Fighting melanoma with smartphones: a snapshot of where we are a decade after app stores opened their doors

Background: Smartphone applications (“apps”) exist for primary and secondary prevention of melanoma. Our aim was to review currently available apps for community, patient and generalist clinician users. Design: Prospective study, April 2017 – May 2017. Main outcomes: Appropriate apps available to Android and Apple smartphones were assessed in regards to app specific information (target user, cost, store rating, last update), functions offered and clinician, professional or scientific input and or peer review. Comparison was made with a similar 2014 review of the app market. Results: 43 apps meeting inclusion criteria were found. Compared to 2014, 24 of 43 (55.8%) were new, and apps performing automated image analysis declined from 46.1% to 23.3% market share. 23 of 43 (53.4%) were free to download, 48.8% (n = 20) required payments of some form. The most common functionality was monitoring/tracking with 24 of 43 (55.8%) apps performing this. 15 of 43 apps (34.9%) reported clinician, professional or scientific input; in 2014 it was only 4 of 39 (10.3%). 2 of 43 apps (5%) mentioned peer-reviewed evidence along with professional input. Not all apps had ratings. On Android 20 of 22 apps had ratings; average app rating was 3.5, range 1.6 to 4.6. On Apple, 13 of 13 had ratings; average rating was 3.5; range 1– 5. Conclusions: Since 2014 there have been an expanding and changing landscape of apps targeting melanoma diagnosis. There remains a lack of evidence backing their efficacy. This is concerning given their public availability and the gravity of their subject matter

Medical Selfies: Emotional Impacts and Practical Challenges

Medical images taken with mobile phones by patients, i.e. medical selfies, allow screening, monitoring and diagnosis of skin lesions. While mobile teledermatology can provide good diagnostic accuracy for skin tumours, there is little research about emotional and physical aspects when taking medical selfies of body parts. We conducted a survey with 100 participants and a qualitative study with twelve participants, in which they took images of eight body parts including intimate areas. Participants had difficulties taking medical selfies of their shoulder blades and buttocks. For the genitals, they prefer to visit a doctor rather than sending images. Taking the images triggered privacy concerns, memories of past experiences with body parts and raised awareness of the bodily medical state. We present recommendations for the design of mobile apps to address the usability and emotional impacts of taking medical selfies

Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre

Background: Rectal cancer treatment outcomes for socioeconomically disadvantaged and regional patients have been suggested to be suboptimal in Australia. We investigate outcomes at a regional tertiary centre in order to determine the prognostic impact of patient and treatment factors. Methods: Patients who underwent short and long course neoadjuvant therapy followed by surgery for stage II–III rectal cancer over an 11‐year period were identified. Results were analysed to determine oncological and surgical outcomes along with whether patient and treatment‐related variables were prognostic. Accessibility/Remoteness Index of Australia (ARIA) and Index of Relative Socioeconomic Disadvantage (IRSD) was used to determine remoteness and socioeconomic status, respectively. Results: A total of 207 patients underwent short (n = 103, 49.8%) and long course (n = 104, 50.2%) over the time period; 81.6% (n = 169) were from outer regional, remote or very remote communities and 55.1% travelled >200 km for treatment; 57.0% were in the most disadvantaged three IRSD deciles. Five‐year cancer‐specific survival, recurrence‐free survival and local recurrence were 83.1% (n = 172), 76.3% (n = 158) and 7.3% (n = 15), respectively. Wound complications were higher in outer regional, remote or very remote patients (25.4% versus 13.2%, P = 0.03). Remoteness, socioeconomic indices, distance to treatment and neoadjuvant type were not prognostic for any other oncological or surgical outcomes on univariate or multivariate analysis. Conclusions: Despite demography suggesting geographic and socioeconomic barriers, oncological and surgical outcomes at our regional centre were comparable to international and Australian trials. Further, these factors were not prognostic. Geographically remote patient's may safely have neoadjuvant modality individualized without compromising care

Traumatic pulmonary pseudocysts mimicking a congenital malformation of the lung

Traumatic Pulmonary Pseudocysts (TPPs) are a rare consequence of thoracic trauma that is seen disproportionately in young adults and paediatric populations. In this case report, we detail a case of a TPP initially misdiagnosed on imaging as a Congenital Cystic Adenomatoid Malformation (CCAM). Conservative management and monitoring for resolution of TPP is highly effective as in most cases it self-resolves without issue or need for intervention. This contrasts with the surgical treatment often indicated for symptomatic CCAMs. Clearly, failure to recognize TPP as a rare but important differential of pulmonary cystic lesions in the context of trauma can lead to significant distress for the patient's family, over investigation and unnecessary or harmful interventions. We also review in this article the literature surrounding the radiological appearances, clinical features and management of both conditions

Efficacy of smartphone applications in high-risk pigmented lesions

Melanoma apps are smartphone applications that assess risk of pigmented lesions using a smartphone camera and underlying algorithm. We aimed to assess the capability of melanoma smartphone applications (apps) in making clinical decisions about risk, compared with lesion assessment by specialist trained dermatologists.A prospective study of 3 melanoma apps was conducted between 2015 and 2016, recruiting 30 patients with 57 pigmented lesions. Risk categories assigned by the apps were compared with the clinical decisions of two consultant dermatologists classifying lesions as 'suspicious' or 'benign'.Of the 42 lesions deemed clinically suspicious to a dermatologist, from 9 to 26 were classified as suspicious by the apps; of the 15 clinically benign lesions 3 to 15 were correctly classified as benign by the apps. The apps' sensitivity and specificity ranged from 21 to 72% and 27 to 100.0%, respectively, when compared with the specialists' decisions. Two apps were unable to analyse 14 and 18% of lesions submitted, respectively. Interrater agreement between dermatologists and apps was poor (κ\ua0=\ua0-0.01 SE\ua0=\ua00.16; P\ua0=\ua00.97) to slight (κ\ua0=\ua00.16 SE\ua0=\ua00.09; P\ua0=\ua00.12).None of the melanoma apps tested had high enough agreement with the dermatologist's clinical opinion to be considered to provide additional benefit to patients in assessing their skin for high-risk pigmented lesions. The low sensitivity in detecting lesions that are suspicious to a trained specialist may mean false reassurance is being given to patients. Development of highly sensitive and specific melanoma apps remains a work in progress