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High-Res Skin Imaging Expansion 'to Speed Cancer Diagnoses'

NHS England (NHSE) has announced that the use of high-resolution skin imaging or 'teledermatology' is to be substantially expanded to help speed up diagnoses of skin cancer.

The technology involves a small lens the size of a 50p piece attached to a phone camera, also called a dermatoscope, to take high-spec images of spots, moles, or other lesions. It can enable a dermatologist to double the number of patients reviewed in a day. 

The British Association of Dermatologists (BAD) said on its website that there had been "a substantial uptake in the use of teledermatology and remote consultations across the majority of dermatology departments in the UK". 

The devices enable differentiation of benign and malignant skin lesions and allow benign lesions such as seborrhoeic keratoses to be identified without needing a biopsy. They can identify cancerous lesions including basal cell carcinomas, squamous cell carcinomas, and malignant melanoma. The use of teledermatology can speed specialist review and so increase clinic capacity where face-to-face consultations are still required.

Teledermatology Rollout to be Accelerated Across the Country 

At present teledermatology is used in only about 15% of trusts offering dermatology services, but NHSE said that the rollout will be accelerated and it should be available to all areas of the country by July this year. Tens of thousands of patients could benefit from speedier diagnosis and treatment of skin cancer, it said.

In addition to specialist use, the use of dermatoscopes will also be expanded across GP practices to support faster diagnosis for people living in more rural areas and avoid the need to travel for specialist appointments, according to NHSE. 

The Royal College of General Practitioners is supportive of dermoscopy use in primary care. "With training it is most useful in excluding the common benign lesions that can mimic skin cancers, including seborrhoeic keratoses, haemangiomas, sebaceous hyperplasia, dermatofibromas, comedones and benign moles," it said, adding: "It also has a role in detecting the most recognisable pre-cancerous lesions, including Bowen's disease and actinic keratoses."

NHS Trusts have also been asked to expand the use of teledermatology within community diagnostic centres, 108 of which are now open and offering skin checks in local areas.

Increasing Numbers of Patients Checked for Skin Cancer

More than 600,000 people were referred for skin cancer checks in the last year, NHSE said, which was an increase of 9% over the previous year and double the number sent for checks almost a decade ago. Due to teledermatology, some hospitals had been able to diagnose and treat virtually all skin cancer patients within 2 months of an urgent GP referral. More than 56,000 patients with skin cancer received NHS treatment last year. 

Somerset GP, Dr Tom While, said: "Being able to get a swift and specialist opinion on a skin lesion or rash, and advice on treatment or local surgical options, often negates the need to refer the patient on to another hospital to see the specialist in person. This not only reduces waiting lists, but strongly benefits my patients who live in rural areas, saving them from long unnecessary journeys. 

"If a patient does need to be referred on to a specialist, then the teledermatology service helps to streamline that process, ensuring the patient is seen in the correct clinic at the right time." Dr While described it as "a fantastic service and an asset to rural general practice", and was "hard to imagine working without it".

Artificial Intelligence Could Speed Diagnosis Even More

The NHS is also trialling the use of new technology that uses artificial intelligence (AI) along with magnifying lenses to assess skin lesions "within seconds". Deep Ensemble for the Recognition of Malignancy (DERM) is currently the only technology marketed in the UK as an AI medical device. It has been shown to identify melanoma, non-melanoma skin cancers and other conditions accurately from historical images of suspicious skin lesions.

Initially it will be used alongside clinician assessments, but the hope is that it will provide both faster and more accurate skin cancer detection. During an earlier testing phase, DERM was shown to have helped avoid around 10,000 face-to-face appointments. 

NHSE chief executive, Amanda Pritchard, said: "Record numbers of people are being checked and treated for cancer and thanks to efforts to ensure people come forward with worrying symptoms, we are now diagnosing a higher proportion of cancers at an early stage, increasing people's chances of beating this cruel disease. 

"There is no denying that increased demand has placed huge pressure on services, but championing the use of digital technology and new ways of working is key to reducing waits and is exactly why we are accelerating the use of teledermatology. It is a small piece of kit that has the potential to speed up diagnosis and treatment for tens of thousands with skin cancer.

"We are going a step further even and expanding the use of artificial intelligence lenses in teledermatology to diagnose skin cancers, and this is proving highly effective in areas that have trialed the technology so far."

Asked to comment by Medscape News UK, Cancer Research UK's director of evidence and implementation, Naser Turabi, said: "Teledermatology is a technology that has the potential to speed up the diagnosis of skin conditions, including skin cancer. While it's positive to see initiatives by NHS England that set out to reduce waiting times for diagnosis and treatment, to ensure the greatest benefit for all patients across the country and deliver the best value for money this innovation needs to be backed by sufficient funding and training for staff."