapted from Halpern et al (49)

Number of MDN (melanocytic dysplastic nevi) is associated with melanomas & some of them were identified using baseline photographs(45) while some studies concluded that

decreased age , male gender and family history of CM is correlated with biopsy rates after TBP and not the number of melanocytic nevi.(50).98

According to a study made in Barcelona (8), there has been low rate of excisions in the high-risk group of melanoma patients when combining digital dermatoscopy (DD) and digital body photography (DBP), where the method was called as ‘two step method of digital follow up’(8).

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detection strategies, particularly in men aged >60 years, in whom both partial and full-body PSE were associated with thinner tumors.(51)

Table 2. Pros and cons of TBP according to studies done is recent years (42),(13),(14), (52),(53)

Utility of TBP Barriers to the use of TBP

Helps to detect melanoma Logistic constraints

Prevents unnecessary biopsies An inability to magnify the images

Prevents unnecessary biopsies Financial considerations

Improves documentation Medical liability

Decrease rate of benign to malignant excision Inefficient organization

Increase in SSE Privacy concerns

Safe during pregnancy

Excellent visualization of small lesions Increased cost-benefit ratio

Increased record keeping

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2. METHODOLOGY

This systematic review was conducted in accordance with the PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) recommendations to analyze and determine whether or not if the whole-body photography can be a standard diagnostic tool in the screening of early CM and nonmelanoma skin cancer.

Following terms were combined to search in Medline to identify the literature. Total AND OR AND “body” OR “human body “OR “body” AND “photography” OR

“photography”) AND (“skin neoplasms” OR (“skin” AND “neoplasms”) OR “skin neoplasms” OR (“skin” AND “cancer”) OR “skin cancer”) AND (“melanoma” OR “melanoma”) AND (“diagnosis” OR “diagnosis” OR “screening” OR “mass screening” OR (“mass” AND

“screening”) OR “mass screening” OR “screening” OR “early detection of cancer” OR (“early” AND “detection” AND “cancer”) OR “early detection of cancer”) AND (“early diagnosis” OR (“early” AND “diagnosis”) OR “early diagnosis”).

The initial search strategy was conducted in PubMed with the following terms and order: total body photography, melanoma, early diagnosis, and skin cancer. This gave 49 articles. Then the following filters were applied to yield 11 articles: free full text, articles published within the last 10 years, studies conducted on humans, and English language articles. Out of those 11 articles, 4 articles were legible for review. Then, a further of 5 articles were added on a Google Scholar search later. This resulted in a total of 9 articles to be selected in this literature review.

Table 3. Inclusion and Exclusion Criteria.

Inclusion Criteria Exclusion Criteria

Free full text Literature reviews

Published within last 10 years Systematic reviews

Human studies Meta-analysis studies

English language studies Animal or non-human studies High-risk patients for CM (E.g. family

history)

Non-high-risk patients

CM specific Not CM specific studies

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3. RESULTS

Figure 7. Prisma flow chart on articles selection for this literature review

Studies included in the literature review

(n=4)

Total amount of studies included

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Table 7. Summary of 9 articles that were included in the final thesis analysis Year Of

the study

Author of the study

Type of study Mean Age of Patients (in Years) No of patients Underwent TBP

Melanoma confirmed with histopathology after TBP confirmed & overall benefits.

2012 Salerni G et al (8)

Cohort study 37 618 12 groups; DD alone & DD with TBP

but results were not mentioned separately. 12.6% patients were given diagnosis on CM 2019 Drugge et al

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Cross-sectional study 54 218 65 (30%) had at least one malignant lesion

2018 Andrew J. Marek (54)

Randomized controlled trail study

54.3 69 94% satisfaction recorded. SSE rates increased significantly from 58% at baseline to 83% at

6 months

2015 Dengel LT et al (53)

Cohort study - 11 55 easy lesions- (mean lesion size 4.7mm); all visualized, sensitivity 100%

55 difficult lesions- (mean lesion size 3.9mm);54 out of 55 visualized, sensitivity 98% Imaging sessions were scored by the patients;

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Patients satisfaction – 96%

2016 Secker L et al (14)

Cohort study 41 179 31.1% – found this useful

44.7%- neither agreed nor disagreed. 34.8%-led to excision of the mole & 35.7% cases doctor decided not to excise due to no changes in

the TBP 2010 Goodson at el

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Cohort study - 1076 DELM photographs compared with TBP

Total 275 biopsies;

168 (61%) motivated by TBP = 91% proved to be DN, The remaining lesions were: eight pigmented spindle or Spitz nevi, three MIS, and two invasive melanomas.

