We recently spoke with Dr Daniel Keith, consultant dermatologist at North Bristol NHS Trust, about his work on the Dermoscopea project, which offers innovative dermoscopic imaging and online educational resources for specialist and non-specialist healthcare professionals.
The free digital educational tool was developed as an open-source solution which offers functional, self-assembled equipment to help “improve diagnosis of benign skin lesions and early detection of skin cancer” and “widen access to and use of dermoscopy”.
An overview of the dermoscapea project
First, Dan gave us some background about the project, which he founded in 2020 alongside his clinical fellows, Kalina Bridgewater and Amy Prideaux, to tackle some of the “financial and educational barriers” found within dermoscopy. “Proper medical dermatoscopes cost hundreds, if not thousands of pounds,” he explained, “and the equipment required to convert them and to be able to take photographs, again costs a further hundreds to thousands of pounds. So, you’re looking at costs of around two and a half thousand pounds at least to set up a dermoscopy system with an ability to take photographs.”
It was this price point that inspired Dan and Kalina to “develop a way for people to gain access to dermoscopy in a cheap and easy way” with the primary goal to “spread an educational message around dermoscopy to mostly non-specialists – people who don’t necessarily have special interests in skin disease but need that extra bit of information to help them in their consultations in the community”.
The first thing Dan and his team came up with was the loupe dermatoscope and digiscope adapter, with the loupe working as a magnifying lens with a flat glass plate on the bottom, allowing users “to replicate the effect of a dermatoscope without actually having a dermatoscope”, which Dan said costs between £10 and £40 on Amazon and eBay. As for the digiscope adapter, he highlighted its ability to “adapt either to a cheap digital camera or your own smartphone”, which meant it was also possible to bolt it onto the loupe system at a cost of around £5.
After building and testing the system, they were able to start publicising it as a way for people to get dermoscopy for less than £50 while producing “reasonable quality images that could be sent to specialists if needed”. Dan noted that the basis of the project was to offer something that “required no technical ability” and worked “for everyone”, which was why they chose to “create a website where people could find it for free and copy what we’ve done, accompanied by an educational component”.
We went onto discuss the second part of the Dermoscopea project, which Dan explained was “inspired by a Christmas cracker present”, in which he received a currency microscope for detecting forged currency through the use of ultraviolet light and white light alongside a magnifying lens. Dan and his team partnered this type of microscope with the diascopy process to create a “budget dermatoscope-like device for less than £5”.
Key successes
Next, Dan gave us an overview of some of the key successes that have come from the project, noting “over 10,000 views on the website” since 2023, “from 62 different countries around the world”, emphasising how “widely spread” this solution now is. He also mentioned how they’ve demonstrated “comparable improvements in diagnostic confidence with our devices compared to conventional dermoscopy” while also working on taking old but working dermatoscopes and donating them to low-income countries, which has been “slowly growing” as they invite different departments across the UK to donate equipment.
Dan shared that the system has “developed faster than we thought”, growing from “something that we thought was just going to be put on the internet and left available for people to use to having someone new contacting us every week, giving us ideas on what else we can add to the website”. Emphasising why this type of success is important, Dan explained how the project is “still ongoing with the intention that everyone who has signed up to the project is never going to make any profit from this, it’s just being done for free”, however he also highlighted that this “may start to become more and more of a challenge the more the project grows”.
In a survey conducted in 2024, the team found that the online educational content was “the most useful section”.
Challenges with accessibility
As one of the key drivers for the project, it was important for Dan to get the accessibility side of things right for the dermatoscope. He shared how involvement from partners from around the world helped him to see gaps that he might not have seen otherwise, including Hagar Elgezeri, a colleague from Kasr Al Ainy School of Medicine, University of Cairo, Egypt who has quite a big role in helping the team develop. Dan noted how Hagar had “commented on some of the things that we were publicising, noting that, although the solutions are great and really cheap, some of them are hard to obtain in developing countries”.
Dan mentioned how the original thought process was that “if you can get them on Amazon or eBay, you can get them anywhere in the world”, however, through his contact he discovered that this wasn’t always the case. “It turns out that was not entirely straightforward, especially in very poor countries,” he said, sharing how this one individual in Egypt was able to replicate some of the elements but that “she had to order it through her friend in Turkey, who ordered it through Turkish Amazon and then posted it to Egypt”.
However, what Dan did discover was that most of these regions have 3D printers readily available, which is what led him to consider 3D printable dermatoscope. “We’d seen someone had publicised one before and made it free for everyone, but it’s a very complicated device which requires a lot of technical ability to put together,” Dan said. “So, we gave, Jack Norris, an art and design student from Sheffield Hallam University the task of creating a 3D printable scope that could be put together with no technical ability, using easily sourced materials and no tools required. Eventually we ended up with the final products, which included a handheld dematoscope and a smartphone adapted dermatoscope,” he explained, before highlighting how printing these products together in the UK costs around £15.
Next steps and plans for expansion
Speaking on the future plans for the Dermoscopea project, Dan outlined some key projects he and the team are hoping to look at within the next couple of years, including the creation of a newer version of their dermatascope based on the feedback they get from the people who print them. “We have had some people who’ve fed back to inform us in terms of designing a better one in the future,” he said, “and one of the ideas we’ve had is to turn the design into a rolling undergraduate project, where future generations of undergraduate engineers can sign up to continue the development of the project and make better versions of it”. He went on to add how they’ve already been approached by manufacturers offering to help with “making 1000 dermatascopes for free and distributing how we want it”
Other projects include looking at an affordable way of performing a wood’s light examination, which Dan explained “is an ultraviolet test which is quite useful in low-income countries because it’s very good at picking up infectious skin disease”. He noted how this is a “fairly low-tech product that costs between £300 and £500 in a medical context, but we’ve potentially got a solution that we’re testing at the moment that costs about 40 pence”.
Finally, Dan shared how they’re looking at a “budget imaging technique for skin of colour”, which involves taking old photographic equipment and converting it at the cost of about £30, in which the team have taken a “25-year-old digital camera and modifying it in a way that might improve skin lesion diagnosis or skin disease diagnosis in darker skin”.
We’d like to thank Dan for joining us and sharing his expert insights into this topic.
