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Why we don't use "algorithms" to "diagnose" skin cancer

Apps support, rather than replace, doctors

From the beginning, clinical safety was the biggest factor in how we went about designing the SkinKeeper app.

We wanted something that both the patient and the doctor would find valuable - something that helped make this critical interaction in modern human health even richer than it would be without it.

And so, we were adamant that we would (and have) create a service that:

  • Does not replace skin assessments by an experienced health practitioner. Rather, we wanted something that would let you partner with your doctor to have a more information-rich conversation.
  • Does not make claims that it can technologically diagnose the potential of a mole being malignant. Rather, we wanted to help people simply capture photographs and comprehensive, clinically relevant information, built up over time, that could help the doctor make the best possible judgement.
  • Be genuinely useful to doctors. That’s why we tested the concept and the actual reports generated by SkinKeeper with a range of medical providers, including a leading dermatologist and several GPs (they loved it).
  • Be simple and usable to patients. That’s why we conducted usability tests with a range of people, including melanoma sufferers, people with a high risk of contracting the disease, and people who just wanted to make sure a mole was ok (they also loved it!).
  • Give the doctor the full picture. So we included recordkeeping options not just covering your moles, but also who you are, your family history, records of sunburns/tanning bed use, a range of other important and well-accepted risk factors. We also created ways for people to record medical quality mole imagery, by importing doctors' photos taken with a dermoscope.
  • Help you remember to visit a GP to check your moles. So we let you set reminders to do skin checks or visit a doctor.
  • Help you learn when to be worried enough about a mole that you see a doctor. That’s why we included high-quality medical information from cancer.gov about risk factors, pictures of skin cancers and prevention tips in a small library of health information available right from the front page menu.

In short, we worried (thoughtfully and critically) about how we help people without giving them a false sense of security, and designed SkinKeeper the way we did.

And that’s why we were adamant that, even though lots of people mentioned a series of apps in the app store that applied “algorithms” to photos of moles and “evaluated” their risk of being cancerous, we weren’t going to go there. And we didn’t. These apps made us worry, because:

  • that type of technology is not tested to the level that a cancer diagnostic to be considered clinically safe and reliable
  • we feel that people may expose themselves to a real danger of feeling reassured by the "diagnosis", and so not bothering to see their doctor, when they really, really should.

In a recent article in the Courier Mail (“Thumbs down for iPhone Apps for Mole Checks”), Queensland, Australia, journalist Jackie Sinnerton made the point, with the help of Cancer Council’s Chief Executive Professor Ian Olver, that these type of apps that tried to automatically “diagnose” skin cancer could “wrongly reassure Queenslanders that dangerous moles are low-risk and delay ‘life-saving’ medical checks.” In the words of Professor Olver, “There is no substitute for getting your skin checked by a professional.” And we totally agree.

We believe the iPhone has amazing potential as a tool to educate people about skin cancer, and help them have informed conversations with their doctor. And that’s why we designed SkinKeeper the way we have. We would like to think that our app is going to save lives, through delivering education, awareness and encouraging people to have that conversation with their doctor.

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Comments

19:55, 18 February 2012 | Author : Andrew

@Liselle apps that do use algorythms are like homeopathic remedies - all they do is stop people from getting real treatment.That's probably why your doctor would have freaked out :)

09:15, 18 February 2012 | Author : Liselle

I used to write down lots of info about my moles but Id forget to take them to my doctor. She would have freaked if I said I did not need to see her because I had an app