A Simple Method to Monitor Skin Cancer

1 Leela Sayed, MRCS, MBChB, BSc Plastic Surgery Department University Hospitals of Leicester Leicester Royal Infirmary Infirmary Square, Leicester, England [email protected] Nadeem Akhtar, FRCS Plas, MRCS, MBChB, BSc Plastic Surgery Department University Hospitals of Leicester Leicester Royal Infirmary Infirmary Square, Leicester, England Sir: I 2011, 102,628 new cases of nonmelanoma skin cancers and 13,348 new cases of melanoma were registered in the United Kingdom. With the advent of cheaper foreign holidays and frequent use of sun beds, the increased ultraviolet exposure has brought about a 4-fold increase in the rates of malignant melanoma since the mid-1970s.1 Skin cancers on the face, limbs, and anterior trunk are often easily identifiable by patients themselves; however, those that are present on the back of the neck, posterior trunk, and buttocks tend to be incidental findings by friends, family, or the clinician during a routine check-up. Consequently, the patient is unable to inform the clinician whether there have been any characteristic changes in the lesion and over what time scale they have occurred. An additional dilemma also arises when deciding the best management plan for the patient with multiple potentially cancerous lesions. The diagnostic options include excision biopsy, incision biopsy, or close surveillance for change in clinical features. We propose the use of patient self-photography as an aid to those that fall into the close surveillance category. Most patients or friends and family of patients have access to a digital camera or a smartphone that can be used to take photographs of the lesion(s). The photograph can then be taken to the next planned consultation with the specialist dermatologist or plastic surgeon to be objectively assessed and monitored for changes. This may help with the decision for surgical intervention for diagnostic purposes or evidence of recurrence of a previously excised skin cancer. An additional adjunct to simple photography can be to use a smartphone application. The National Health Service supports the application “mole monitor” as it claims to map skin lesions on a 3D body model, use comparison tools to track changes in the lesions, and notify you when it is time for the next photograph. Using an application for tracking multiple skin lesions may be a more precise method of cataloging multiple lesions when compared with simple photography alone. Patient self-photography reduces problems with confidentiality and data protection as the patients store the photographs themselves. However, by actively involving patients in the process of surveillance, it must be emphasized that information acquired from the Internet or the smartphone application should not be used as a replacement for specialist consultation.2 Furthermore, they need to be educated about what signs/symptoms and changes warrant seeking expert advice sooner than planned. For the specialist, patient self-photography may act as an objective indicator of active change of the potentially cancerous skin lesion(s), and for patients, this may act as a simple and inexpensive method of active involvement in their own health.