Is 3D total-body photography effective in early detection of melanoma?
Clinical Applications
By Kathryn Schwarzenberger, MD, FAAD, December 1, 2025
In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with H. Peter Soyer, MD, FACD, FAHMS, and Monika Janda, PhD, about their JAMA Dermatology paper ‘3D Total-Body Photography in Patients at High Risk for Melanoma – A Randomized Clinical Trial.’
DermWorld: Your paper investigated whether the use of 3D total-body photography improved early detection of melanoma and other skin cancers in individuals at high risk of melanoma. Why did you choose to study this topic?
It was therefore important for us to test whether new and emerging imaging technologies could be used to enhance teledermatology health services models to improve health outcomes in the setting of skin cancer surveillance. Specifically in this study, the health service model we aimed to test was how effective 3D total-body photography would be when added to the routine skin checks people were already receiving with their own doctor. Assuming that not all dermatologic practices would have advanced total-body imaging devices, how would a teledermatology setting with junior doctors acting as skin imaging technicians impact key outcomes, such as the number of benign skin lesions excised? The study started in 2018, and artificial intelligence decision support tools were not used in this study. While there were a number of previous studies on teledermatology options in skin cancer care, very few used a randomized design to allow stringent comparison with usual care.
DermWorld: For those who did not read your paper, how did you go about assessing the efficacy of 3D total-body photography in improving early detection?
DermWorld Insights & Inquiries
DermWorld: What were your findings?
Drs. Soyer and Janda: We found that participants in the two groups were diagnosed with a similar number of new melanomas on average. We observed a significantly higher number of keratinocyte cancers (basal cell carcinomas and squamous cell carcinomas) in the intervention group. Rates of keratinocyte skin cancers in the Australian population are very high, due to their link to UV exposure, and approximately 69% of Australians will be diagnosed with a keratinocyte skin cancer in their lifetime. Unsurprisingly, our findings also reflect that high prevalence.
We also observed more excisions of suspicious, but benign, lesions in the intervention group. This was different from our hypothesis where we had proposed that the addition of imaging would allow us to reduce the number of benign excisions.
These findings likely occurred due to the increase in scrutiny of the participants who were assessed both by teledermatology based on total-body photography and their usual care teams, which led to more suspicious lesions being identified.
With sequential imaging, we can track new moles or any changes in size or color over time, which are potential signs of skin cancer. If we notice such changes in the teledermatology setting, we tend to err on the side of caution and recommend excision. This detailed assessment of changes was only possible because of the ability to compare images taken at different points in time and in this study may have contributed to the higher number of excisions.
DermWorld: In daily practice, how should dermatologists integrate 3D total-body photography and digital dermoscopy into surveillance of high-risk patients — should it be reserved for select cases, or do you see it as a tool to replace/augment routine clinical skin checks?
Drs. Soyer and Janda: This study tested a teledermatologic service that is quite different to how dermatologists would usually implement 3D total-body imaging in their daily practice, where they would see the patient in person, and would then compare the current status of their skin to the images from previous visits. The treating doctor in this study did not have access to the total-body images. In clinical practice, we recommend that 3D total-body images be made available to the treating doctor to support clinical decision-making and their assessment of the person while in clinic. This use of imaging will better integrate with the intended clinical workflow for this technology.
DermWorld: Given the increase in benign lesion excisions observed in the intervention group, what practical strategies would you recommend for dermatologists to minimize unnecessary biopsies while still maintaining vigilance for melanoma?
Drs. Soyer and Janda: When clinicians use 3D imaging in their clinical practice, observing stability in a lesion over time can allow them to prevent excision of benign lesions.
In our research setting, our next steps are to test teledermatology when AI clinician support is added, and to assess whether using AI can improve the sensitivity and specificity compared to what we observed in the current study. In the future, as AI clinician support matures, we expect that trials may compare usual care and imaging-based AI directly. Results of such a future trial may, however, still be a few years away.
H. Peter Soyer, MD, FACD, FAHMS, is chair of dermatology at Frazer Institute at The University of Queensland in Australia. Dr. Soyer is a shareholder of MoleMap NZ Limited and e-derm consult GmbH and undertakes regular teledermatological reporting for both companies. Dr. Soyer is a medical consultant for Canfield Scientific Inc., and a medical advisor for First Derm.
Monika Janda, PhD, is a leadership fellow at the National Health and Medical Research Council of Australia and serves as the director of the Centre for Health Services Research and a professor in behavioral science at The University of Queensland in Australia.
Their paper appeared in JAMA Dermatology.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
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