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Ask the Experts

Finding Melanomas

by Berkeley Wellness  

My dermatologist recently started offering something called MelaFind to help find melanomas. Is it worth the out-of-pocket cost?

It’s hard to say. Though it seems promising, it’s not clear how much benefit this new imaging technology provides beyond a thorough skin exam by a skilled dermatologist to warrant paying $150 to $200 (not covered by insurance). Dermatologists eyeball skin lesions and often also use a magnifier, called a dermoscope, to see them better. But they can miss some melanomas because they look benign in their early stages. MelaFind is supposed to improve the odds that dermatologists will spot melanomas early on, when they are more curable.

Approved by the Food and Drug Administration (FDA) in late 2011 (though not yet available nationwide), this hand-held optical scanner takes images below the skin’s surface to better assess the shape, size, depth and color patterns of suspicious moles. It then uses an algorithm to classify the lesions as “high disorganization” (meaning there is a lot of irregularity and thus a higher chance of cancer) or “low disorganization.” The information can help the doctor decide if a biopsy should be done. It’s not a screening tool to be used on all moles, however.

Preliminary research—funded by the manufacturer and/or done by researchers affiliated with it—suggests that MelaFind improves the rate of melanoma detection. But it also labels some moles as suspicious when they are not melanomas, has a high number of inconclusive results and misses some melanomas. It’s uncertain whether the device detects less common types of melanoma or those on dark skin, and it can’t be used on the palms of hands or soles of feet, lips, genitals, under nails or near the eyes. Overall, its effectiveness in real-life clinical practice isn’t known, and there’s no evidence that its use decreases the number of unnecessary biopsies. The FDA is requiring further study of the device’s safety and effectiveness.

A catch-22 is that your dermatologist has to be suspicious of a mole in the first place to want to image it. And if it looks suspicious enough to image, he or she would likely advise a biopsy no matter what the device shows.

Bottom line: If you have a lot of moles and/or a mole that changes shape, size or color, see an experienced dermatologist. Besides MelaFind, there are other advanced technologies that may be used, such as digital dermoscopy or total body imaging, which track moles over time. None, including MelaFind, are a substitute for good clinical judgment, however.