107 biopsies (39%) no photographic change, primarily biopsied because of patient’s concern- only 2 proved to be melanoma

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hence no TBP Melanoma In situ 44% 31% (IM) 0.33mm 0.83mm

Total of 121 melanomas diagnosed.

TBP influenced the biopsy in 66 of 121 melanomas. As shown in the table median depth was

significantly less in IM when TBP was used (p=0.02).

12 of 121 were identified as new lesions, 11 out of 12 were by TBP (91.6%).

2018 Drugge et al (56)

Cohort study 218 The study found significantly lower numbers of biopsies while comparing with another study by Abssi et al (3.1 vs 12.01), with a similar MIS; INV ratio 1.56;1

2010 Rice et al (57)

Questionnaire type of study 113

dermatology departments

TBP used by – 67% TBDP alone – 33%

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CM: cutaneous melanoma; SSE: self-skin examination; DELM: digital epiluminescence microscopy; DN: dysplastic nevi; MIS: melanoma in situ; TBDP: total body digital photography; IM:invasive melanoma; AMS: atypical mole syndrome; INV:invasive; TBP: total body photography; DD: digital dermoscopy.

AMS patients using TBP were shown to have reduced anxiety

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4. DISCUSSION

Role of TBP in diagnostics methods of melanoma

According to the study made by Salerni et al (8), TBP was included in a two-step method combined with DD to identify melanoma in early stages. The research included high risk patients from a DFU (digital follow up) program which was conducted from 1999 to 2008. Based on 10 of years monitoring in 618 patients, the study showed benefits of combining TBP with digital dermatoscopy (DD), such as early diagnosis of melanoma and significant reduction in biopsy rates. The important limitation was the missing of a control group. Therefore, the ultimate importance of TBP cannot be concluded when it’s not used. Also, the importance of maintaining the follow up with TBP is to identify a new or changing nevi.

From a study made by Puigs et al (58) in October 2007, emerging lesions can be

clinically challenging to be distinguished from a melanocytic nevi even with a dermatoscope due to lack of specific features or criteria. TBP maintains the photographic record of each visit which makes it easier not only to identify the new lesion but to also rule out melanocytic nevi, making it an important tool in early diagnosis of CM and highly useful in identifying new lesions. Another study by drugge et al (16) proved TBP is comprehensive and an efficient method through a cross-sectional study.

Melanoma incidence has been rising globally for the past decades due to the lack of standard screening programs (17) (18)(21). Number of studies have chosen to assess the role of TBP in high risk patients in order to reduce the cost, unnecessary procedures and to be more feasible compared with a mass population screening.

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SSE has been correlated with thinner melanoma diagnosis, which proves again the importance of TBP in diagnosing melanoma at a curable stage.(52) TBP increases the rate of survival by 23% at 10 years when comparing the tumor thicknesses <0.8mm -98%: & >4mm 75%) according to a study by Rayner et al (59).

Determining whether TBP shows a decrease in biopsy rates and increase in melanoma detection rates

A study conducted by Goodson at al (11) compares two photographic (DELM vs TBP) methods in different time-lapses suggests a better pathway towards recognizing an evolving neavi at a curable stage. In general, the study has given us the opportunity to determine whether there is significant decrease in biopsy rate, melanoma detection and melanoma derivation using these methods on top of assessing which method is better. Results concluded the superiority of TBP over DELM photography in relation with decreased biopsy rates and a decrease in nevus-to-melanoma ratios. Nevertheless, it’s also proven to be a time efficient tool despite the resolution of photographs being the only limitation.

Table 8 Summary of study photographic approaches made by Goodson et al. (11)

DELM 1999 to 2004

TBP 2004 to 2009

Average Time at initial visit 30-50 20-30

Average time at FU (FU-follow up) visit, examination, and photo comparison

30-50 10-20

Mean biopsy 1.1 0.59

Melanoma detection rate 1.9% 4.4%

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A brief comparison about diagnostic accuracy of TBP for early detection of CM

According to 3 studies, (57) (59)(60) a combination of TBP & SDDI lets all existing lesions on a patient to be monitored from a macroscopic prospective together with the dermoscopy morphology, which was proven to increase the sensitivity of the diagnosis.

