Managed Care - August 2012 - (Page 12)

EVIDENCE REVIEW Many insurers have not yet updated their coverage policies since the FDA cleared this scanning tool in November 2011 Computer-aided Multispectral Digital Analysis (MelaFind) for Assessing Atypical Skin Lesions A summary of ECRI Institute’s Emerging Technology Evidence Report Managed care leaders are striving to make evidence-based decisions about new and emerging health technology. Managed Care and ECRI Institute have joined in a collaboration to bring bi-monthly summaries of the Institute’s Emerging Technology Evidence Reports. ECRI Institute is an independent not-for-profit organization that researches the best approaches to improving patient care by analyzing the research literature and data on clinical procedures, medical devices, and drug therapies. tion and close surface lighting to improve visual clinical examination that enables inspection of structures that the naked eye cannot see. Lesion features that a clinician may inspect during dermoscopy include pigmentation patterns, lesion shape, and changes suggestive of cancer. Use of dermoscopy is intended to reduce false-negative melanoma diagnoses and may often address the false positives (such as the identification of characteristics of pigmented seborrheic keratoses, a benign epithelial lesion). The MelaFind System The MelaFind System is a “noninvasive, multispectral computer vision system that uses light from visible to near-infrared wavelengths to evaluate skin lesions up to 2.5 mm beneath the skin.” Multispectral analysis is intended to enable dermatologists to assess skin lesion properties that are not visible to the human eye to improve accuracy of lesion categorization. According to the manufacturer, MelaFind can help dermatologists improve the accuracy of lesion categorization, potentially increasing melanoma detection rates and reducing the number of unnecessary biopsies used to rule out melanoma in patients with benign lesions. The findings to our key questions are as follows: 1. Does use of the MelaFind system added to standard practice (i.e., visual examination, dermoscopy) increase melanoma detection rates? The results of one study suggest that the addition of MelaFind to standard practice increases melanoma detection rates; however, the study’s small size and case-control design preclude definitive conclusions about its impact or value in a clinical setting. 2. Does use of the MelaFind system added to standard practice (i.e., visual examination, dermoscopy) decrease the number of unnecessary biopsies? M elanoma is a potentially deadly skin cancer that arises in cells called melanocytes, which make the brown pigment melanin. Early diagnosis and prompt treatment improves survival. Melanoma that is confined to the epidermis (i.e., melanoma in situ) is curable in virtually all cases by simple excision. However, when melanoma advances or metastasizes, it is difficult to treat. When treated with conventional chemotherapy, most patients die within 6 to 10 months. However, with the advent of newer treatments, including targeted inhibitors and immunotherapies, median survival time, in some patients, has increased to more than one year. Histopathologic examination of biopsy samples is the standard for definitive diagnosis of melanoma. Clinicians identify and biopsy suspicious lesions, but early malignant lesions are difficult to distinguish from benign irregular and atypical pigmented skin lesions and moles. Current screening methods involve visual examination with the naked eye or a dermascope. Visual assessment alone has been associated with a risk of false-negative diagnoses (missed melanomas) as well as false-positive diagnoses, which lead to unnecessary biopsies. Dermoscopy provides 10X or higher magnifica- 12 MANAGED CARE / AUGUST 2012

Table of Contents for the Digital Edition of Managed Care - August 2012

Managed Care - August 2012
Editor’s Memo
Legislation & Regulation
News & Commentary
Medication Management
Evidence Review
Compensation Monitor
Private Exchanges: Practice Makes Perfect
Hospitals and Providers Ganging Up on Plans?
Q&A: Kaiser Permanente’s Sharon Levine, MD
God Save the Health Care System!
Future Points to Greater PBM/Plan Cooperation
Formulary Files
Plan Watch
Tomorrow’s Medicine

Managed Care - August 2012