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Hats off to the University of Heidelberg

Well maybe not hats off, we are a company that encourages people to be sun smart after all! So we shall leave our hats on and offer a round of applause instead. 

The University of Heidelberg has published a paper in the Annals of Oncology that demonstrates the important role that artificial intelligence (AI) can play in melanoma detection. At Skin Analytics this is something that we have believed for a long time. This paper is another example of high quality research that backs us up.

In simple terms, The University of Heidelberg customised the Google Inception Network and trained it to recognise melanoma. They then prepared 100 images of skin lesions, some of which were melanoma, so that that could compare the diagnostic ability of AI and dermatologists.

On one side there was the specifically trained AI network and on the other side 58 qualified dermatologists. Each side reviewed the images, provided diagnoses and the results were then compared. The outcome showed that AI was better at identifying melanoma than the dermatologists.

It is probably important to say that in our opinion the test that was run by the University of Heidelberg was probably a little biased towards AI. Clinicians don’t only view an image to make their decision, they use many other factors too and removing these factors is a little like asking you to do up a button without using your thumbs.

By any measure, this study is rather exciting because it shows that AI has a huge role to play in finding melanoma earlier to help improve survival rates. (If want you can read the paper here).

When it is all said and done we believe that dermatologists and AI can work in tandem to help improve the health outcomes for skin cancer patients. That is why at Skin Analytics we are focused on delivering a solution that works with clinicians, not in place of them. A small but important difference.

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16 Questions... A Lifesaver?

Is it possible for 16 simple questions to help save your life? Yes, it really is.

QIMR Berghofer has released an online test that helps to identify whether you are at a high risk of developing melanoma within the next 3 and a half years.

This is significant because melanoma is the most deadly form of skin cancer. According to the World Health Organisation over 132,000 cases of melanoma are diagnosed every year. Time is crucial with melanoma because in its early stages it is almost always survivable. But as it develops, it becomes more difficult to treat.

So time is an important factor in combating melanoma, but in modern life time can be in short supply. It is unlikely that you will notice a new mole as soon as it starts to develop on your body. Or an old mole as it starts to change. Once you do notice, it can take weeks or even months to remember to see a doctor about it. That is exactly why an instant online test is so valuable.

By studying the skin of over 40,000 people, the team at QIMR Berghofer were able to identify the key predictors of melanoma. They converted this knowledge into a fast, accurate and easy to use online quiz. Taking the quiz can help to establish your risk of developing melanoma within the next 3 and a half years.

A quiz may not take the place of regular skin check-ups, but it can help you find out how at risk you really are. As they say, being forewarned is being forearmed. Knowing you are in a high risk group can help motivate you to actually make that appointment to see a doctor. And with melanoma that extra time may be critical.

Do yourself a favour, take the quiz. 16 questions, 60 seconds. It might just help to save your life: https://publications.qimrberghofer.edu.au/Custom/QSkinMelanomaRisk

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AI Standards for Healthcare

Are we on the verge of releasing skynet on the world? Not even close, but a set of standards for the application of AI to healthcare is overdue.

Would then stifle innovation or provide us with the landscape to deliver real value to the healthcare industry? That was the question I asked myself time and again after we were recently invited to an event run by Nesta and BSI and attended by other small firms such as the NHS, Google Deep Mind and Babylon Health.

We were all sitting in a rather dreary room along Victoria Embankment here in London debating the role of regulation and standards for AI used in healthcare. At Skin Analytics we’re generally advocates for proportional regulation based on the risks and associated impacts. The new Medical Device regulations are a great step I believe as many Class I products, such as ours, are outside the risk profile that was originally envisaged software was capable being.

Ultimately, the last thing we want to see is innovation being suppressed under volumes of red tape. At the same time, we’re trying to change healthcare, meaning that we’re dealing with people’s health and that’s not an area to “move fast and break things” for fairly obvious reasons.

Back to our dreary room however, and we proposed a number of areas that need to be part of any standards developed in this area but there are two I feel quite strongly about

The first is the requirement for a well designed clinical evaluation that is suitable for the approach and intended use of any AI service. Desk based research just doesn’t cut it in the world of AI. Too often we see the real world performance of an AI system to be significantly below expectations. Only a prospective clinical study can meet this requirement.

The second is defining an algorithm update process that ensures that no AI system in healthcare is evolving without a clear set of acceptance criteria for any modifications to the algorithm. In our world this means building a test set that is held apart from the training data and enables new versions to be benchmarked against the old. 

These shouldn’t stifle innovation in any way. Good clinical evidence is the lifeblood of evidence based medicine and there is simply no way around it. Services that go around the medical community should be closely scrutinised by the regulatory authorities to ensure adequate evidence exists. 

