Melanoma Detection in the Digital Age: Total Body Photography

In most cases, the earlier a melanoma is found and treated, the better the patient’s outcome. That’s why learning what to look for, performing monthly self-checks, and getting a clinical skin exam if you are at high risk for melanoma or other skin cancers is so important. During a full-body skin exam, your dermatologist may use a device called a dermatoscope, which combines a flashlight with a microscope to look at moles more closely. Many dermatologists also take photographs to track lesions over time. After identifying a suspicious spot, a dermatologist might suggest removing it outright or taking a biopsy for further testing under a microscope.

However, if you have many moles or your moles display complex or atypical patterns on dermoscopy, detecting new or changing lesions can be very difficult. Total Body Photography, an emerging technology that uses high-definition digital images, can provide a detailed map of your skin that allows your doctor to track existing, new, and changing lesions more easily. 

Total Body Photography is another tool that can help you and your doctor make the most of your clinical skin exam.

Total Body Photography: Taking Detection to New Heights

The purpose of Total Body Photography is to capture high-quality baseline images of your entire body, head to toe, to help your dermatologist track changes over time. Total Body Photography differs from, and is more complex than, simply taking a photo of a lesion and including it as part of a patient’s medical record. For Total Body Photography, high-resolution photos of a patient's entire body are captured and then analyzed using artificial intelligence (AI) systems to help the dermatologist identify new or changing lesions.

“At its core, the idea of Total Body Photography is not new,” explained Andrew Walls, MD, Director of Cutaneous Imaging at the Brigham and Women's Department of Dermatology/Dana-Farber Cancer Center. “Photography has always been a useful tool in dermatology. And as medical records are digitized and AI is being integrated in the process, Total Body Photography is becoming an appealing tool for physicians.”

Not only can Total Body Photography be used to monitor your skin for any changes, it also allows your dermatologist to zoom into any specific lesion of concern, providing immense detail. Many patients find this enhanced visibility comforting and consider Total Body Photography an added layer of protection to their normal skin exam. In addition, Total Body Photography can be used to identify other skin concerns earlier than what is possible with the naked eye alone. 

“Leveraging technology to hone in on our skin, specifically moles, is a vital tool for being proactive in the fight against melanoma and other skin cancers,” explains Matthew Ruiz, a melanoma survivor whose medical team uses Total Body Photography. “Assembling a team is important, and leveraging the latest and greatest technology with that team is empowering for the patient.”

The Challenges and Champions of Total Body Photography

Dr. Walls always wanted to offer his patients Total Body Photography, but implementing it in his clinic was no simple task. Due to the intricate and expensive technology and systems required, acquiring the infrastructure to support Total Body Photography is a challenge for many dermatology clinics. In many cases, outside funding and support is necessary to make this new tool available to patients and to maintain and expand it as the technology evolves.

Additionally, Total Body Photography is not usually covered by insurance. In many cases, this means that the cost is the patient’s responsibility to cover out-of-pocket or by tapping into a health savings or flexible spending account. In other instances, a clinic might secure outside funding to help offset these costs. Either way, making Total Body Photography accessible to all interested patients is an ongoing hurdle for doctors and clinics alike.

As a longtime champion for Total Body Photography, Dr. Walls is currently leading a working group of 25 doctors from across the country who offer the service at their clinic or are in the process of implementing the technology.

“It’s nice to bring everyone together to compare and contrast systems, get feedback on new protocols and processes, and to share the lessons we learn implementing the technology,” explained Dr. Walls. “It’s an educational experience for us as a group to understand how we each are bringing this to patients and battling the various complexities involved.”

Additionally, the working group is drafting a publication detailing the steps and processes a clinic can adopt to launch their own Total Body Photography program. The group hopes the publication will make the innovative tool more broadly available. The group is currently collecting data via surveys looking at the various clinical workflows, financial operations, and logistical challenges across institutions. “The hope is that through this working group, and the data collected, we can create a workable blueprint that other clinics can follow,” said Dr. Walls.

For Dr. Walls, and his peers, Total Body Photography is a useful tool to aid, not replace, dermatologists. Citing a meta-analysis of several studies examining the efficacy of Total Body Photography^1,2, Dr. Walls explains that when Total Body Photography is used, dermatologists are performing fewer biopsies and those they do perform yield a higher ratio of melanoma to benign diagnoses. For patients, this is great news because it means fewer scars and less recovery from unnecessary biopsies while making sure that biopsies that are performed are necessary.

What You Need to Know About Total Body Photography

As the underlaying technology continues to improve, the use of Total Body Photography will likely expand. Dr. Walls hopes that future versions of Total Body Photography technology will require less manual comparison of images (for dermatologists), and that artificial intelligence can better support decision making when it comes to next steps, such as the need to biopsy versus continue close monitoring. Above all else, though, AI has to be reliable and equitable across all skin tones in order for it to be widely adopted.

There is also a hope that as more clinics adopt Total Body Photography, interest from patients will grow, and in turn insurance companies might begin to cover the service. This would help make the technology more affordable for clinics to offer and would make Total Body Photography more accessible for patients in the community. Rather than see these factors as finite roadblocks, Dr. Walls and his colleagues are facing them head on through their efforts to make this a more accessible option to patients.

If you are a patient interested in Total Body Photography, here are some things you should know:

• Not everybody is a candidate for Total Body Photography – your doctor should help determine your eligibility.
• If you are identified as a good candidate for Total Body Photography, plan to have your photos taken shortly thereafter.
• It may be a bit of an awkward experience for you as a patient, but it is very routine for your doctor.
• All of your images will be stored under the highest level of data security.
• As of right now, Total Body Photography is not covered by insurance. Expect an out-of-pocket fee each time new images are taken – unless the clinic has secured outside charitable funds to help offset these costs. Be sure to ask about the fees involved before your photos are taken.
• Total Body Photography is a tool to improve your clinical skin exams. Be sure to continue to see your dermatologist as directed.