Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studiesBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m127 (Published 10 February 2020) Cite this as: BMJ 2020;368:m127
All rapid responses
Re: Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies
My name is Zeljko Ratkaj, and I am CEO of TeleSkin ApS, the company that developed the mobile application skinScan.
While I totally support the paper finding and conclusions that you have based on thorough analysis, I must notice one thing. It was mentioned in the paper the following:
“SkinScan was evaluated in a single study of 15 moles with five melanomas. The app did not identify any of the melanomas.”
Based on the following reference:
Chadwick X, Loescher LJ, Janda M, Soyer HP. Mobile medical applications for melanoma risk assessment: false assurance or valuable tool? 47th Hawaii International Conference on System Sciences; 6-9 January, 2014;2675-84.
Application skinScan in the form it is known was mostly developed during the year 2014 and 2015, and it was released in Denmark (only in Denmark) in August 2015. In 2016, we released in Norway and other Scandinavian countries, and in NZ, Australia and UK we released the app in 2017 and 2018. We had this huge window of releases because, even though we had Class I Medical CE certification, we wanted to be compliant with the medical rules in the countries where we released the app. That is why we, for example, still have not released the app in Germany, because being compliant with German medical rules is rather complex and for us, as a small company, very hard to achieve.
That is also why is rather impossible that our app was the study subject in the paper that was being referenced to. This paper, since it was released officially in January 2014 (in Australia) was probably conducted during the year 2012/2013, and at that time, our app was just an idea because we were still in the process of app analysis and applications for our internal use, primarily as a follow up tool for doctors and patients in Serbia.
I was one of the authors that published the paper:
“Melanoma screening with skinScan, Windows mobile phone application, 8th World Congress of Melanoma, July 17 – 20, 2013, Hamburg, Germany, Congress Center Hamburg (CCH)”
and we had a pilot app for internal use (not published) where we discussed the possibility of using this kind of app for screening purposes. We conducted the study internally on the Dr. Jadran Bandic (one of the IDS board members at that time) private clinic “ORS Hospital”, Belgrade, Serbia. And we still believe that the strongest side for this kind of app is in the medical screening area as a telemedicine and follow up tool, but there are still lot of obstacles for this idea to come to life.
In 2013, we also received Microsoft Health Users Group 2013 Innovation Awards, Innovation in Flexible Mobile Workstyle Solutions, for this solution that was an image gathering tool with ABCDE questionnaire without any kind of image analysis, coupled with an “Ask our Doctor” service, where the users were sending the cases to certified doctors. Again, in that period of time we were still primarily following the idea of a screening tool.
Because of all of the mentioned above, it is really impossible that our app was the subject of the study in Australia, since they mention the SkinScan app developed for iOS platform and our iOS version of the app was released in 2015.
We had a similar situation with the paper:
Ferrero et al. ” Skin scan: A demonstration of the need for FDA regulation of medical apps on iPhone. JAAD (2012)68,3,515
And we had several unpleasant situations where we needed to explain that we are not the company and the app that was mentioned and that everyone can check us and the company on the internet. It is just that the “skinScan” name is really catchy and lot of companies were (and some still are) using the name without right to use it.
Zeljko Ratkaj, CEO
Competing interests: No competing interests
We have been made aware that the app named “SkinScan” in the Chadwick et al 2014 study is not related to the current “skinScan” app produced by TeleSkin (https://teleskin.org/) as we infer in the paper. It appears that there was more than one app using the name SkinScan at the point in time when the study was done. Chadwick et al indicate that the version of the “SkinScan” app they evaluated later became SkinVision. Thus we now believe that the data we described as relating to SkinScan would better be described as being for the an early version of the SkinVision app. We apologise to Teleskin for this error.
The review currently contains no data on the accuracy of the any version of the SkinScan app from TeleSkin. We have been made aware of an unpublished study of the TeleSkin SkinScan app which we will endeavour to add to the review. The TeleSkin SkinScan app is CE marked and is available for download as described in Table 1 of the paper.
Competing interests: No competing interests