Freckles and moles are part of the job for dermatologists. Their ability to remember, from one visit to the next, whether the spots on a patient’s back have stayed the same might seem like a mystery. It turns out they don’t have to remember — that’s what dermatological photography, also known as total-body photography, is for.
I’m very freckly, and I’ve had several atypical moles biopsied over the years. Total-body photography documents all the moles on your skin to help doctors keep track of changes. It’s useful, and sometimes critical, but it’s also not something that everyone needs.
“This is for someone who’s at increased risk of melanoma,” says Douglas Grossman, a dermatologist, University of Utah professor and investigator at the Huntsman Cancer Institute. “They either have numerous moles or atypical moles that are risk factors for melanoma that need to be monitored.”
Whether or not you should have total-body photography depends on several factors, including your risk level for melanoma and your dermatologist’s opinion. Cost can also be a prohibitive factor; health insurance typically doesn’t cover the service, which can cost anywhere from $250 to $400 or higher, says Jennifer Stein, a dermatologist and associate professor at the NYU School of Medicine. If you meet the criteria below, however, it may be something worth asking about.
How it works
Total-body photography, which began picking up steam in the early 2000s, is primarily reserved for adults age 20 and over. Teens and children aren’t candidates because they’re still developing new moles, and melanoma is exceedingly rare before adulthood.
Who takes the images varies by practice. Some academic centers have medical photographers who do total-body photography. In small towns or other places where medical photographers aren’t available, a medical assistant might be trained to shoot images, or your dermatologist may send you to a professional photographer. During a photo session, you’ll need to disrobe completely, so that the images document every inch of your skin, although some centers may allow you to wear underwear. Some centers don’t take photos of the genital area unless there are moles present.
The photographer will take about 25 pictures, focusing on different body parts, and you’ll receive the photos as prints and/or digital images. Your dermatologist will ask you to bring your images to appointments, so she can compare your skin to the photos to see how your moles have changed or stayed the same over time. (Doctors typically prefer that patients keep their photos in their possession at all times, so they don’t have to keep the sensitive images in the office. Some digital images include HIPAA security features, which should give patients peace of mind when their photos are viewed on a physician’s computer.) Your doctor can also show you how to use the images for at-home self-checks.
If you live near one of a handful of academic or cancer centers nationwide with more advanced photography systems, you may have a different experience: Some systems can create one continuous image of your skin, rather than snapshots of different sections. You stand with your legs straddled and your arms lifted away from your torso, so that your skin is optimally exposed, and the machinery documents your skin from multiple angles.
Other systems use algorithms to map moles and spot changes over time.
Benefits of total-body photography
Your dermatologist might take photos of specific suspicious moles during an appointment to note if they change. Total-body photography is the next level up — a more comprehensive way for a derm to keep track of your entire body and notice subtle changes early.
“The whole point of total-body photography is that you’re prepared for a melanoma that can arise anywhere on the skin, not just from the moles,” Grossman says. “Most melanomas arise de novo, not from a preexisting mole, so if you’re only focused on the moles, you’re going to miss the new lesions that could be melanoma.”
For high-risk patients, total-body photography might prevent unnecessary biopsies. Research by Grossman has shown that people at risk of melanoma who were monitored by total-body photography had nearly five times fewer biopsies of questionable moles, compared to their previous monitoring methods.
Photographic evidence helped me avoid an unnecessary biopsy. My dermatologist wanted to biopsy a suspicious-looking mole near my neckline. My total-body photography images were too new to help her determine if the spot had always looked that way. Fortunately, I remembered that a headshot taken on my wedding day showed the same mole. When I shared the image with my dermatologist (the mole looked exactly the same, 10 years earlier), she agreed that it wasn’t necessary to biopsy.
Comparing photos over time and taking follow-up images as needed may help catch melanoma early, particularly among people at high risk, according to research.
“Some people have lots of moles and atypical moles, which means it’s hard to tell the difference between a funny-looking mole and an actual melanoma,” says Stein, who co-authored the study. “All of those moles can act as a camouflage for an actual melanoma.”
Other research found that total-body photography can decrease patient anxiety about melanoma risk.
“Some patients are so anxious about melanoma, they won’t even look at their skin,” Stein says. “You can really reassure them with the photos. They can refer back to the photos and see that it’s not changing and feel better.”
Not every dermatologist is a fan of TBP. It’s a personal preference, according to Stein. And dermatologists who do use TBP vary in how they incorporate the practice into care. Some will rely entirely on it, while others may use total-body images as a general reference point and then also take close-up photos of any concerning moles.
Apps for skin monitoring
If you can’t afford total-body photography or your dermatologist doesn’t recommend it, you might consider using an app to monitor your skin. More than half of the available skin-monitoring apps allow you to take at-home total-body photography images, but you shouldn’t put too much stock in them. Some of these apps are affiliated with dermatology departments or cancer centers, and they’re probably the most reliable. But a recent study found that more than half of skin-monitoring apps weren’t created with input from dermatologists, and varied considerably in their effectiveness as cancer-screening tools. There’s no system in place to ensure that apps are safe and effective, and many are not HIPAA-compliant. There are also no quality standards for the algorithms used to determine whether moles look suspicious. You may get false-positive or false-negative results, causing unnecessary worry or delayed treatment.
“These apps are functioning as diagnostic devices, but they do not have validation studies showing how accurate they are or are not,” says study author Laura K. Ferris, a dermatologist and associate professor at the University of Pittsburgh. “This is a problem, as the prognosis for melanoma — the deadliest skin cancer — is very good when caught early and dismal when caught late. So delays in care can mean the difference between life and death.”
Mole-tracking apps are better than diagnostic apps; they may help you monitor moles between dermatologist appointments. The photos you take might not be as high-quality as those shot by professionals, but they can still help you document changes.
“If a patient came in and showed me a photo of a mole that they took at home six months ago and it had changed, I would certainly take that seriously and would use that information in my medical decision-making,” Ferris says.
But if you download one of these apps, don’t use it as a substitute for medical care: See your dermatologist as often as they recommend if you have risk factors for skin cancer, and perform regular skin self-checks on your own.