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MelaFind in Practice:
Real-Time Insights
MelaFind helps dermatologists to be more accurate, but it also serves the dual function of
preventing unnecessary biopsies.
By Gary Goldenberg, MD
E
arly detection of melanoma is critical for securing
appropriate treatment. While a number of potential
therapies are currently under investigation to treat
melanoma at varying stages, several advancements in
technology offer clinicians significant new ways of approaching melanoma in both the detection and biopsy phases.
Of these technologies, the device that has perhaps gained
the most prominence is MelaFind (MELA Sciences). Since
its FDA clearance in 2011, MelaFind has been the source of
robust discussion and debate. During that time it has shown
to be an extremely valuable device, if used and approached
appropriately. Ahead, I will discuss the utility of MelaFind
from the perspective of my experience using the device in
my own practice.
The Science of Melanoma
Detection Technology
MelaFind is meant to complement a skilled physician’s
process for detection of early melanoma. Instead of performing painful biopsies on areas that contain abnormal
pigmentation, MelaFind allows for the requisition of actual
quantitative data concerning a lesion. It gains feedback via
light inputs, which are then processed by an algorithm.
This provides clinicians with an enlarged detailed image
of the area in conjunction with various quantitative data
concerning cellular disorganization. Ultrasensitive lenses
and sensors are used to detect light scatter, and within
seconds a 3D anatomical map of the lesion is calculated.
Importantly, MelaFind is not a
diagnostic tool, but is rather used
for its ability to deliver valuable
additional information for a more
informed decision concerning
possible melanoma developments.
MelaFind can penetrate up to 2.5mm into the skin surface,
making it capable of being used virtually anywhere on the
skin while providing extremely accurate data that helps
to distinguish between melanoma and other types of skin
lesions.
MelaFind is painless for the patient and requires virtually no pre-procedure preparation. Alcohol is applied to
the targeted areas, and the MelaFind handheld applicator
is used directly on the skin. MelaFind works by pulsing a
series of 10 different wavelengths of light, precisely measuring the spectral output of the lesion, providing completely
objective data about the physical makeup of the lesion.
Importantly, MelaFind is not a diagnostic tool, but is rather
used for its ability to deliver valuable additional information for a more informed decision concerning possible
melanoma developments.
May 2013
PRACTICAL DERMATOLOGY 25
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Perception and Approach
As with any new technology, several assumptions and preconceptions have taken hold in the medical community
about MelaFind. Therefore, before discussing how I use
this machine in practice, it may be helpful to address some
of these views. For example, there seems to be a perception that MelaFind, by its design, displaces the diagnostic
capacities of the dermatologist. This, however, is misrepresentative of MelaFind’s capabilities. It bears reiterating
that MelaFind is not a diagnostic device. Rather, it is an
aid that can be used in particular situations that can help
dermatologists decide when to biopsy and when not to
biopsy. Thus, MelaFind is similar to dermoscopy, in that it
is a tool that helps you be more accurate. It’s not designed
to be used for the most obvious lesions or benign growths.
In fact, a study comparing the use of MelaFind among
family practitioners and dermatologists showed that dermatologists were still better at diagnosing melanomas than
family doctors.1 These findings underscore the reality that
MelaFind is an aid; a tool in the diagnosis of melanoma,
not a means of diagnosis.
MelaFind is most useful in situations wherein the clinician is unsure about a particular lesion. Results from a
MelaFind scan will lend greater assurance to the decision
of whether to biopsy the lesion or keep a watch for future
visits. It is also useful when you have a patient with a large
number of moles. In this situation, there are some moles
that you will look at and know that you need to biopsy,
as well as some moles that are obviously benign. But for
moles that are somewhere in between, you can use dermoscopy as well as MelaFind, both of which will aid in the
decision-making process.
When it comes to the utility of MelaFind, perception
and approach make all the difference. It is not only unfair
to hold MelaFind to an absolute diagnostic standard, but
it is also a misunderstanding of the device and its function.
Another faulty understanding of MelaFind is to compare
it to clinical photography. Photography allows clinicians
to follow a lesion over time, not only to see if it’s changed,
but also to see if there is anything new. By contrast,
MelaFind provides important information about a lesion
at the moment. In the end, the clinician is still making the
call to biopsy a mole or not, but the MelaFind device provides an in-the-moment analysis that can determine the
relative likelihood that a lesion is malignant.
MelaFind in Practice
When it comes to how MelaFind is incorporated into
practice, there are many different avenues one can take. I
have two devices in practice, and I perform the procedure
myself. When a patient is in for a full skin check, I will
26 PRACTICAL DERMATOLOGY
May 2013
biopsy the moles I am worried about. For any moles that
are ambiguous, we will schedule the patient for a specific
MelaFind appointment.
During these MelaFind appointments, after the patient
is undressed, I examine the patient along with my nurse
and we select up to five lesions to scan with MelaFind.
Originally the MelaFind card would only allow up to five
scans in a visit. Now it allows more, but as a matter of
comfort, I will only scan up to five lesions. The reason
for this is that if a larger number of moles all come back
as high-risk for malignancy, we would have to perform
many biopsies in one visit. The general rule with deciding
which moles to scan: if I scan it, I’m not worried about it
enough to biopsy the mole without the MelaFind scan.
If the scan results come back high, I will then biopsy the
lesion. If the risk is low, we can keep a watch on that particular mole and perhaps scan it again on a future visit. If,
on the other hand, I am worried about a specific mole and
the MelaFind says the malignancy risk is low, I would still
biopsy the lesion.
In my practice, I tend to use MelaFind only when I am
less certain about a particular mole. To use the device too
much is essentially undermining its function. MelaFind
helps us to be more accurate, but it also serves the dual
function of preventing unnecessary biopsies. It is designed
such that it will provide more false positives than false
negatives, so in instances where you do not need a
MelaFind to be worried, the better option is always to
biopsy.
Another Piece of Evidence
MelaFind has a great deal of utility in dermatology practices, however the perception of that utility can be a matter
of context. Diagnosing skin cancer is a nuanced process,
and a device such as MelaFind aids in clarifying some of
the gray areas, by providing real-time data that may lend
greater assurance to the decision to biopsy or not. How one
approaches and thus applies this device is key, however.
Neither MelaFind nor any device can replace clinical skills.
Rather, MelaFind is designed to function in conjunction
with clinical skills. The data it provides function as more evidence that clinicians can use in aiding the critical decisions
on a direction to pursue when it comes to potentially malignant melanoma. n
Gary Goldenberg, MD is an Assistant Professor
of Dermatology and Pathology at the Mount Sinai
School of Medicine Departments of Dermatology
and Pathology.
1. http://clinicaltrials.gov/show/NCT01011153