Table 1. Imaging technologies.

Modality	Benefits		Limitations		Cost		Use by primary care		Use by dermatologists		Sensitivity	Specificity
Total body photogra- phy	Allows provider and patient to monitor pigmented lesions over time.		Time consuming and expensive largely due to the cost of the photographer.		$400-500 (varies by photographer).		May improve skin examination quality by primary care physicians, although no randomized controlled trials have been conducted.		May improve skin examination quality by dermatologists, although no randomized controlled trials have been conducted.		Unknown	Unknown
Confocal scanning laser micro- scopy (CSLM)	Handheld device that provides high-resolution visualization (comparable to standard pathology) to the level of the superficial dermis.		Requires a high level of operator experience, relatively high upfront cost to the provider.		$50,000 per device. $1 (supplies) to image a lesion.		No, prohibitively expensive and high level of experience required for device use and image interpretation.		Yes, but usually academic centers with specialized pigmented lesion programs.		88-98%	83-99%
MelaFind	Simple binary output (biopsy vs. don't biopsy). User experience is not as essential as with other devices such as CSLM.		Requires clinical expertise in diagnosing common dermatologic lesions, e.g. differentiating nevi from seborrheic keratoses		$7000 per device. $25 to $175 for evaluation of one lesion and around $25 for additional lesions (not covered by insurance).		No, although analysis algorithm and binary output holds potential for use by a primary care physician. Current device algorithm requires training to identify a clinically suspicious lesion suitable for imaging.		Yes, improves the sensitivity and specificity of dermatologists in detecting melanoma.		98%	10%
Siascope	Handheld device, provides high-quality images, less expensive than other devices.		Operator dependent, requires experienced users who can accurately interpret SIAscope images.		$5000 - $8000 per device.		No, although a scoring algorithm targeted at primary care physicians is currently in development and shows promise.		Yes, but operator dependent.		80-94%	83%

Abbreviations: CSLM, confocal scanning laser microscopy.