The Dot Work of Dermatology & Surgery Clinic's Mole Mapping Machine - Men's Folio
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The Dot Work of Dermatology & Surgery Clinic’s Mole Mapping Machine

  • By Bryan Goh

The Dot Work of Dermatology & Surgery Clinic's Mole Mapping Machine
Designed by Inomed and deployed at the Dermatology & Surgery Clinic, Dr. Evelyn Tay takes us through the Mole Mapping service — a method to analyse, identify and track moles be they malignant or not.

I’d start by asking what is a mole and are they similar to freckles?
Dr Evelyn (DE):
Moles and freckles may look similar but there are some differences. Firstly, moles arise from a deeper layer of the skin compared to freckles. Secondly, freckles are more sensitive to sunexposure. Moles will not go away completely unlike freckles which can completely disappear with avoidance of sun exposure.

The Dot Work of Dermatology & Surgery Clinic's Mole Mapping Machine
How did the idea to create a Mole Mapping machine come about?
Inomed (I): Previously, doctors used two methods to detect suspicious nevi (moles). One was digital serial digital epiluminescencemicroscopy (DELM) photography using dermatoscopes, a laborious process that detects subtle changes in the nevi. The other was total body (TB) photography which involves photographing existing nevi and uninvolved areas of skin for comparison.

TB photography was excellent at detecting new lesions and was time-efficient.However, the resolution of the photograph was at times limited.Canfield developed both the IntelliStudio and D200evo to work in conjunction and assist doctors in taking TB photographs, along with the ability to view and record subtle changes in lesions, while enhancing time efficiency.

How does total body photography help the detection process?
DE:
Total body photography helps us track a patient’s moletopography over time. With a patient with hundreds of moles, it’s not practical to take close-up high-resolution photos of everyone. Whole-body photography enables us to detect the new moles that develop, enabling us to pay closer attention to them.


It also allows us to have a visual snapshot of the moles a patient has at one point in time. So when they come back for follow-up, we can detect any changes in colour, size, or border.

What is the mole mapping procedure like for a patient?
DE: The patient consults with the doctor, who will assess their risk factors and address concerns regarding evolving moles. The doctor then proceeds to do a traditional full-body skin examination. Lesions that need closer attention are then marked out.The patient will then do mole mapping with TB photography; close-up images of moles marked earlier will be taken with adermatoscope.

Images are then analysed by artificial intelligence(AI) software before the doctor decides on the next course of action based on the patient’s history, physical examination, and molemapping data.

The Dot Work of Dermatology & Surgery Clinic's Mole Mapping Machine
What about the post-mapping examination process? Are there warning signs you look out for on the digital imaging system?
DE: The digital imaging system sorts out the lesions based on size and colour and runs it by a database of both benign and malignant skin lesion images. Similar to a physical examination, lesions with heterogeneity of colour, irregular borders, irregular pigment networks, or larger sizes are flagged up

What happens next when a malignant mole is detected?
DE: If a mole is malignant, it needs to be staged properly. Further treatment usually involves surgery. A lymph node biopsy, immunotherapy, orchemotherapy may be required in more advanced cases.

Should changes in a mole’s appearance be a big concern? Or could it be due to environmental factors or the skin/body care products one uses?
DE: Moles can become darker or irritated with sun exposure; they may also change in colour and size with hormonal changes during pregnancy for example.

What can patients do for themselves beyond checking for size, texture, and colour changes?
DE:
Patients with higher risk should carry out preventive measures such as using sunscreen, wearing clothing with Ultraviolet Protection Factor (UPF) when sun exposure is more intense, and avoiding high-risk activities like sun tanning or the usage of sunbeds. Chemo prevention measures such as the consumption of nicotinamide and polypodium leucotomos may be helpful.

The Dot Work of Dermatology & Surgery Clinic's Mole Mapping Machine
How truly accurate is the Mole Mapping machine?
DE: Molemapping has been proven to reduce unnecessary skin biopsies while increasing the detection rate of melanoma should a skin biopsy be performed. As dermatologists who see lots of patients with many moles, it is indeed very helpful to be able to track the moles with photographs across a period instead of relying on one’s memory.

Mole mapping, however, cannot be used on its own to detect skin cancer, it needs to be used in conjunction with a proper skin check conducted by a trained professional such as a dermatologist.Mole mapping is a useful tool in a dermatologist’s armamentarium to monitor high-risk patients.

Do you think teledermatology could ever replace an in-person consultation given its convenience?
DE: 
Telemedicine is an efficient tool for remote medical assistance because of the visibility of most dermatological conditions. Teledermatology can be used by both patients and primary care physicians (GP doctors) to present dermatological conditions to a dermatologist. Teledermatology reduces waiting times and costs, improves access for patients who experience difficulties attending in-person appointments, and decreases appointment cancellations.

The Dot Work of Dermatology & Surgery Clinic's Mole Mapping MachineHowever, we also note that there are aspects that adversely affect teledermatology such as technological barriers (poor internet connection, limited access to platforms etc.) or a lack of technological skills, resulting in the possibility of erroneous diagnoses.Ultimately, teledermatology provides cost-effective consultation for initial and certain follow-up dermatological conditions.

Nevertheless, face-to-face consultations will remain the standard practice to eliminate the shortcomings of teleconsultations.

Considering how fast technology has been moving, what doyou think is the next upgrade for the Mole Mapping machine?
I: The future of most medical technology lies in artificial intelligence, and IntelliStudio is already equipped with an AI-Driven smart lesion analysis tool called DEXI. It’s a ground-breaking scoring system calculated to assist in the diagnosis of suspicious lesions.

Refining the quality and resolution of the pictures taken or increasing the sophistication of the algorithms used in DEXI could be the next upgrade.

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