Non-invasive melanoma testing?

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wamcp

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I'm not a dermatologist so I'm asking if any of you know if this new non-invasive melanoma testing will be adopted widely? Or would there be initial resistance to this as it would reduce the number of biopsies performed?



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I'm not a dermatologist so I'm asking if any of you know if this new non-invasive melanoma testing will be adopted widely? Or would there be initial resistance to this as it would reduce the number of biopsies performed?



1) i don’t think it will be adopted widely

2) i no longer allow reps into my office (even pre covid) because they always have a latest/greatest tech to offer. always published in a throwaway journal. always involving massive amounts of paperwork for little to no reimbursement. i like to think that i am flexible and will follow the literature to do what’s best for my patients: if this truly becomes the gold standard for pigmented lesion analysis, i will adopt it. but color me skeptical
 
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I'm not a dermatologist so I'm asking if any of you know if this new non-invasive melanoma testing will be adopted widely? Or would there be initial resistance to this as it would reduce the number of biopsies performed?



Those studies are ridiculous. 18% of the lesions analyzed were melanoma? I can do way better with dermoscopy alone.

Is their suggestion that these lesions would not be biopsied?

Until there is something non-invasive with a 0.0001% false negative rate that’s not happening. Because there not good medico-legal coverage and a small skin biopsy is not really “invasive” in any real sense.
 
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Interesting, but I wouldn't adopt it widely. I'd be too worried about a false negative.

The only place I see for it is in lesions that I'm not quite sure on but have a low level of concern. For those honestly, I can just biopsy quickly and get what I believe is more accurate information. Plus almost universally, my melanoma patients (Hx of) are of the mindset "If you have any doubt, just biopsy it please".

I guess another use could be in patients with dysplastic nevus syndrome or a tons of dysplastic nevi...just schedule a long appointment and tape all of their lesions. That still doesn't change the fact that all their lesions need to be monitored. I do this with full body photography. Taping all of their lesions every time they would come for a check is just not a pragmatic approach.

Plus, while biopsy may not fully remove a lesion, most patients (especially patients with prior melanoma) are probably going to feel psychologically better about a biopsy (removing a piece of skin) than any 'taping' method while they are waiting for their results.
 
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Interesting, but I wouldn't adopt it widely. I'd be too worried about a false negative.

The only place I see for it is in lesions that I'm not quite sure on but have a low level of concern. For those honestly, I can just biopsy quickly and get what I believe is more accurate information. Plus almost universally, my melanoma patients (Hx of) are of the mindset "If you have any doubt, just biopsy it please".

I guess another use could be in patients with dysplastic nevus syndrome or a tons of dysplastic nevi...just schedule a long appointment and tape all of their lesions. That still doesn't change the fact that all their lesions need to be monitored. I do this with full body photography. Taping all of their lesions every time they would come for a check is just not a pragmatic approach.

Plus, while biopsy may not fully remove a lesion, most patients (especially patients with prior melanoma) are probably going to feel psychologically better about a biopsy (removing a piece of skin) than any 'taping' method while they are waiting for their results.
Thanks for the perspective. I guess regardless, more and more insurers are willing to pay for this non invasive testing as they perceive it as cost saving...


(Disclosure: i do own shares of its stock, which is spiking on the news)
 
Thanks for the perspective. I guess regardless, more and more insurers are willing to pay for this non invasive testing as they perceive it as cost saving...


(Disclosure: i do own shares of its stock, which is spiking on the news)

Its almost entirely garbage as it exists now. Dermatologists have figured this out so the company is aggressively jockeying to try their hand at duping primary care physicians.
 
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This will be fun to see in clinic...”you’re doing a biopsy? But my PCP was using the best new technology that prevented biopsies! You really need to get with the times doctor. I’m going back to the expert!”
 
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