Kelly Nelson, MD, PhD, provides an update on melanoma screening, diagnosis and prevention at the 2017 MD Anderson Melanoma Patient Symposium held in Austin, TX on May 6, 2017.

1. MELANOMA SCREENING,
DIAGNOSIS, AND PREVENTION, OR
WILL ARTIFICIAL INTELLIGENCE
PUT ME OUT OF A JOB?
HTTP://MDACC.PARTICIPOLL.COM/
Kelly Nelson, MD FAAD
Associate Professor
Department of Dermatology
MD Anderson Cancer Center

2. ■ No conflicts
http://mdacc.participoll.com/

3. What is your relationship to melanoma?
■ A: I have not had melanoma and I don’t
know anyone who has
■ B: I have not had melanoma, but I know
someone who has
■ C: I have been diagnosed with melanoma,
but it was not in my lymph nodes (stage
0-II)
■ D: I have been diagnosed with melanoma,
and it was only in my lymph nodes (stage
III)
■ E: I have been diagnosed with melanoma
that has spread elsewhere in my body
(stage IV) 0A B C D E
http://mdacc.participoll.com/

4. If you have been diagnosed with
melanoma, who found your melanoma?
■ A: I did
■ B: family/friend
■ C: a physician/provider
0A B C
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5. If your melanoma was found by a
physician, what kind?
■ A: primary care provider
■ B: dermatologist
■ C: surgeon
■ D: other specialist
0A B C D
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6. If you found your melanoma, when you
showed it to a doctor, what did he/she say?
■ A: yep, that’s a melanoma
■ B: that looks kinda funny, let’s take that
off
■ C: that spot is fine, you don’t need to be
worried
0A B C
http://mdacc.participoll.com/

7. Melanoma Prevention
■ Primary
– Let’s keep it from
happening in the
first place
■ Secondary
– When it happens
let’s diagnose it
as early as
possible

9. Seeing
it
Diagnosing
it
Access to
care
Melanoma Secondary Prevention

10. Seeing
it
Diagnosing
it
Access to
care
Melanoma Secondary Prevention

12. Seeing
it
Diagnosing
it
Access to
care
Melanoma Secondary Prevention

13. Superficial spreading melanoma, Breslow depth 0.7 mm

14. Melanoma in situ

15. Melanoma in situ

16. Seeing
it
Diagnosing
it
Access to
care
Melanoma Secondary Prevention

17. Ugly duckling
Ugly Duckling

18. Ugly Duckling

19. Clinically subtle melanoma

20. Diagnostic technologies
■ Reflectance confocal
microscopy
■ Optical coherence tomography
■ High frequency ultrasound
■ Tape stripping
■ Spectroscopy
■ Expensive
■ Bulky machines
■ Challenging image
acquisition
■ True predictive capacity

21. Dermoscopy
Lancet Oncol 2002;3(3):159-65; PMID 11902502

22. Dermoscopy
■ Pigmented basal
cell carcinoma
– Vessels: crisp,
arborizing
– Pigment:
blue/grey ovoid
nests
– ulceration
■ Melanoma
– Vessels:
disorganized
– Pigment: light
brown
homogenous,
reticular pattern,
globules
http://mdacc.participoll.com/

23. Which one is the melanoma?
A B
0A B

24. Which one is the melanoma?
A B
0A B

25. Which one is the melanoma?
A B
0A B

26. 0A B
Which one is the melanoma?
A B

27. Which one is the melanoma?
A B
0A B

28. Which one is the melanoma?
A B
0A B

29. Which one is the melanoma?
A B
0A B

30. Which one is the melanoma?
A B
0A B

31. 0A B
Which one is the melanoma?
A B

32. 0A B
Which one is the melanoma?
A B

33. Automated dermoscopic analysis
MelaFind
 Automated multispectral
dermoscopy analysis
 FDA approved
 Expensive
 Sensitivity: 98.4%
 Specificity: 9.9%
Arch Dermatol 2011;147:188. PMID 20956633

34. 0A B
Have you heard about this?
A: yes
B: no
Nature. 2017 Feb 2;542(7639):115-118; PMID 28117445
http://mdacc.participoll.com/

35. Artificial Intelligence and Image
Recognition
■ Feature extraction + Classification
■ Deep Convolutional Neural Network
– Overlapping data intake fields
– Convolutional processing
– Deep learning
■ GoogleNet Inception v3 CNN architecture

36. https://medium.com/@ageitgey/machine-learning-is-fun-part-3-deep-learning-and-convolutional-neural-networks-f40359318721
http://cs.nyu.edu/~fergus/tutorials/deep_learning_cvpr12/
Feature extraction

37. Classification
https://devblogs.nvidia.com/parallelforall/deep-learning-nutshell-core-concepts/

38. Nature. 2017 Feb 2;542(7639):115-118; PMID 28117445

39. Nature. 2017 Feb 2;542(7639):115-118; PMID 28117445

40. Nature. 2017 Feb 2;542(7639):115-118; PMID 28117445

41. Nature. 2017 Feb 2;542(7639):115-118; PMID 28117445

42. Essential Next Steps
■ Validation
■ Validation
■ Validation

43. Take Home Points
■ Primary Prevention: UV protection
■ Secondary Prevention: Patient Access, Seeing it, Diagnostic Accuracy
■ Ideal Diagnostic Technology: Portable, Cheap, Accurate
■ Validation is essential