In Australia, skin cancer is the most common cancer, with melanoma being the fourth most common registrable cancer after prostate, colorectal, and breast cancer . In 2003, there were 9,524 new cases of melanoma – a 14% increase in incidence since 1993 – and 1,146 deaths (764 males and 382 females) . The risk of developing melanoma before the age of 75 is 1 in 24 for males and 1 in 34 for females ; melanoma is the most common cancer in the 20 to 39 year old age group .
Because the prognosis for melanoma is very good when lesions are excised 'early' (97.9% 10-year survival ≤ 0.75 mm Breslow thickness) and poor when they are not (40% 10-year survival > 4 mm Breslow thickness), the National Health and Medical Research Council has emphasized the importance of the early diagnosis of melanoma . When compared with dermatologists, General Practitioners (GPs) can be highly sensitive but less specific for the diagnosis of melanoma ; this results in a relatively high proportion of excision biopsies  and secondary health care referrals  of benign pigmented skin lesions (PSLs).
To improve the accuracy of melanoma diagnosis by GPs, a variety of diagnostic algorithms and instruments have been developed. The most widely-published, evaluated and revised algorithms are the 'ABCD'  and 'Seven Point'  checklists, each of which has a significant sensitivity-specificity trade-off [9, 10]. The most developed diagnostic instruments utilize dermoscopy, multispectral imaging, confocal laser microscopy, ultrasonography, optical coherence tomography, or magnetic resonance imaging . Short training courses in dermoscopy, the cheapest and most-evaluated method, have been shown to increase the sensitivity of GPs for the diagnosis of melanoma without increasing their specificity [12, 13]. A 2002 systematic review of dermoscopy concluded that "...dermoscopy improves the diagnostic accuracy for melanoma in comparison with inspection by the unaided eye, but only for experienced examiners" . Clearly, to reduce the number (and cost) of biopsies and referrals of benign moles, GPs require more training and better tools to improve the specificity of their diagnosis of melanoma.
The MoleMate™ system incorporates a hand-held scanner that utilizes spectrophotometric intracutaneous analysis (SIAscopy™) to produce images of the light-absorbing chromophores haemoglobin, melanin and collagen in the epidermis and papillary dermis. Certain features of these images are combined with a customized diagnostic algorithm to predict the 'suspiciousness', or 'potential malignancy' of scanned lesions, indicating the need for biopsy or referral. Using an algorithm derived from patients referred to a hospital skin cancer clinic, SIAscopy™ has been shown to have a sensitivity of 82.7% (95% confidence interval [CI] 70.3% – 90.6%) and specificity of 80.1% (95% CI 75.1% – 84.2%) for the diagnosis of melanoma . Receiver-operator characteristic analysis showed that the SIAscopy™ experts achieved a diagnostic accuracy similar to that of 11 dermatologists with 9 hours of dermoscopy training . The MoleMate™ system, which uses a diagnostic algorithm derived from patients attending primary health care clinics, has been shown to have a sensitivity of 100% (95% CI 44% – 100%) and specificity of 78% (95% CI 75% – 82%) for the diagnosis of melanoma . For comparison, a 2001 systematic review of studies of unaided clinical diagnostic accuracy for melanoma found that biopsy or referral sensitivity and specificity were 82–100% and 70–89% for dermatologists and 70–88% and 70–87% for Primary Care Physicians (GPs) . The MoleMate™ system is currently undergoing a randomised controlled trial (RCT) in general practices in the east of England.
To facilitate the learning of the assessment of MoleMate™ scans by primary health care providers, a computer program, the MoleMate™ training program, was developed by the manufacturer, Astron Clinica™, and researchers from Cambridge University. The self-administered program takes approximately 90 minutes to complete and trains users to identify the typical SIAscopic™ features of pigmented skin lesions including seborrhoeic keratoses, haemangiomas, melanocytic naevi and melanomas.
In 2007, researchers from the University of Cambridge, UK, tested the MoleMate™ training program on 18 GPs ; the aim of this study was to test a similar group of Australian GPs and compare the results.