Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

One of the 3 experts was familiar with these technologies but none of the experts had used these technologies in clinical practice. None of the experts felt these technologies have been superseded.

Level of innovation

All 3 experts agreed that DERM, SkinVision, Moleanalyzer pro and nomela are innovative technologies. They noted that these technologies are innovative in providing faster, computer-assisted diagnosis. However, 1 expert noted that published evidence does not represent the current NHS clinical pathways for any of the technologies. Another expert highlighted that the technologies would add to the complexity of care in the clinical settings as both GPs and secondary care clinicians would have to be trained and maintain their skills to use them.

Potential patient impact

All 3 experts agreed that the main potential benefit would be faster diagnosis, appropriate triage of conditions and referral for further management. However, 1 expert noted that there have been no published studies assessing the usability of these technologies, which is a notable issue for patient-facing technologies. One expert stated that computer-generated decisions will always be perceived as using more robust data and providing a more accurate diagnosis than a clinician-generated decision. Another expert commented that patient-facing technologies could be beneficial for people who are comfortable using new technologies. They may feel anxious about their moles or have a large number of moles and are able to afford and access technologies which offer the potential for self-referral. All 3 experts agreed that it is too early to understand the changes these technologies could have on the current clinical pathway and if they would result in improved outcomes as these technologies are not widely used in the NHS. Two experts were concerned that if clinicians became dependant on these technologies for diagnosis, they may in the long run reduce clinician skills and experience of differential diagnosis of potential melanoma. They also noted that lack of inclusion of diverse skin types and access to digital technologies may widen health inequalities in society.

Potential system impact

Two of the 3 experts agreed that these technologies, through improved accuracy of diagnosis, will lead to system benefits by reducing the number of unnecessary visits to secondary care, and unnecessary biopsies, and ultimately increase system throughput. One of the experts was unclear on the potential system benefits of the technologies. The 3 experts stated that there would be a high initial cost associated with these technologies in terms of purchasing, maintenance of software and training of staff. However, 2 of the experts predicted that cost in the long run could be lower compared with standard care if it results in early detection of melanoma and appropriate referral and treatment. One expert highlighted that a clear health economic assessment of these technologies needs to be done to ascertain the claimed benefits as healthcare costs come from diverse sources. Two of the experts noted that the optimal positioning of these technologies in the care pathway is crucial in reducing healthcare costs and that block pricing would be a better model than price per use. One expert highlighted that the current positioning of these technologies varies, so their potential impact and resource consequences will also vary. One expert noted that for the adoption of these technologies, robust clinical governance considerations need to be in place to address issues such as data protection, interoperability of the technologies within the NHS system, diagnostic coding and patient safety needs.

General comments

One expert stated that dermatology knowledge and experience among GPs is lacking and that these technologies could support GPs in making accurate diagnoses. Another expert stated that these technologies should be used in combination with the person's full clinical history to reduce the number of referrals to secondary care. All 3 experts agree that these technologies act as an addition to the current clinical methods for diagnosis of melanoma. One expert did not think NICE guidance for these technologies would be necessary as the current published guidance already covers the use of a dermatoscope by GPs and in a secondary care setting. Another expert felt there was insufficient evidence to support NICE guidance, and a third expert thought that there would be value in NICE guidance. In terms of factors that could hinder adoption, 1 expert highlighted that a lack of appropriate regulatory approvals that can be obtained with unpublished data could possibly contribute to the lack of confidence in the efficacy and safety of these technologies in real‑world settings. Two other experts noted system compatibility issues; in particular, systems that recommend onward referral to secondary care need full electronic referral system compatibility across institutions.