In a recent letter to the editor of the Journal of the American Academy of Dermatology, Ferrero et al. noted several troubling issues with currently available mobile medical applications designed for dermatological purposes.
Namely, in this case, the authors looked at an app called ‘Skin Scan,’ which was created to help with the identification and management of skin cancer. The authors then used the app against images from UpToDate, the National Cancer Institute, and Fitzpatrick’s Dermatology in General Medicine. In total, they tested the app against 93 images from the aforementioned resources, and found only 10.8% (10/93) were rated as high risk melanomas.
The authors noted that there was a high frequency of ‘unable to analyze,’ results. One issue may have been the fact that the authors were comparing printed images versus live patients lesions; however, their assessment was that this should not have been a barrier to the apps utilization.
What is interesting is that this comes after the recent study in JAMA Dermatology, where several apps were found to have a broad spectrum of sensitivity and specificity, as we have written about before. As we have noted, along with others, the rise of unreviewed mobile medical applications may pose a high risk for patients due to the clinical knowledge they claim to pawn. Could these types of apps that claim to ‘diagnose’ diseases overplay or under identify issues that could place patients at further risk of either testing or relative placation of fears?
What is interesting in this current example, is that ‘Skin Scan’ is no longer available. It seems to be now called SkinVision. While Ferrero and colleagues did their original investigation back in March of 2012, it seems that SkinVision is now set to create a clinical trial in Europe to compare the effectiveness of this app against traditional diagnostic tools, per a statement by their Chief Executive in the Wall Street Journal. This is a good sign, as noted in our earlier articles, because these types of apps need to be reviewed and conducted in studies to demonstrate their appropriateness and applicability.
We are in the ‘Wild West’ phase of mobile technology with very little data to demonstrate usability and integration into daily practice. To move forward, these methods must be tested and reviewed in order to verify their appropriateness as a future standard of care and safety to the population. Otherwise, we are stuck with what is essentially snake oil medicine.
Ferrero NA, Morrell DS, Burkhart CN. Skin scan: a demonstration of the need for FDA regulation of medical apps on iPhone. J Am Acad Dermatol. 2013;68(3):515-6.