July 8, 2013
I started my residency in Dermatology in 1986. At that time a researcher at NYU medical center who was one of the world leader’s in Melanoma, was working on a device that would incorporate a computer model to aid in the diagnosis of Melanoma by capturing the image with a camera.
I finished my residency in 1989 and by then many others had stated work on similar devices according to the literature. When I first read about the SIAscope in Europe, I was excited to hear about it and wondered when such a device would be available in the US. A few years later, sure enough, the device was FDA approved and I visited the developers at the next American Academy of Dermatology meeting. The result looked too good to be true. The company was willing to let me try the device for a 6 month period before I purchased it.
Once the device was in the office (a much more cumbersome camera than currently used), I started looking at my patient’s with moles. If I was going to remove the lesion based on my usual clinical signs of irregularity, I would then take an image of the lesion and record my findings. The device never guided me to leave a lesion alone that was a Melanoma! But it would have saved many patients a biopsy.
Over the past years, the device has been a great tool at reassuring patients that a lesion was benign if my exam alone was not enough to comfort them. Surprisingly in a few patients that I was worried clinically had Melanoma, who for whatever reason did not want a biopsy, I have been able to show them on the device the signs of the cancerous lesions and convince them to let me remove it. I can honestly say in the years since I have the device, I have been able to save some lives by convincing a patient they needed a lesion removed and were only convinced once they saw the image on the screen.
Although my fellow Dermatologists seem hesitant to purchase and use a device that has no CPT code to bill, I personally do not charge patient’s to take images of their moles. It takes about 2 minutes to teach any of medical assistants to take the images for me and they could even interpret them after doing a few. I have had patients come to see me from as far away as Texas and Chicago, in the US and one that comes from England. (She says it is easier to get in to see me for an exam than a Dermatologist in London, and the shopping in New York is better). I still hold out hope that the device will someday soon be available for patient care.
I have never had any question of liability or any malpractice cases arising from the use of the device. If the machine were used by a non medical person, I feel the risk of capturing the image incorrectly is almost impossible. If it were available as a service in a widely distributed way, I think the only issue would be what would you be able to sell people while they wait in line to have a lesion checked. I think the positive response that you would get would not only be great for public relations for any retailer that has the machine but you would be saving lives (and those lives are customers).
As I see it, it is a win win for any store that would have the device. A lawyer would have to go over the liability issue but just like the AAD’s skin cancer screenings done yearly, I am sure they could come up with a form that would indemnify the store for providing this service. Which chain buys the device first will surely give them an advantage in helping advance their increase entrance in patient care. Giving a Shingles vaccine or a flu shot must have a greater liability potential than these images.
If you have any other questions about the device, please feel free to get in touch.
Ronald Falcon, MD