An app to look at that mole? Dermatologists advise caution

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While snapping a photo of a suspicious mole with a phone and uploading it to an app might seem like the swiftest way to a diagnosis, dermatologists say users should be wary of such technology, especially when it comes to screening for skin cancer.

Several apps allow users to provide a list of symptoms and an image of their skin, whether it be a changing or an itchy rash, and submit it—for a fee—to an online . That dermatologist can then recommend a cream, provide information on how to watch a benign-looking mole, or suggest making an appointment for an in-person biopsy with a local dermatologist.

The practice is called teledermatology, and it's not only prevalent in smartphone app stores. Dermatologists say this practice is used in their profession, especially in rural or underserved areas where patients don't have the opportunity to visit a dermatologist's office.

But with more apps popping up, doctors warn users to be cautious, even if the convenience is tempting.

"There's a huge spectrum in the apps—this is the problem," said Dr. Carrie Kovarik, associate professor of dermatology at the University of Pennsylvania. "It's difficult to know what's good, what's not, what they do, who's on the other side."

If the app is created by a medical provider, that's usually a good sign, Kovarik said. That way, users can be sure who is on the other side, and if they need a follow-up appointment, the app can connect them.

Many apps "often don't close that loop of care," she said. "If you need to be seen in person, a lot of times those (apps) don't have ability to get you to the next step."

But Dr. Alexander Borve, a California-based who developed one of these apps, called First Derm, said users of his app are able to take feedback from the dermatologists consulting for his product and use it to get an appointment sooner at their local provider. "We are very good at triaging skin conditions."

The app also isn't as daunting for users as going to the doctor, and provides useful information about skin conditions and what to look for, he said.

"When we're not 100% sure, we are very transparent," he said of opinions on suspicious moles. "We recommend you go in, and a dermatologist will take a skin biopsy."

Borve said do not include apps like his in their coverage, but he has kept his prices to around the cost of a co-pay. First Derm services range from about $30 to $60, depending on how fast a user wants results, which can take up to two days, or just hours, he said.

Dr. Elizabeth Fahrenbach, a dermatologist at North Branch Dermatology on the Northwest Side and at Amita Health Resurrection Medical Center, said she's skeptical about using apps, specifically for patients worried about . May is Skin Cancer Awareness Month.

Fahrenbach said that although she appreciates teledermatology in some situations for skin conditions like acne or eczema, she worries it can provide a false sense of security to patients looking to be checked for skin cancer, including melanoma. "It doesn't take the place of a dermatologist."

"Specifically for moles, it makes me nervous. Melanoma can be so varied in its presentation," she said. And the app "relies on the patient to notice an abnormal thing first."

Fahrenbach said that often her patients will come in for a check, worried about a mole or spot they've noticed on their body, but in doing the check, Fahrenbach will notice other things that need to be further examined. "That (mole is) benign, but there's something they didn't even notice."

"That's a pretty common phenomenon; an app isn't going to address that issue," she added. And "it's unrealistic to take a picture of every mole on your body and send it in. You might as well go to the doctor."


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