Melanoma is responsible for 75% of all skin cancer deaths . In the pre-cancerous stages, a GP will find it difficult to discriminate a melanoma from a normal mole. This circumstance leads to a large number of unnecessary referrals and results in bottlenecks in the public health service, and more importantly a cancerous mole in its early stage may not create the sense of urgency needed for the patient to see his/her GP. The 5-year survival rate is 93% to 97% for melanoma detected at an early stage, but drops to between 10% and 20% for advanced stage detection , implying that there is a need for accurate diagnostic tools to enable early detection while avoiding unnecessary biopsies [3-6].
Which Pigmented Skin Lesion (PSL) is a melanoma? Which PSL should be biopsied?
The clinical challenge is the decision whether or not to biopsy!
The doctor and/or the patient may be suspicious of a pigmented skin lesion (PSL) and concerned that it may be a melanoma. Clearly if the PSL appears grossly unusual or is ulcerated or bleeding then the decision to biopsy or resect the lesion is straightforward: however at this stage it may be too late as the cancer may have metastasized.
In the case of a quite innocent looking PSL, early diagnosis of melanoma requires a highly trained clinician, and very often an unnecessary biopsy is made to be certain no cancer is present. A biopsy is a minor surgery, which is accompanied with risk and anxiety for the patient and high cost for the health care provider.
BM-OTD is designed and developed to help GPs make the difficult decision whether or not to biopsy. Obvious benefits include increased specificity (i.e. fewer unnecessary biopsies), less anxiety for the patient, and significant cost savings for the health care provider.
 A.F. Jerant, J.T. Johnson, C.D. Sheridan, T.J. Caffrey, Early Detection and Treatment of Skin Cancer, Am. Fam. Physician 62 (2): 357–68, 375–6, 381–2 (2000).
 V. Foerster, “Optical scanners for melanoma detection” [Issues in emerging health technologies, Issue 123]. Ottawa:Canadian Agency for Drugs and Technologies in Health (2014).
 E. A. Kupetsky and L. K. Ferris, “The diagnostic evaluation of MelaFind multi-spectral objective computer vision system,” Expert Opin. Med. Diagn. 7, 405–411 (2013).
 S. J. Divito and L. K. Ferris, “Advances and short comings in the early diagnosis of melanoma,” Melanoma Res. 20, 450–458 (2010).
 C. Herman, “Emerging technologies for the detection of melanoma: achieving better outcomes,” Clin. Cosmet. Investig. Dermatol. 5, 195–212 (2012).
 H. Lui, J. Zhao, D. McLean, and H. Zeng, “Real-time Raman spectroscopy for in vivo skin cancer diagnosis,” Cancer Res. 72, 2491–2500 (2012).