Dispelling the myth that all AI is updating itself in unknown ways is important and defining the release of improved versions of any solution is a core part of any well designed software process. 

Delivering value in healthcare requires any innovator to ensure that they are delivering a quality solution that enhances or improves the health outcomes in a cost effective way. 

That may take longer to deliver and consequently more blood, sweat and tears from founders but it if those principles are at the core of the idea, you will be more likely to achieve your goal. Unless skynet takes over that is.

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What you need to know about Melanoma, Vitamin D and UV exposure

The dangers and benefits of sun exposure are significant and complicated. 

On one hand sunshine includes ultraviolet light, or UV, which is able to penetrate the skin’s surface and interact with the melanocyte cells there. If this damage is not repaired by the body, it can lead to the development of melanoma.

So for a long time the pervading message from public health bodies is to avoid harmful UV radiation by staying out of the sun and applying sunscreen. 

However, the studies show a different relationship between the type of sun exposure and melanoma. Intermittent exposure, mostly associated with sunburn has been shown to cause melanoma. But studies show those who work outside and are exposed to the sunshine all the time have no increased risk.

So what is going on here? Firstly it is important to say that we don’t know for sure. Yet. 

One of the answers there is growing evidence for is that Vitamin D may have a role to play. And this is where it gets contentious.

The same UV wavelengths that causes damage to the melanocytes, helps to produce Vitamin D. We need Vitamin D for a whole range of things and the vast majority of what we get is from exposure to the sun.

And increasingly there is evidence that higher levels of Vitamin D may reduce the severity of melanoma.

So it seems like a good point to recap what we’ve covered.

Sunlight = UV exposure

UV exposure = mutations to melanocytes which if unrepaired, lead to melanoma

UV exposure = Vitamin D production

Higher Vitamin D levels = may lead to lower incidence of melanoma

As you can see UV exposure seems to cause melanoma and increase Vitamin D levels which may reduce melanoma. 

An award winning medical journalist recently wrote a well thought out article talking about the health of a suntan. 

However, if you take only that away from this article, it would be a mistake in our opinion.

Dermatologists in the US are very clear that Vitamin D production is limited with sun exposure. So while 10-15 minutes sun exposure will increase Vitamin D, after that it will start to lower it again.

The relationship between melanoma, Vitamin D and UV exposure is indeed complicated. But there are some very clever scientists working very hard to help figure it out.

For the time being, we’re going to enjoy the sunshine responsibly. We’re not going to avoid it but we are going to make sure we limit the amount of UV we expose our skin to.

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The importance of knowing your own skin

Want to know the secret of surviving melanoma?

It’s simply knowing your own skin. 

Why, because the most sensitive indicators of melanoma are either a changing mole OR one that looks different from all your other moles. 

So if you spend the time to get to know your own skin and that of your family, you’re giving yourself the best chance to find any suspicious moles earlier. And if you can do that, you’re giving yourself the best chance to deal any potential melanomas while they are just getting started and not nearly as dangerous.

Remember, melanoma is still a rare disease, so you don’t need to spend your life being worried about it. It does pay, however, to get to know your skin so if anything is a bit odd, you find it fast.

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Not been to see the doctor yet? This might be why.

It seems simple doesn’t it? You notice something concerning, book an appointment and head to the doctor to get it checked out. Easy – as a patient all you have to do is get yourself there and the doctor will do the rest.

And yet delays in seeking medical advice, particularly in relation to suspected cancer, are a well-documented occurrence.

We’re particularly interested in this phenomenon as a result of our work with melanoma. 

Keep reading

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When to worry about a mole

What do moles look like?

Moles can range in colour. They are generally medium to dark brown but can also be skin-coloured or black.

The majority of moles are flat, relatively even in colour and regular in shape. Some moles are raised and these are usually soft to touch and lighter in colour.

Who should check their moles?

Everyone should check their moles, at least every 3 months. But if you have developed new moles, or a close relative has a history of melanoma, you should examine your body once a month.

Which ones should you worry about?

Moles to worry about are those that look different to other existing moles. Dysplastic moles are moles that look different to ordinary moles and may evolve to melanomas. If you have multiple dysplastic moles you are at greater risk of melanoma.

If you have any moles that are larger than most, have smudgy or irregular edges, are uneven in colour or have some pinkness, you should see a doctor and get them checked.

Any moles that appear newly in adulthood should be checked. The most concerning sign, however, is a changing mole. So that’s what we check for. If you notice a change in colour or shape, or the mole becomes itchy, painful or starts to bleed, see a doctor immediately.

