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May 22nd
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The future of melanoma screening: MoleSafe and digital photography

bezozoRichard050712_optA Millburn-based company is leading the way in bringing to patients a new system of melanoma screening that offers a greater chance for detection and prevention, and lower costs.

Since 2008, Molesafe, with locations in Milburn, Freehold and NYU Medical Center, has been using a digital-photography based system that produces images that allow a dermatologist to detect melanomas while still quite small, or before they reach a size that a patient might even notice the troubling spot themselves. The earlier detection allows for quicker treatment and better patient outcomes, said Dr. Richard Bezozo, president of MoleSafe

The MoleSafe system was developed in New Zealand in 1997, he said. It relies on digital photography methods that present doctors with an unprecedented view of pigmented skin legions, allowing for earlier diagnosis of melanoma.

The MoleSafe scan is as important to the diagnosis of melanoma as is a mammogram in the diagnosis of breast cancer, he said.

“A doctor’s first tool is his eyes,” Bezozo said. MoleSafe enhances a doctor’s ability to see the characteristics of a mole, dark spot on the skin or lesion to determine if melanoma is present. “By using dermoscopy, it makes the melanoma appear to be lighted from behind, as if in a light box,” he said. The process combines high magnification and high light intensity to display subsurface features that cannot be seen with the naked eye. This was a diagnostic option that was not available until the development of digital dermoscopy, Bezozo said.

For the past 25 years, the criteria for determining the presence of melanoma was based on the ABCDs of melanoma Asymmetry; Borders (irregular); Color (variegated); and Diameter greater than 6 mm or .24 inches, about the size of a pencil eraser. Later, the E for evolution was added, which represents how a spot evolves over time.

MoleSafe allows a doctor to create a timeline of a patient’s skin, a critical tool in prevention and treatment, Bezozo said.

The program begins with a comprehensive history focusing on your skin. This is followed by total body photography that allows for a heightened perspective of your skin, the largest organ of your body. Finally, total body dermoscopy is performed. Each mole is examined with a dermatoscope, the lesions that meet their criteria are then imaged and mapped and sent for an evaluation by an expert dermatologist.

As Molesafe is the most advance early detection and surveillance program for melanoma, patient’s follow-up annually for reimaging. New dermoscopic images of previously imaged moles (serial dermoscopy) when compared, can reveal the most subtle changes, Bezozo said. The dermatologist and patient can keep a digital record of the images. Soon, he said, that record will be available as a downloaded file from a cloud computer storage system. This program will help patients perform a more complete home exam, while allowing physicians to monitor images in their office using MoleSafe’s system.

While total body photography has long been a key diagnostics tool used for patients at risk of melanoma, Bezozo said the old Polaroid or Kodak images do not have the clarity or depth of the digital images available from MoleSafe. In the past, high risk patients endured a series of biopsies as doctors worked to identify melanomas as early as possible

Melanoma is the most deadly form of skin cancer. It is the most common cancer for young adults between ages 20 and 30, and the main cause of cancer deaths in women between 25 and 30.

An estimated 76,250 cases of melanoma occur annually in the United States. In 2011, there were 8,790 reported melanoma deaths, and the number is expected to rise this year to 9,180.

Tanning, whether by the sun or in a tanning booth, is a key factor in the development of melanoma, Bezozo said.

Clearly, deep and long exposure to the sun without sun screen or protective clothing, sets conditions that could lead to melanoma growth, he said. A recent story about deeply tanned New Jersey woman accused of taking her young daughter to a tanning salon is also a warning about the dangers of such behavior.

The National Institutes of Health (NIH) declared UV radiation a carcinogen in 2000.

The vast majority of mutations in melanoma are caused by ultraviolet radiation, the Skin Cancer Foundation reported.

“One or more blistering sunburns in childhood or adolescence more than double a person’s changes of developing melanoma later in life,” the foundation said.

An infant less than six months should be fully protected from the sun, even in winter, Bezozo said.

Millburn’s MoleSafe center is one of 40 melanoma screening centers around the world. Over the past five years, 120,000 screenings of 62,000 patients have been conducted. The tests imaged and diagnosed more than 1 million lesions, and identified nearly 1,000 melanomas.

Bezozo said the cost of the initial screening is $395 and follow-up screening costs $295. The procedure is accepted by a growing number of insurers, and, he said, he feels eventually the test will be accepted generally by the insurers.

It is a money-saver for both patients and insurers, he said. Because the images provide a better view of the suspected melanoma, and make it easier to determine melanoma from non-cancerous moles and spots, fewer biopsies are done, he said. In addition, recent studies from New Zealand indicate that Molesafe detects melanoma at a thinner level then other methods and therefore are more likely to be cured.

While there is a debate about the need to conduct some medical tests such as screenings for prostate cancer or breast cancer for adults of a certain age, Bezozo said screening for a medical condition is a less expensive option than waiting until a dangerous disease is fully present.

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