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Skin exam goes more high-tech

Digital microscopy, widely used in Europe, would benefit people with an above-average risk of melanoma, many U.S. doctors say.

April 30, 2001|By Shari Roan | Los Angeles Times Staff Writer

In medicine, there is perhaps nothing as low-tech as a skin cancer examination. Doctors simply use their naked eyes to scan patients' bodies for signs of trouble.

But a new high-tech method that enhances the ability of the human eye to identify the most serious form of skin cancer is starting to pop up in some dermatologists' offices, including at least three Los Angeles offices. Called digital microscopy, the technology could benefit individuals with an above-average risk of developing melanoma.

Digital microscopy, which is costly and still considered somewhat experimental, is being used by only a few doctors nationwide. Already widely used in Europe, most U.S. doctors say that it could prove to be of enormous benefit to patients who are at higher risk for melanoma because they have a large number of odd-shaped moles.

"It hasn't gained tremendous acceptance in the United States because there hasn't been much evidence that it offers enormous advantage over using your eyes," says Dr. Mark Lebwohl, a New York dermatologist, adding that many doctors are waiting to learn more about the technique before purchasing the equipment.

Los Angeles dermatologist Andrew Kaufman says that digital microscopy is an important advance given the nation's surging rate of melanoma. Since 1981, the incidence rate of melanoma has grown by 3% each year, according to the American Cancer Society. An estimated 51,400 people will be diagnosed with the disease this year.

"We've seen a dramatic increase in melanoma incidence. And digital microscopy is something that can help us identify melanomas at an early stage," says Kaufman, an assistant clinical professor of dermatology at UCLA School of Medicine.

Melanoma is rarely life-threatening if detected early. Survival rates drop dramatically, though, if the cancer has already spread.

With digital microscopy, doctors use a hand-held microscope attached to a camera and computer to take and store pictures of a mole or skin abnormality. The technology is sometimes referred to as digital epiluminescence microscopy.

Once the pictures are scanned into the computer, doctors can magnify them to get a closer look at the skin.

"By magnifying the lesion, it extends the ability of the human eye to identify melanoma," says Dr. Albert Lefkovits, an assistant clinical professor of dermatology at Mt. Sinai School of Medicine in New York.

During a traditional exam, when a doctor finds a suspicious-looking mole--one in which the border, shape, color or texture is unusual--the patient is often advised to have the mole surgically removed to check for cancer.

That recommendation, however, can be impractical for people with a condition called dysplastic nevi, which means they have a lot of atypical moles, says Lefkovits.

"The traditional way, in the hands of an experienced physician, is still pretty good," he says. "However, if you're going to try to pick up every melanoma, you're going to end up doing biopsies on a lot of benign lesions."

Removal of moles during biopsies can also leave scarring.

Digital microscopy can help a doctor refine the exam so that noncancerous moles aren't removed unnecessarily, he says. It can also help a doctor better identify moles that could be cancerous.

"It can show details and small changes in what would have looked like a benign lesion," says Lefkovits.

A 1995 study of digital epiluminescence microscopy found that the tool increased a doctor's ability to accurately diagnose melanoma by 10%--but this was only true for doctors who were trained and experienced in using the technology.

"The person doing the procedure needs to be trained," says Kaufman. "But right now, most [medical student residency programs] don't include training in dermoscopy."

The ability to store the image electronically also gives doctors objective information on whether a mole has changed from year to year.

Obtaining digital images of skin lesions also allows doctors to easily send the images to colleagues for second opinions, says Lefkovits.

Digital microscopy isn't cheap, however. Examinations average from $200 to $400, depending on the number of moles a person has. Health insurers may not cover the exam, which typically takes about 45 minutes. Some experts believe that more insurers will embrace the technology once the evidence is stronger of its ability to detect cancer earlier, and thus reduce the number of unnecessary biopsies.

"It's not necessary to use this technology in all patients," says Kaufman. "A [traditional] exam by a dermatologist is still an excellent method. But people at high risk for melanoma really appreciate having this."

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