Many dermatologists use nevus photography, or mole mapping, to follow atypical nevi, and some consider it the standard of care. In fact, huge display booths of mole mapping equipment manufactures can be found at most large dermatology meetings, such as the American Academy of Dermatology’s Annual Meeting. Despite these trends, three questions need to be answered before dermatologists can adopt mole mapping as the standard of care.
1. Is there any evidence that mole mapping helps our patients — have there been any prospective, randomized controlled trials to show that mole mapping helps to detect malignant melanoma early and increases patient survival?
A recent study by Weinstock and colleagues examined the use of mole mapping diagrams to increase skin self-examination accuracy and showed that such diagrams may improve the accuracy of skin self-examination.1 This study is particularly important since Lew and colleagues showed that medical care providers discover only approximately 25% of malignant melanomas while patients and their family members discover approximately 50% and 20%, respectively.2
A study by Marghoob and colleagues retrospectively reviewed 576 patient records and identified a total of 12 patients who had malignant melanoma diagnosed with photographic assistance.3 But do these data really represent enough evidence to suggest that mole mapping is the standard of care?
2. If mole mapping is the standard of care, then who will pay for it?
Mole mapping isn’t free and it may not be cheap. While at a conference, I discussed the issue of cost with a sales representative of a company that markets mole mapping software. The representative simply said to charge the patients out-of-pocket. She also mentioned that the national rate varies between $300 and $500 per mole mapping session. It seems to me that only a small percentage of our patients would be able to afford this “luxury.”
One could certainly simply purchase an inexpensive digital camera for office photography, but there are costs associated with this as well.
If mole mapping is truly a standard of care, then shouldn’t insurance cover the associated cost? Or, is this just another service that we are expected to provide for free?
3. Are there any medical-legal pitfalls for dermatologists who employ nevus photography routinely?
Let’s evaluate the following scenario: a dermatologist is following a patient with clinically atypical nevi using mole mapping. If this patient develops a malignant melanoma, could a plaintiff’s attorney claim that if this patient’s “atypical nevus” was removed earlier, this patient would have never developed a malignant melanoma in this lesion? Sure, we can’t remove all of our patients’ nevi, but now there is proof (a high-resolution photograph) clearly showing that this lesion was “atypical” from the very beginning!
It would be difficult for any expert witness to deny that the lesion in question is clinically atypical, especially when the photograph in the courtroom will be blown up to 4 by 6 feet.
Standard of Care?
Our job is to do what’s best for our patients. While I think nevus photography may be useful, I believe it’s wrong to claim that mole mapping is the standard of care, since it implicates that those dermatologists who do not routinely employ mole mapping practice below the level at which the average provider in a given community would practice.
Many dermatologists use nevus photography, or mole mapping, to follow atypical nevi, and some consider it the standard of care. In fact, huge display booths of mole mapping equipment manufactures can be found at most large dermatology meetings, such as the American Academy of Dermatology’s Annual Meeting. Despite these trends, three questions need to be answered before dermatologists can adopt mole mapping as the standard of care.
1. Is there any evidence that mole mapping helps our patients — have there been any prospective, randomized controlled trials to show that mole mapping helps to detect malignant melanoma early and increases patient survival?
A recent study by Weinstock and colleagues examined the use of mole mapping diagrams to increase skin self-examination accuracy and showed that such diagrams may improve the accuracy of skin self-examination.1 This study is particularly important since Lew and colleagues showed that medical care providers discover only approximately 25% of malignant melanomas while patients and their family members discover approximately 50% and 20%, respectively.2
A study by Marghoob and colleagues retrospectively reviewed 576 patient records and identified a total of 12 patients who had malignant melanoma diagnosed with photographic assistance.3 But do these data really represent enough evidence to suggest that mole mapping is the standard of care?
2. If mole mapping is the standard of care, then who will pay for it?
Mole mapping isn’t free and it may not be cheap. While at a conference, I discussed the issue of cost with a sales representative of a company that markets mole mapping software. The representative simply said to charge the patients out-of-pocket. She also mentioned that the national rate varies between $300 and $500 per mole mapping session. It seems to me that only a small percentage of our patients would be able to afford this “luxury.”
