Emerging Trends: Skin Checking Algorithms
In our new series, Emerging Trends, we are looking at those technologies in digital health that are on a certain ‘hype cycle’ – technologies and […]
Dr. Bertalan Mesko, PhD
8 min | 17 June 2021
In our new series, Emerging Trends, we are looking at those technologies in digital health that are on a certain ‘hype cycle’ – technologies and solutions that currently stand out from the rest because of their novelty, timeliness, or greatness. These are solutions everyone’s talking about or the ones they should. We are beginning with skin checking algorithms, which is definitely a course currently rising. Let’s have a deeper look.
Everyone should have a skin check done from time to time. Skin cancer is one of the most common cancer types worldwide: one in five people in the U.S. is expected to receive a skin cancer diagnosis during their lifetime. Early detection and treatment are invaluable: almost all skin cancers (both melanoma and nonmelanoma) can be cured if found and treated early. Prevention and detection are the key.
However, these two concepts failed miserably in 2020. The hardships of COVID included a general absence from all diagnostic appointments. One fearful fact dermatologists pointed out in a survey was that about 21% of melanomas might have gone undetected in 2020.
Therefore, the American Cancer Society estimated that the number of new melanoma cases diagnosed in 2021 would increase by 5.8 per cent. Telemedicine could be helpful if there were enough medical professionals to work online – but ultimately, technology could provide much more than online visits. It could actually do the job.
Dermatology takes pole position in leveraging A.I.
Multiple studies compare the effectiveness of algorithms against certified professionals. The results are plausible, and it seems the ever-present saying about A.I. in healthcare has its place here, too: “A.I. will not replace dermatologists. But dermatologists using A.I. will replace those who don’t.”
A study in Nature in 2020 confirmed that on cleaned data for selected lesions, A.I. is as good as or even superior to human experts in image-based diagnosis. Which is a good thing, considering that there’s a constant shortage of dermatologists, especially in rural areas. Therefore, it comes as no surprise that Google decided to throw their hat in the ring: the tech giant launched an A.I.-based app to diagnose skin conditions. It turns out the search titan took notice of the ten billion searches annually that were aimed at skin/hair/nail issues and acted upon. The algorithm also shows information about the particular condition reviewed by dermatologists and advises on the next steps, like offering a doctor’s appointment. And the best thing? It’s for free and works with multiple skin colours.
Dermatology apps under the microscope
But of course, Google wasn’t the first to create an A.I.-based skin checker. Pioneering the technology on the market, SkinVision started working on the technology in 2012. We reviewed the tech in 2019 and were left with generally positive experiences. Ever since the very first certified skin cancer application has continued to grow, it has also been offered to employees of companies among well-being benefits.
Not even two weeks after Google’s launch of Derm Assist, another company announced that it received the European CE mark for its smartphone-based dermatology A.I. Earlier this year, Australian-based medical investment firm Advanced Human Imaging (AHI) bought a Canadian startup, Triage, to enter the market. DermaScan is capable of screening 588 skin conditions in 133 categories with a smartphone. So it seems like an excellent investment – especially given that the CE mark validates the A.I.-powered tool throughout the EU.
How much regulation is enough?
Some researchers, however, question the accuracy and reliability of these apps. Scientists from the University of Birmingham have found that some apps had “poor and variable performance”, even though they had the necessary regulatory approval. The authors of the study were concerned about both kinds of outcomes. False positives are causing unnecessary anxiety, while false negatives may result in undiagnosed melanoma.
Hungarian-based skin checker application emdee.ai is trying to overcome this gap. The company claims to provide a ‘pocket-sized dermatologist’ by giving a prediction & prevention platform for both medical professionals and patients. I have talked with their CEO recently about how the app works and how they built the deep neural network for better A.I. performance together with Semmelweis Medical University. He explained how their system is used as a supplement to a dermatologist’s professional opinion.
Emdee.ai helps to improve the diagnostic accuracy, but the diagnosis in fact comes from the dermatologist. “The app has a version that the dermatologists and GPs can use to get a kind of second diagnosis.” And there’s also a web-based system for medical professionals supporting diagnostics: “the emdee Physician Console can be used to improve their diagnostic accuracy and store the dermoscopic and regular photos of patients.”
Nomela, another skin checker, offers professionals a CE marked rule-out screening test of pigmented skin lesions suspected of melanoma. The application provides primary care professionals with the opportunity to reduce unnecessary dermatology referrals to secondary care. The screen test is quick and easy, and gives immediate, live feedback to the trained medical professional carrying out the screening with an iPad.
Miiskin offers access to its platform for patients and providers alike. Patients can do regular checking, while physicians have access to A.I.-powered diagnostic support. The first skin checker app approved on the NHS App Library, Miiskin clearly states that it does not provide a diagnosis. Instead, “it’s simply your own tool to document changes to your skin when performing your regular skin check.”
Issues with methods
Although professionals in principle agree on the need for such apps, they often question the methods. For example, smartphone-based photo-taking might lack the clarity and the meticulous details that are very significant in skin diagnostics. Results from skin checking apps can be misleading, bringing the patients false hopes or anxiety. Their price questions the concept that these apps would help save people’s lives regardless of income inequalities or location.
Ultimately, these are my 3As for skin checker algorithms for the future:
- Accessibility: if the app works under at-home conditions with photos taken by a patient
- Analyse: can the app reliably analyse the images for the patient and not give a false reassurance that they should never have to see a doctor
- Availability: whether the service will remain available to the masses without the analysis of the follow-up being very expensive for the patient.
Using advanced technologies to reduce the number of skin cancer issues could be crucial in pushing back the disease. Although I think such apps should be widely used in the new norm and indeed, everyone should check their skin regularly, rigorous testing and assessment of their benefits would be highly needed on the market.
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