Below is a handy guide written by the SunSmart charity in Australia. 

You’ll notice it’s sometimes very hard to tell the difference between a mole and a melanoma.

An important characteristic is change. Melanoma, by definition is a mutation of cells, which means they grow out of control. So the best way to spot a melanoma is to look for moles that change.

We can help you do that at Skin Analytics but regardless if our service is right for you, keep an eye out for changing moles and keep your family healthy.

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To screen or not to screen, how do we save more from melanoma?

“There's not enough evidence to weigh the benefits and harms of performing routine visual examinations to screen for skin cancer.��

This is the conclusion from the U.S. Preventive Services Task Force in a recently concluded review of screening.

But not everyone agrees and there have been formal statements from dermatology groups opposing the conclusions. What is clear is that screening the entire population comes with significant costs and with significant over treatment, including biopsies. 

Over treatment is a feature of medicine and not a sign of poor care but of a complex problem and while not pleasant for those involved, it’s significantly better than metastatic disease from a spreading melanoma. The associated costs though, can cripple already struggling healthcare systems who have to prioritise other medical interventions.

All of this debate is based on two facts.

Firstly, you have to see a lot of people to find melanoma with lifetime risk less than 2% even in countries of high melanoma rates like Australia and New Zealand.

Secondly, of all the lesions sent for biopsy to rule out melanoma, only roughly 4-5% of them turn out to be melanoma. The procedure is safe, relatively cheap and the consequences of missing melanoma are devastating, so clinicians don’t take any chances.

Combining the two means there is a lot of cost to find a melanoma. Which is where we think the technology we’re developing has such utility. We’re using Artificial Intelligence (AI) to decide whether a lesion needs to be biopsied and right now the performance suggests we can accurately reduce the number of biopsies to find a melanoma. Significantly.

If you combine the fact that we can provide assessments for a low cost to anybody who is concerned, we can change the economics of population based screening.

We like to think that means we can make a skin cancer screening service available to everyone and if we can do that, we can make sure that more people survive the disease.

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Crowdfunding - a view from the trenches

It’s day 5 of our crowdfunding campaign and the tension in the office is palpable. 

As I write this, we have £169k pledged of our £450k round meaning we’re doing well. But I also know that success comes with momentum and our next goal is to get up to £225k within the next 5 days. If we can do that, we’ll be on the hot list and get further exposure and improve our chances of closing the round.

Thinking back on our decision to raise a round through Crowdcube and I have to say we were a little naive. The amount of work on both sides to put together a campaign is very significant, not least because every claim needs to proven during due diligence. 

I had to take one of my team off the site because getting her transcript from University of Cambridge was taking too long and we couldn’t prove she’d been there otherwise!

For all the pain, the Crowdcube team have been great and protecting the integrity of the information benefits everyone. Investors can trust what they read, start ups can really compete on the quality of their work and Crowdcube can make sure that their sourced deals are the best out there.

Back to Day 5 though. The support of the 48 investors who believe in what we’re trying to do has been great. To think there are 48 people (so far!) who have chosen to spend their hard earned money on trying to beat melanoma with us makes me very proud.

Momentum is our word of the day, time to get shouting from the rooftops!

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Summer’s over - can I stop my skin checks?

Here in London we've noticed it getting a little chillier over the last couple of weeks. Winter coats are coming out and central heating is going on.

But we also know summer's over because our summer surge of site visits is starting to drop off. We always get a peak of people visiting our website during July and August but that starts to reduce as Autumn approaches.

It's understandable - we think it's because skin cancer tends to be in the news during the summer and sun protection is nearer the top of most people's to do lists. It may even be because summer clothes mean people can see more of their skin and so notice abnormal lesions or moles. 

It's great that awareness increases during the summer and we know it's a key opportunity to help people become more skin aware.

But we also want you to know that your risk of developing skin cancer is the same whatever the season. Winter may be here, but your mole checks are as important as ever.

That's because the main cause of melanoma is long term sun damage. Sustaining 5 or more severe sunburns in childhood can increase your risk of developing melanoma - at any point - by 80%. And that risk doesn't go away just because you're wearing your winter coat.

Your skin checks need to be regular. We want you to pay as much attention to your skin in the winter as you do in the summer. 

Read our popular guide on how to check your moles and stay skin safe all year round. 

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The best way to tackle melanoma?

Melanoma is one of the fastest growing cancers in the world and it disproportionately affects young people. 

Current global survival rates are up at around 75%. That's good, but until it's 100%, we need to do better.

So where do we start?