One could certainly simply purchase an inexpensive digital camera for office photography, but there are costs associated with this as well.
If mole mapping is truly a standard of care, then shouldn’t insurance cover the associated cost? Or, is this just another service that we are expected to provide for free?
3. Are there any medical-legal pitfalls for dermatologists who employ nevus photography routinely?
Let’s evaluate the following scenario: a dermatologist is following a patient with clinically atypical nevi using mole mapping. If this patient develops a malignant melanoma, could a plaintiff’s attorney claim that if this patient’s “atypical nevus” was removed earlier, this patient would have never developed a malignant melanoma in this lesion? Sure, we can’t remove all of our patients’ nevi, but now there is proof (a high-resolution photograph) clearly showing that this lesion was “atypical” from the very beginning!
It would be difficult for any expert witness to deny that the lesion in question is clinically atypical, especially when the photograph in the courtroom will be blown up to 4 by 6 feet.
Standard of Care?
Our job is to do what’s best for our patients. While I think nevus photography may be useful, I believe it’s wrong to claim that mole mapping is the standard of care, since it implicates that those dermatologists who do not routinely employ mole mapping practice below the level at which the average provider in a given community would practice.
Many dermatologists use nevus photography, or mole mapping, to follow atypical nevi, and some consider it the standard of care. In fact, huge display booths of mole mapping equipment manufactures can be found at most large dermatology meetings, such as the American Academy of Dermatology’s Annual Meeting. Despite these trends, three questions need to be answered before dermatologists can adopt mole mapping as the standard of care.
1. Is there any evidence that mole mapping helps our patients — have there been any prospective, randomized controlled trials to show that mole mapping helps to detect malignant melanoma early and increases patient survival?
A recent study by Weinstock and colleagues examined the use of mole mapping diagrams to increase skin self-examination accuracy and showed that such diagrams may improve the accuracy of skin self-examination.1 This study is particularly important since Lew and colleagues showed that medical care providers discover only approximately 25% of malignant melanomas while patients and their family members discover approximately 50% and 20%, respectively.2
A study by Marghoob and colleagues retrospectively reviewed 576 patient records and identified a total of 12 patients who had malignant melanoma diagnosed with photographic assistance.3 But do these data really represent enough evidence to suggest that mole mapping is the standard of care?
2. If mole mapping is the standard of care, then who will pay for it?
Mole mapping isn’t free and it may not be cheap. While at a conference, I discussed the issue of cost with a sales representative of a company that markets mole mapping software. The representative simply said to charge the patients out-of-pocket. She also mentioned that the national rate varies between $300 and $500 per mole mapping session. It seems to me that only a small percentage of our patients would be able to afford this “luxury.”
One could certainly simply purchase an inexpensive digital camera for office photography, but there are costs associated with this as well.
If mole mapping is truly a standard of care, then shouldn’t insurance cover the associated cost? Or, is this just another service that we are expected to provide for free?
3. Are there any medical-legal pitfalls for dermatologists who employ nevus photography routinely?
Let’s evaluate the following scenario: a dermatologist is following a patient with clinically atypical nevi using mole mapping. If this patient develops a malignant melanoma, could a plaintiff’s attorney claim that if this patient’s “atypical nevus” was removed earlier, this patient would have never developed a malignant melanoma in this lesion? Sure, we can’t remove all of our patients’ nevi, but now there is proof (a high-resolution photograph) clearly showing that this lesion was “atypical” from the very beginning!
It would be difficult for any expert witness to deny that the lesion in question is clinically atypical, especially when the photograph in the courtroom will be blown up to 4 by 6 feet.
Standard of Care?
Our job is to do what’s best for our patients. While I think nevus photography may be useful, I believe it’s wrong to claim that mole mapping is the standard of care, since it implicates that those dermatologists who do not routinely employ mole mapping practice below the level at which the average provider in a given community would practice.
