Artificial intelligence (AI) technologies for assessing and triaging skin lesions referred to the urgent suspected skin cancer pathway: early value assessment

DERM is an artificial intelligence (AI)-based skin lesion analysis technology intended for use in the screening, triage and assessment of suspected skin cancer lesions in people aged 18 or over. DERM can be used within teledermatology services after referral from primary care. It is intended to be used as an automated tool or with a healthcare professional review (known as a second read), to decide if further assessment by a dermatologist is needed. A smartphone is used to take images of skin lesions using a dermoscopic lens attachment, and the images are uploaded to the online platform. The DERM platform uses an AI-based fixed algorithm (it does not update itself automatically) to analyse the dermoscopic images and provide a suspected diagnosis of the lesion. If DERM labels the lesion as benign, the person is discharged from the urgent suspected skin cancer pathway and is sent the results with safety-netting advice. If DERM labels the lesion as pre-cancer or cancer, an NHS dermatologist reviews the case virtually and decides on a management plan for the person. DERM can classify lesions as one of the following types: melanoma, squamous cell carcinoma, basal cell carcinoma, intra-epidermal carcinoma, actinic keratosis, atypical nevus or benign lesions (this includes benign vascular lesions, seborrheic keratosis, dermatofibroma, solar lentigo and melanocytic benign nevus). If a lesion has features of more than 1 lesion type, DERM uses a risk hierarchy to classify it as the more severe suspected lesion type.

The cost of an assessment using the online DERM platform is £30 per referral. There is an extra cost of £8.20 per referral if NHS teledermatology staff virtually review a case to decide on the most appropriate outcome. The total price can be discounted to £35.90 per referral if the subsequent biopsy results from the lesions that have been assessed by DERM are shared with the company. It costs an extra £17 to have a case reviewed by the company's second-read dermatologist. The company states that these costs include training and data storage. DERM has a class III CE-mark certification.

The committee agreed that Moleanalyzer pro is out of scope for this assessment because it is not intended to be used for triaging lesions referred on the urgent suspected skin cancer pathway. The technology's intended use is for assessing pigmented lesions. It is designed to provide additional information to help inform a decision on whether to do a biopsy.

Skin cancer is an abnormal growth of skin cells and most often develops on skin that has been exposed to the sun. There are 3 major types of skin cancer: melanoma, squamous cell carcinoma and basal cell carcinoma. There are also other rare skin cancers. The first assessment of a skin condition is done by a GP in primary care, to determine the appropriate referral pathway. Section 1.7 on skin cancers in NICE's guideline on suspected cancer describes the criteria for urgent referral of suspected skin cancer. People whose lesions are referred on this pathway should be given a diagnosis or ruling out of cancer within 28 days of being referred by their GP.

Historically, GPs directly referred everyone with suspicious skin lesions for a face-to-face appointment with a consultant dermatologist, using the urgent suspected skin cancer pathway. Direct referral to face-to-face appointments is still used for people with multiple suspicious lesions, a history of skin cancer or other risk factors, or when other clinical pathways are unavailable in the local area or are unsuitable.

NHS dermatology services need to reduce backlogs and delays in providing face-to-face appointments because of limited staff, including dermatologists. The demand from an increasing number of urgent referrals for suspected skin cancers can mean that face-to-face appointments for people with other non-cancer skin conditions are delayed. This includes people with painful and debilitating inflammatory skin conditions. In 2022, the teledermatology pathway was introduced to support early diagnosis of skin cancer. It provided the opportunity for digital images to replace face-to-face appointments for people referred to the urgent suspected skin cancer pathway. This evaluation assesses the benefits of using AI technologies within teledermatology services.

This assessment has 2 comparators, urgent teledermatology services and urgent face-to-face secondary care dermatology appointments. Comparisons are discussed between DERM used within teledermatology services and teledermatology services alone, and DERM used within teledermatology services and face-to-face dermatology assessment alone.