title: Efficacy of smartphone applications in high-risk pigmented lesions.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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'.
  
  
  RESULTS
  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 = -0.01 SE = 0.16; P = 0.97) to slight (κ = 0.16 SE = 0.09; P = 0.12).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dermatology Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ngoo
authors.affiliation: Dermatology Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Finnane
authors.affiliation: Dermatology Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.|Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: McMeniman
authors.affiliation: Dermatology Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tan
authors.affiliation: School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
authors.affiliation: Dermatology Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.|Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: H Peter
authors.initials: HP
authors.lastname: Soyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003880:Dermatology / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008545:Melanoma / Q000145:classification / Q000000981:diagnostic imaging*; D008875:Middle Aged; D063731:Mobile Applications; D015588:Observer Variation; D010781:Photography; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000145:classification / Q000000981:diagnostic imaging*; D000068997:Smartphone
keywords: dermatology; melanoma; smartphone; telehealth