sungam

This is fantastic and I would do something similar if I had the same resources.

Whole genome sequencing and single cell sequencing are actually surprisingly inexpensive (compared to the cost of almost any cancer treatment) and there is a good argument that we should do this by default for any type of cancer for which there are not effective treatments.

I would encourage all patients to learn as much as possible about their own diagnosis. There may be clinical trials available in another centre that your clinician is not aware of or tumour-agnostic trials that target specific mutations that are present in a range of different cancers.

There is a good argument for allowing patients to try experimental treatments once standard treatments are exhausted. The provider liability issues could easily be solved by legislation. A bigger issue is that there will always be people who want to exploit vulnerable cancer patients by charging exorbitant amounts for plausible-sounding treatments which have no evidence base.

As an individual trying multiple experimental treatments at once is the logical approach if there is no other option. However it will not be possible to know which of these is effective and which have caused side effects so to develop more effective treatments we do need structured and carefully controlled clinical trials. Unfortunately there is a huge regulatory burden for any kind of clinical trial at present and this should be massively streamlined for cancer patients where even if the treatments cause harm the alternative is death.

Performing the procedure requires a high level of skill in interpreting scans (angiograms) in real time.

In fairness, while I’m sure it didn’t work out for all of them, one of these students became one of the youngest self made billionaires in history

This is true, however I am sure that AI-based image analysis will also replace some of the work of dermatologists eventually so nobody is safe...

Not at the present time. I think if the project takes off I will move it to static hosting anyway to reduce the attack surface.

I think we are going to see more and more people in diverse fields developing applications that meet the requirements of a small niche that may not have been economically viable previously.

Not tried but my guess is ChatGPT will be quite accurate but get a small proportion wrong. The challenge with skin cancer is that we cannot afford to miss even 1:10,000 cases

For an experienced front end dev yes - for the average dermatologist no chance!

This is true - there are more than 2000 different conditions in dermatology but the most important ones to recognise are skin cancers

There would be no reason to do this - skin lesions removed are almost always sent for pathological analysis even if expected to be harmless

That's great! I used the publicly available images from the ISIC challenge dataset which are CC licensed.

Thanks - I'm glad you found it useful! I have been meaning to make it for many years but could never justify the time involved until AI made it possible.

Yes we call this the "Ugly Duckling" sign

Yes a doctor would get a history which will help, however I get a high score on these images and another skin cancer doctor that commented also got a high score so in most cases the diagnosis can be made accurately on the image alone.

There are lots of apps that do this. It's (relatively) easy to get AI to perform at the same level of a dermatologist but liability/risk management/regulation is much harder to solve

Thanks for your comment - the purpose of this app is patient education rather than diagnosis but I will definitely have a look at the relevant stats in more detail!

Will add this in next version!

It is randomized so probably just bad luck! FWIW I get a high score and another skin cancer doctor who commented also gets a high score so it is possible to make the diagnosis in most cases on the basis of these images.

Thanks for your kind words with regards to the app and well done for getting such a high score!. I agree that BCC is often subtle. My practice is also largely focused on skin cancer. I would say that the majority of melanomas (and SCCs) that I diagnose would be obvious to a patient that underwent a short period of focused training and checked their skin regularly. A possible explanation for the difference in our experience is that the incidence of skin cancer (and also atypical but benign moles) a lot higher in Australia than in the UK.

Thanks for the suggestion I will do this if I can source the images

Yes I could add this quite easily - will do in the next version

Lots of models out there but I would not trust any for diagnosis without review of a dermatologist yet. The challenge is unanticipated edge cases and managing risk/liability/regulation. I have no doubt that if a major AI company focused on this problem then these issues could be overcome with current technology but perhaps the market is not big enough to justify the investment required.

Sorry - wasn't expecting anyone to use the app or any traction on HN! Will update

Thanks for this - and thanks for maintaining this incredibly useful resource. What would be the best way to contact you?

Thanks for this - I need to look at this more carefully

I agree with you - if a patient is concerned by a specific skin lesion and requests removal then I will support this even it appears harmless particularly if it is new or changing

This is why dermatology involves risk management not just image interpretation. Yes the lesion will likely change with time. Realistically yes, if you have a melanoma that looks like a harmless mole then the diagnosis is likely to be delayed. But remember that these are a tiny proportion of all skin cancers and you are much more likely to get some other form of cancer - most of which occur internally and cannot be seen at all.

Making an app like this is (relatively) straightforward. The challenge is managing liability / risk / regulation. For individual doctors we accept that some errors will occur and there is a well defined insurance / liability framework. We do not yet have this for AI but I think it will come eventually.

Unfortunately not that useful - we could do that now by taking a very small (e.g. 2mm) punch biopsy, and if it shows melanoma obviously that is helpful and the rest of the lesion needs to be removed. The issue is that a negative result doesn't exclude melanoma elsewhere in the lesion.

I have been working with a startup to try and develop a non-invasive molecular test for melanoma so hopefully this will be possible in the future.

No - the app is just asking users to give their own opinion on publicly available images so there is no duty of care