the incidence of malignant melanoma has been increasing by 2.6% annually over the last decade , with approximately 76,790 new cases resulting in 9,480 deaths in 2013 . additionally , melanoma is one of the most common forms of cancer in young adults and represents a significant health concern , particularly in terms of years of life lost . a key prognostic indicator of melanoma is the depth of the lesion in millimeters at the time of diagnosis . melanoma in situ , which is confined to the epidermis , is considered completely curable . however , once melanoma has progressed and metastasized to other parts of the body , effective treatment is limited . therefore , melanoma prognosis and cure rates can be dramatically improved by early diagnosis when the lesion is thinnest . clinical signs of early melanoma are often ambiguous ; even the most experienced dermatologist may have difficulty identifying and differentiating it on a clinical basis from other pigmented lesions , such as atypical nevi . as a result of this clinical need , diagnostic tools have been developed to aid the clinician in deciding whether a lesion is suspicious enough to require biopsy . handheld epiluminescence microscopy or dermoscopy is a common modality used to inspect the pigment network pattern at the epidermodermal junction zone and to evaluate it for indicators of malignant transformation . more recently , the advent of computer - based systems provides sophisticated functionalities allowing for software algorithms to analyze specific features of lesions relevant to predicting malignancy . in addition , diagnostic aids for mole mapping , such as total body photography , improve the ability to longitudinally monitor patients who have too many moles to otherwise track for clinically significant changes . emerging technologies , such as in vivo reflectance confocal microscopy , optical coherence tomography , and even infrared imaging are currently being investigated to determine their utility for noninvasive diagnosis of melanoma . this article summarizes the currently available modalities used to aid in the detection of melanoma in conjunction with full body skin examinations . one of the most frequently used tools , total body photography or mole mapping , is an effective means of monitoring pigmented lesions over time . this method uses high - quality , professional , full - body photographs to document the appearance and location of pigmented lesions on the body . high - resolution photographs of a single lesion under dermoscopy can also be taken , and is frequently used for monitoring suspicious lesions where biopsy is not yet indicated . at each physician visit , pigmented lesions from these photos are compared to those seen on a full body examination to aid in the identification of new and/or changing lesions . however , this method is time consuming and expensive , largely due to the cost of the photographer . analysis of individual , high - risk lesions over time based on comparisons with digital photos has been shown to be effective in detecting new and subtly changing pigmented lesions [ 4 - 6 ] . one observational trial of 530 high - risk patients with 53 diagnosed melanomas demonstrated increased sensitivity in detection of melanoma when digital dermoscopy photos were available for comparison , compared to lack of photographs . another trial found that total body photography assisted with detecting new or subtly changing melanomas , which did not fit classical clinical features of melanoma . melanomas detected were also thinner , although this could be a reflection of sampling bias since patients who undergo total body photography may also be more likely to follow - up with their dermatologists or employ other sun - protective measures . total body photography seems to be most useful in high - risk patents , including those with a strong history of melanoma or older individuals . in patients younger than 50 , less than 1% of new lesions identified on full body skin examination , using their total body photographs as a reference point , were diagnosed as melanoma . in comparison , in the cohort of patients 50 years and older , 30% of new lesions discovered using the same method were diagnosed as melanoma . several other studies have demonstrated the usefulness of total body photography in the detection of melanoma in high - risk populations . despite these documented benefits in detecting melanoma using total body photography , there is still a lack of data to support whether this modality leads to decreased morbidity and/or mortality [ 11 - 13 ] . total body photography , while effective for tracking clinical change in lesions or the development of new lesions , is time - consuming and laborious . in addition , in the us , health insurance often does not cover the cost of taking the professional photos , which ranges from $ 400-$500 . traditional digital total body photography relies on physical photographs , which