Deducing if TBP can be a standard diagnostic tool in screening high risk CM patients

TBP can be done by a professional photographer, physician, a nurse or by an automated system to diagnose melanoma at a thinner tumor stage (61). A study by Dengel et al (51) with 20 volunteers facilitates adding TBP through automated system as a standard screening tool in everyday clinical practice(53). Same study suggests even with most difficult lesions, visualization (109 of 110 lesions (99%)) was much easier favoring TBP inclusion by a dermatologist in daily clinical practice with minimal challenges such as lightening and positioning.

Study by Rayner et al (59) acknowledges the reduction in patient and physician anxiety through TBP monitoring, by giving an example from another study (62) of 108 patients with a history of melanoma had reduced worry in all scales after undergoing conventional total body digital photography.

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The study by Secker et al (14) included 179 patients out of 311 high risk melanoma patients who performed SSE every 2 months and had standard CSE once/twice every year received the TBP. 75.3% of the participants had >5 atypical nevi and 35.6% had a FAMMM diagnosis. there was a significant correlation between TBP and SSE, and stronger correlation was found for confidence of the patient being able to detect changes in moles themselves which increases the early diagnostic rate remarkably.

Finally, a study made at Utah university of medicine (55) managed to overcome the barrier of missing a control group to compare TBP advantages. They compared two groups of high-risk patients who received TBP but failed to Follow up and those who received TBP and did follow up with SSE and further TBP session.

Table 9. Analysis of melanoma diagnosis and overall survival rate after TBP (55) Patients who received TBP

and did not come for FU (control group)

Patients who received TBP & came for FU

Diagnosis of in situ melanoma 31% 44%

Median depth of invasive melanoma

0.83mm 0.33mm

Influence the decision to biopsy 54.5%

New lesions identification 91.6%

Changing lesions identification 83%

Deaths during this period (2.8%) Equally distributed

Survival analysis Limited to overall and not melanoma specific survival TBP: total body photography; FU: follow up.

The table gives an overall outcome of the study by Jennifer et al which validates; • Higher rate of melanomas detected using TBP.

• Invasive melanomas diagnosed using TBP photographs were thinner than those diagnosed without TBP or FU.

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5. STUDY LIMITATION

The limitations in this study include primarily only two databases (PubMed & Google scholar) search in order to provide this brief overview. Secondarily, one member collected the data, which may have had an impact on articles selection where numerous relevant articles may not have been reviewed or overlooked. Finally the lack of articles on this topic with a control group was the biggest limitation.

6. CONCLUSION

In regard to the already existing skin cancer screenings, finding new, improved, and more efficient methods would surely provide patients with a reliable way to facilitate screening

programs.

There are certain criteria that need to be met when one tries to obtain an optimal diagnostics and screening program. The Role of total body photography in diagnostic of

cutaneous melanoma includes; enhanced accuracy in the early diagnosis of cutaneous melanoma, decrease in unnecessary biopsy rates, increase in self-skin examination, decrease in patient anxiety, a better and more time/cost effective method, and to be available to all individuals regardless of their socio-economic backgrounds.

Accuracy of total body photography in diagnosing cutaneous melanoma is highly sensitive by few studies but what proved to be more effective is the use of total body

photography in combination with sequential digital dermatoscopy imaging; as shown with a higher accuracy in diagnosing cutaneous melanoma. However, more research is required to validate these results when comparing them to the use of total body photography alone. Further it should be noticed that in many of the studies analyzed, the rates of biopsies

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Total body photography has helped to increase the detection rate of cutaneous melanoma. According to the studies by increasing self-skin examination, analyzing photographic change by comparing two different time lapse pictures and by decreasing patient anxiety as they feel more comfortable to visit the physician with the digital photographs in the which also ease them in self skin examination makes the detection rate higher.

Looking back at the results, it is clear that total body photography showed the capability to meet the criteria, albeit with a few limitations. The challenges total body photography

presented with are namely: logistics constraints, financial burden, inefficient organization, and privacy concerns, must be considered as well.

These limitations are important in the potential benefit total body photography carries. For example, a lot of studies documented that follow up by their patients, when compared to patients that did not follow up, was important enough to increase the chances of early detection significantly. Also, the financial situation of one person differs from another; this presents with an obstacle that not many can afford to overcome as total body photography is not a cheap method of screening. These examples could reveal that this tool may not be an ideal screening candidate and that a cheaper, more reliable alternative should be sought after.

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THE ROLE OF TOTAL BODY PHOTOGRAPHY IN EARLY MELANOMA DETECTION A literature review