On the crowded front of melanoma research and treatment, detection and imaging technology remains an integral piece. That's because it allows clinicians to be more selective about what lesions to biopsy. Of these technologies, MelaFind has been the source of robust discussion and debate since it was cleared by the FDA in 2011. During that time it has shown to be a valuable device, if used and approached appropriately. Moreover, recent advancements in the interface have made the technology more user-friendly and accessible to clinicians. Ahead I will share pearls about the utility of this detection technology and how the new interface will be a benefit to dermatologists.
THE UTILITY OF DETECTION TECHNOLOGY
MelaFind works by pulsing a series of 10 different wavelengths of light, precisely measuring the spectral output of the lesion, providing completely objective data about the physical makeup of the lesion. It delivers valuable additional information for a more informed decision concerning possible melanoma developments. However, MelaFind is not a diagnostic tool, nor does it displace the diagnostic capacities of the dermatologist. It provides an in-themoment analysis that can determine the relative likelihood that a lesion is malignant and whether to biopsy. Unlike clinical photography, which allows clinicians to follow a lesion over time, not only to see if it's changed, but also to see if there is anything new, MelaFind provides important information about a lesion at the moment. The clinician must ultimately decide on whether to biopsy the mole or not. In this vein, it is more similar to the dermoscopy, in that it is a tool that helps you be more accurate for difficult lesions.
MelaFind is most useful in situations wherein the clinician is unsure about a particular lesion. Results from a MelaFind scan will lend greater assurance to the decision of whether to biopsy the lesion or keep a watch for future visits.
It is not designed for the most obvious lesions or benign growths. In fact, a study comparing the use of MelaFind among family practitioners and dermatologists showed that dermatologists were still better at diagnosing melanomas than family doctors.1 These findings underscore the reality that MelaFind is an aid for—not a means of—diagnosis.
MelaFind is also useful when you have a patient with a large number of moles. In this situation, there are some moles that you will look at and know that you need to biopsy, as well as some moles that are obviously benign. But for moles that are somewhere in between, you can use dermoscopy as well as MelaFind, both of which will aid in the decision-making process.
Although melanoma detection technology (when used appropriately) offers several advantages to clinicians, the technology itself is still in its infancy and is likely to grow and develop in coming years. One example of this is the recent introduction of MelaFind's new interface. While the basic function of MelaFind remains the same, the new interface changes how physicians interact with and use the technology by allowing for a more fluid operation of the device. Essentially, the interface offers feedback in a way that's easier to interpret for physicians and easier to understand for patients.
Recently, MELA introduced its new “Smart Data” feature, which breaks down melanoma risk into two simple categories (rather than a numerical score). Density curves (see Figure 1) show the distribution of lesions in the pivotal study by classifier score and frequency, with a red curve representing histologically malignant and a blue curve representing all other not included in the red curve. Malignant curves have higher average scores than “other” curves. When the MelaFind device is used, a green vertical line offers the physicians a sense of malignancy risk. On the probability curve (see Figure 2), the line displays probability of a classifier score being either melanoma or melanoma/ high grade lesion.
Overall, the new interface makes it easy for physicians not only to interpret the risk of melanoma but to then explain it to patients in a way they understand. This, in turn, makes the device more valuable, because otherwise patients may not understand why you are deciding to biopsy certain lesions and not others.
TIPS FOR USING MELAFIND
I have used the MelaFind device for several years now in my practice, and as with any other device, there are certain ways of maximizing its potential. For example, I have found that it is best to not scan more than five lesions in one appointment. The device allows more, but it's important to place limits, because overuse of the device tends to diminish its use. MelaFind should be use in the hardest-to- read lesions. Moreover, if a larger number of moles all come back as high-risk for malignancy, we would have to perform many biopsies in one visit.
Another general rule on what to scan is: If you scan it, then you're worried enough about it to biopsy the mole without a scan. If the scan results come back high, you can then biopsy the lesion. If the risk is low, you can keep a watch on that particular mole and perhaps scan it again on a future visit. If, on the other hand, you are concerned about a specific mole and the MelaFind says the malignancy risk for the lesion is low, it is probably still best to biopsy the lesion.
MelaFind is most useful in cases of uncertainty. MelaFind helps us to be more accurate, but it also serves the dual function of preventing unnecessary biopsies. It is designed such that it will provide more false positives than false negatives.
Diagnosing skin cancer is a nuanced process. Melanoma detection technology aids in clarifying some of the gray areas by providing real-time data that may lend greater assurance to the decision to biopsy or not. The data MelaFind provides function as evidence that clinicians can use in aiding the critical decisions regarding potentially malignant melanoma. Now that it is equipped with a user-friendly interface, both physicians and patients can get more out of the MelaFind device. While the interface upgrade does not alter the clinical benefit of the device itself, it offers perspective to patients and also clinicians on why a device like MelaFind is an important tool in the detection and treatment of melanoma.
No device can replace clinical skills. However, certain devices, like MelaFind, function in conjunction with clinical skills and thus offer great clinical benefit. Therefore, to have a device that improves the accuracy and efficiency with which we detect melanomas is a great benefit to our patients and to our field.
Gary Goldenberg, MD is an Assistant Professor of Dermatology and Pathology at the Mount Sinai School of Medicine Departments of Dermatology and Pathology.