the patient brings to each appointment , or which the physician stores as part of the paper medical record . molemax ( derma medical systems , vienna , austria ) , fotofinder ( fotofinder systems inc , columbia , md , usa ) , molemap cd ( digitalderm inc , columbia , sc , usa ) , smartscope ( midcon distribution inc , overland park , ks , usa ) , dermspectra ( dermspectra , tuscon , az , usa ) , dermatrak skin imaging centers ( canfield scientific , fairfield , nj , usa ) , and melanoscan ( melanoscan inc , stamford , ct , usa ) all offer alternatives to traditional full body photography . all of these devices allow for comparison of high - resolution digital images , and some have software that calculates the likelihood of malignancy based on clinical features . while these devices are promising , many lack large - scale clinical trials supporting their efficacy . of published studies in peer - reviewed journals that examined these devices , all of these devices need to be coupled with clinical judgment when examining any patient for melanoma . confocal scanning laser microscopy ( cslm ) uses the inherent reflective properties of the tissue to distinguish between various skin structures and ultrastructures . this non - invasive technology has a hand - piece that is applied to the skin , with the resulting image showing up on a monitor . reflectance mode is used in clinical practice , while fluorescence mode is still mainly confined to research . under reflective cslm , melanin granules and melanosomes have a higher refractive index than surrounding structures , which can be distinguished on the confocal microscope . cslm can even detect amelanotic melanomas due to the presence of melanosomes in amelanotic lesions . additionally , one study examining 27 melanomas compared to 90 benign nevi found that cslm had a sensitivity and specificity of 88% and 98% , respectively . another study comparing 20 melanomas and 50 benign nevi using cslm found a sensitivity and specificity of 98% and 99% , respectively . positive predictive values have been reported to be as high as 97.5% in diagnosing melanoma using cslm [ 19 - 21 ] . compared to handheld dermoscopy ( in a study of 37 melanomas and 88 benign nevi ) advances in cslm technology promise to make this a valuable tool in improving diagnostic accuracy and ease of use . this technology provides visualization to the level of the superficial dermis and has a resolution comparable to that of standard pathology or 5 m permanent sections . in addition , it allows for non - invasive imaging of multiple lesions during the same session . technologic advances have contributed to the development of more portable cslm devices with handheld imaging pieces connected to a monitor . despite the apparent potential of cslm , upfront costs are also considerable , with commercially available cslm equipment costing upwards of $ 50,000 . after purchasing the equipment , additional supplies are necessary to evaluate each lesion . multispectral technology uses radiation ranging from 4001000 nm to provide the end - user with a series of digital images . they provide multispectral information in the spatial and spectral domains by capturing radiation intensity at a specific point and as a function of wavelength , respectively . melafind ( mela sciences inc , irvington , ny , usa ) uses multispectral technology to quantitatively characterize suspicious lesions . this device evaluates the lesion in 10 different spectral bands , which range from 430950 nm . the images are evaluated by proprietary software , which determines the border of the lesion and analyzes its parameters , such as color variation , asymmetry , perimeter and textural changes . clinicians must first use their own clinical judgment in determining which lesions should be evaluated by melafind , as the technology is highly inaccurate if used on lesions known to be benign such as seborrheic keratosis or cherry angiomas [ 14,22 - 24 ] . this device is designed to aid the physician in determining which lesions to biopsy , providing binary outcomes of positive ( biopsy should be considered ) or negative ( lesion is less suspicious ) . because of its binary output , user experience is not as essential as it is with other devices , such as cslm , but does assume clinical expertise in diagnosing common dermatologic lesions . in a multicenter study on melafind of 1383 patients , the device detected mostly thin melanomas or borderline lesions ( high - grade dysplastic nevi , atypical melanocytic proliferations / hyperplasias ) . in lesions histologically proven to be melanoma , melafind 's average specificity was 9.9% , which was higher than the 3.7% specificity of dermatologists . of note , this multi - centered study was sponsored by mela sciences , which produces the melafind device . currently , the cost of imaging ranges from $ 25 to $ 175 for evaluation of one lesion and around $ 25 for additional lesions . the siascope ( spectrophotometric intracutaneous analysis , made by biocompatibles , farnham , surrey , uk ) uses multispectral imaging to detect three chromophores : melanin ( in the epidermis and upper dermis ) , hemoglobin , and collagen . using a handheld device connected to a monitor , the physician is able to evaluate the pattern of each chromophore in clinically suspicious lesions . in a study of 348 pigmented lesions ( 52 melanomas ) , sensitivity and specificity for melanoma was 80% and 83% , respectively . in a cohort of primary care providers , siascope 's sensitivity was 94% , with a false negative rate of 4% . another study , examining 881 pigmented lesions ( 31 melanomas ) , found no difference in the sensitivity and specificity of siascope use compared to dermsocopy use by dermatologists . thus , it is unclear whether this device provides any more benefits than conventionally used tools ( such as dermoscopy ) when performing a full body skin examination . the molemate system incorporates the siascope device with a diagnostic algorithm for primary care physicians to use . its efficacy is currently under investigation [ 30 - 32 ] . for optimal use , additionally , the siascope algorithms use features common to benign lesions , thus classifying benign lesions such as seborrheic keratosis or cherry angiomas as suspicious . infrared spectroscopy , raman spectroscopy , thermographic imaging , tissue elastography , fiber diffraction , electric impedence spectroscopy , and noninvasive genomic detection   may all play a role in assisting with the diagnosis of melanoma in the future . mobile smartphone apps also offer an opportunity for patients to monitor their own skin for suspicious lesions , but current apps have , thus far , been shown to be insufficiently accurate . cutaneous imaging modalities can be used to enhance screening for melanoma by primary care physicians as well as the monitoring of high - risk patients by dermatologists . dermoscopy can be an effective tool for trained primary care physicians to screen for melanoma . in several studies involving primary care physicians , dermoscopy increased their sensitivity in detecting malignant lesions , leading to improvements in confidence and accuracy in referring suspicious lesions to dermatologists . however , learning dermoscopy can be a time - consuming process for primary care physicians , with the average general practitioner requiring 30 hours of internet - based learning to acquire adequate skills in interpreting dermoscopy images . for dermatologists , dermoscopy can also serve as a valuable tool in monitoring high - risk patients , leading to improved diagnostic accuracy when compared to naked eye examination . total body photography is an effective tool for detecting new or changing lesions by patients , primary care physicians , and dermatologists . in particular , total body photography can improve self - skin examination accuracy and melanoma detection by patients . mole mapping can also improve patients ' self - confidence and knowledge when conducting skin self - examinations . thus , it can be used for both screening purposes and monitoring of high - risk lesions . cslm requires significant operator experience to interpret images , and the equipment is prohibitively expensive for use in primary care . due to these factors , cslm is typically used only at major academic centers with specialized pigmented lesion programs . melafind 's efficacy in detecting malignancy has only been evaluated in dermatologists , showing increased sensitivity and specificity when diagnosing melanomas . because melafind depends on the clinician 's judgment to first identify a suspicious lesion to evaluate , it can result in inter - user variability . however , melafind 's analysis algorithm of suspicious lesions and binary output does hold potential for use by a primary care physician trained to first identify a clinically worrisome lesion . further studies involving primary care physicians need to be conducted to evaluate its efficacy in this population . siascope holds promise for use by primary care physicians . when used by primary care physicians , siascope has a sensitivity of 94% , with a false negative rate of 4% . in the uk and australia , while recent technological advances in the cutaneous imaging and diagnosis of melanoma are promising , there are still significant barriers to their widespread implementation ( for a summary of imaging technologies see table 1 ) . these modalities require time , appropriate training , and experience for proper use . to encourage widespread use , these technologies need to provide accurate information to the clinician in a time - efficient manner . additionally , they need to show improved patient outcomes through decreased morbidity and/or mortality . adoption by primary care physicians will likely enhance the rate of early diagnosis of melanoma and decrease morbidity and mortality in populations at risk .