Melanoma, like any cancer, can be broken up into stages, starting at Stage 1 in the early stages and then progressing to Stage 4 as the cancer spreads. 

When melanoma is caught at Stage 1, survival rates are up around 95%. But when it’s caught at Stage 4, survival rates plummet to around 5-20%.

Cancer treatments are improving all the time but as we can see late stage treatments aren't always successful. They do of course improve survival time and that's very important - but they usually aren't a cure and we need huge advances to make a dent on survival rates.

So what can we do to dramatically improve survival rates and catch that 25%?

What if we could make sure that no melanoma ever progressed beyond Stage 1 when survival is up at 95%? Perhaps so we get to live in a world where almost everyone survives melanoma. Wouldn't that be great?

That relies on all melanoma being caught in Stage 1. Which relies on everyone who has one spotting it early, going to the doctor and getting a diagnosis. 

It seems simple - but it's not easy to check your moles and know what you're looking for. In a recent study by the British Association of Dermatologists, 95% of people were aware that skin cancer rates are rising but 77% said they weren't confident in identifying the symptoms of melanoma.

Education is vital. But we also believe that technology has a huge role to play here. Why not let the latest in pattern and image recognition software help us out a bit? How about we train a machine to do some of the hard work and help us feel more confident when doing our skin checks? Well that's exactly what we're working on at Skin Analytics. 

Here's how it works:

1) Get a high quality image of a mole using a dermascopic lens, just like a dermatologist would use.

2) Run the image through our image processing algorithms (which are well trained and tested, just like a dermatologist).

3) Get an analysis of whether or not the mole needs to be reviewed by a dermatologist. 

The concept is simple but the science behind it is anything but. 

We want to make sure that everyone can screen themselves confidently and safely at home. We want to get that survival rate as near to 100% as we can.

We'd love to know what you think. Please get in touch on support@skinanalytics.co.uk

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Technology in service of your health

Recent advances in medical imaging enabled a large quantity of high quality data to be collected. However, most of that data goes unseen because of the data explosion problem and the time constraints. At the same time the ubiquity of smartphones and improvement in the embedded sensors create amazing opportunities for medicine.

Existing routine skin cancer checks are not only time-consuming (for both patients and doctors), but also dependent on the doctor’s skills. At Skin Analytics we are trying to do the same things in a bit more intelligent way, crafting algorithms that allow for automatic analysis of your moles.

It has nothing to do with magic, but rather with a smart combination of image processing techniques known for years with new data-specific methods. Our goal is to decipher information hidden in every single pixel of your skin photos.

The first step is to understand the problem itself i.e. how the doctors quantify the symptoms. The answer is: they have it in their eyes. And if doctors can spot the symptoms just by looking at your mole, why can’t we ask a machine to do the same from images?  Clinicians, instead, could spend their precious time on cases in which technology cannot give reliable answer.

In order to implement an algorithm that analyses pictures just like human brain does, we need to teach it the principles similar to those underlying our visual system. Perhaps the most exciting area of computer vision is mimicking the way people perceive the surrounding world, and this is what we do at Skin Analytics!

Technology cannot replace doctors, but it can help them to help you.

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When to worry about a mole

What do moles look like?

Moles can range in colour. They are generally medium to dark brown but can also be skin-coloured or black.

The majority of moles are flat, relatively even in colour and regular in shape. Some moles are raised and these are usually soft to touch and lighter in colour.

Who should check their moles?

Everyone should check their moles, at least every 3 months. But if you have developed new moles, or a close relative has a history of melanoma, you should examine your body once a month.

Which ones should you worry about?

Moles to worry about are those that look different to other existing moles. Dysplastic moles are moles that look different to ordinary moles and may evolve to melanomas. If you have multiple dysplastic moles you are at greater risk of melanoma.

If you have any moles that are larger than most, have smudgy or irregular edges, are uneven in colour or have some pinkness, you should see a doctor and get them checked.

Any moles that appear newly in adulthood should be checked. The most concerning sign, however, is a changing mole. So that’s what we check for. If you notice a change in colour or shape, or the mole becomes itchy, painful or starts to bleed, see a doctor immediately.

Below is a handy guide written by the SunSmart charity in Australia. 

You’ll notice it’s sometimes very hard to tell the difference between a mole and a melanoma.

An important characteristic is change. Melanoma, by definition is a mutation of cells, which means they grow out of control. So the best way to spot a melanoma is to look for moles that change.

We can help you do that at Skin Analytics but regardless if our service is right for you, keep an eye out for changing moles and keep your family healthy.

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Early diagnosis = better prognosis: Cancer Research UK

Cancer Research UK’s latest report sheds a stark light on the importance of early diagnosis.

Across 8 common cancers, including melanoma, 10 year survival was up at 81% for those caught at stage 1 and 2 but fell sharply to 26% for those caught at stages 3 and 4.

CRUK’s GP expert Dr Richard Roope said: “It’s important that people are aware of their bodies and, if they notice any unusual or persistent changes, they should see their GP.” 

Skin Analytics’ mission is to make sure that all melanoma are caught at stage 1, when they are much more easily treatable. 

Keep an eye on moles that look different to your other moles. These are called dysplastic moles and are at greater risk of evolving into melanoma.

Any moles that appear newly in adulthood should be checked. The most concerning sign, however, is a changing mole. If you notice a change in colour or shape, or the mole becomes itchy, painful or starts to bleed, see a doctor as soon as you can.

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The importance of knowing your own skin

Want to know the secret of surviving melanoma?

It’s simply knowing your own skin. 

Why, because the most sensitive indicators of melanoma are either a changing mole OR one that looks different from all your other moles. 

So if you spend the time to get to know your own skin and that of your family, you’re giving yourself the best chance to find any suspicious moles earlier. And if you can do that, you’re giving yourself the best chance to deal any potential melanomas while they are just getting started and not nearly as dangerous.

Remember, melanoma is still a rare disease, so you don’t need to spend your life being worried about it. It does pay, however, to get to know your skin so if anything is a bit odd, you find it fast.

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Not been to see the doctor yet? This might be why.

It seems simple doesn’t it? You notice something concerning, book an appointment and head to the doctor to get it checked out. Easy – as a patient all you have to do is get yourself there and the doctor will do the rest.

And yet delays in seeking medical advice, particularly in relation to suspected cancer, are a well-documented occurrence.

We’re particularly interested in this phenomenon as a result of our work with melanoma. 

Patient delay in seeking help for melanoma can have a huge impact on outcomes. If melanoma is caught early, at stage 1, it’s curable in around 95% of cases – and a simple procedure (cutting the mole out) can be all that’s needed. If it’s caught later, once it’s had a chance to grow and spread, then survival rates drop as low as 10%. So for melanoma, early detection is key.

So how do we get people to take action sooner? First we have to find out why people delay seeking help.

This report by Cancer Research UK digs deeper into the factors surrounding delay. They found that reasons for patient delays fell into roughly two categories.

The first was a lack of awareness of symptoms. Some people simply weren’t aware of the symptoms – be it a lump, unexpected bleeding, pain or a changing mole.

Lack of awareness is a familiar problem and from a public health point of view it’s a bit more obvious what we have to do  - help people understand and remember what to look out for. It’s about education and knowledge sharing.

What’s more intriguing is the second category of reasons for patient delays, relating to attitudes to cancer and to seeking help.

The top three “attitude” reasons for failing to seek help were: being worried about what the doctor might find; assuming it would be difficult to make an appointment; and being worried about wasting the doctor’s time.

For melanoma this can be particularly powerful – a patient may ask themselves all sorts of questions before seeking help.

Is that really a new mole or have I just not noticed it before? Is it changing shape or am I imagining things? What if it’s just a freckle and I’m wasting my doctor’s time? What if it is melanoma – what do I do then?

This is where we want our service to transform patient experience. We want to help people overcome the barriers in those moments by giving them a safe and effective tool to understand their symptoms and make that decision sooner. We aim to make people feel confident when checking their skin. And in that confidence we want to see better outcomes and lives saved.  

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NEWS: partnership launch with Vitality Health

We are very pleased to announce the launch of our new partnership with Vitality Health.

Vitality Health (formerly Pru Health) is one of the UK’s leading health insurers and is part of the Discovery Holdings Group from South Africa. It provides private health insurance services and a rewards incentive wellness program to the US, Europe and Australasia.

Vitality Health has recently launched an online GP service for UK customers and we are proud to announce that a Skin Analytics skin check is now part of their suite of diagnostic tests. 

Any Vitality Health customer who calls up the online GP service with a suspicious mole or lesion will be eligible to be referred for a Skin Analytics skin check. The service is available to those with iPhones in its initial phase.

Customers who are referred to Skin Analytics receive a skin check kit in the post which they can use to take high quality images for review by a dermatologist. 

Check out the service in action:

The feedback has been really positive from customers, GPs and Vitality. Our service provides high quality care in a quick and convenient way. 

We believe that our skin check service will help Vitality customers to be more skin aware and take action against skin cancer sooner.

If you would like to find out more about our work with Vitality please contact ally@skinanalytics.co.uk.