ASICA

ASICA is a smartphone app that reminds people with melanoma to conduct a TSSE, guides them through how to do a high quality TSSE and helps them to take action if any concerning skin changes are noticed. The module below outlines how ASICA works.

We know that if melanoma survivors check the skin all over their body once per month, they are more likely to spot if melanoma has come back or a new one has appeared. They can then get the right medical attention at the earliest stage.

First, the app prompts people that it's time to check their skin and reminds them how to do it properly with detailed animated videos. When they find something concerning on their skin, they can send a photograph and a text describing it to a specialist who will check it over and get back to them.

The ASICA research project began in 2012 with the aim of understanding how technology could be used to support people with skin cancer (specifically a melanoma). In a series of linked studies since then we have sequentially developed the app. You can find full details of all of these studies in the publications linked below.

In the first step we developed a mock-up which we tested with healthy volunteers at a workshop. We used the information from this workshop to design a working proto-type which was used for 6 months by 19 people living in Grampian who had been affected by melanoma. We observed how people used ASICA and conducted detailed feedback interviews and focus groups with all those involved. This allowed us to create an improved prototype which we tested in a proper randomized clinical trial. We recruited 240 people from Grampian and Cambridge. Half of them (120) carried on with their normal follow up care only and the other 120 of them used ASICA for one year. We then compared their experiences and found that those who had used ASICA had checked their skin more regularly, felt happier and in a few cases had had skin problems picked up and dealt with more quickly. Overall, those who had used ASICA said they had found it really useful.

From the trial we have learned that ASICA worked well for many users. It helped them to remember to check their skin and then acted as a useful guide to support them to do it thoroughly. Because the evidence for ASICA supporting this aspect of skin-checking was so strong we are now making a simplified version incorporating this function for people to use and download.

While ASICA was helpful and users liked it, we found two big problems during the trial.

First, certain people found ASICA quite difficult to use. These included people who felt too busy, didn't plan when to conduct skin checks in advance, were less confident about checking their skin or who reported problems with their mental health.

Second, we found that when concerns arose (about 5% of checks overall) some ASICA users struggled to provide photographs that were clear enough and information that was detailed enough for the specialist to be able to review and address quickly.

We are now working to solve both problems:

1. We are working with melanoma survivors to learn how to tailor ASICA to the needs of different individuals. For example, how can ASICA support users to create and act on plans about skin checking? What timing of reminders will work best for people who are busy? How can we better support users who struggle with their mental health?
2. Can we develop a “Chat-bot”, a computer programme that has conversations with the user, to help to ensure that ASICA always collects all the information needed by the specialist? Can we introduce technology that lets users know immediately if photos are not clear enough and supports them to take and send better quality photos?

AI will contribute to this ASICA from two prospects: skin image quality assurance and image quality enhancement suggestion generation in an automatic way. There will be a AI model to assessment the quality of skin images taken by patient and a smart elicitation engine (chatbot) to guide patients to submit high quality images and detailed text descriptions.

Are you aged 18 or over? Have you been treated for stage 0-2 cutaneous primary melanoma within the last 5 years? If you answer yes to both questions and would like to help us develop the ASICA app further, please contact us at asica@abdn.ac.uk.

We have designed a course for primary healthcare professionals to improve their skills in triaging skin lesion images like those patients who are using the ASICA app may send to them.

• Create an account and take the course
• Read about the development of the course

• Ntessalen M, Krasniqi A, Murchie P. Development and piloting of an online course to improve knowledge, confidence and attitudes towards triaging images of skin lesions submitted online in primary care. BMC Med Educ. 2024 Aug 5;24(1):839. doi: 10.1186/s12909-024-05840-1. PMID: 39103798; PMCID: PMC11301848. - https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-024-05840-1
• Yi, D., Hua, Y., Murchie, P. & Sharma, P. Label-free Medical Image Quality Evaluation by Semantics-aware Contrastive Learning in IoMT. IEEE Journal of Biomedical and Health Informatics. 2023 (E-pub ahead of print); DOI: https://doi.org/10.1109/JBHI.2023.3340201 - https://ieeexplore.ieee.org/document/10347351
• Ntessalen, M., McCorkindale, S., Krasniqi, A., Morgan, H., Allan, J. & Murchie, P. Barriers and facilitators of adherence to the use of ASICA, a digital app designed to support melanoma survivors: concise report of a qualitative study. Clinical and Experimental Dermatology. 2023; 48 (12) 1358-1360. DOI: https://doi.org/10.1093/ced/llad279 - Barriers and facilitators of adherence to the use of ASICA, a digital app designed to support people previously treated for melanoma: concise report of a qualitative study | Clinical and Experimental Dermatology | Oxford Academic
• Reilly, F., Wani, N., Hall, S., Morgan, H. M., Allan, J., Constable, L., Ntessalen, M. & Murchie, P. User Experiences of a Digital Intervention to Support Total-Skin-Self-Examination by Melanoma Survivors: Nested Qualitative Evaluation Embedded in a Randomized Controlled Trial. JMIR Dermatology. 2023; 6 (12) e39544. DOI: https://doi.org/10.2196/39544 - https://derma.jmir.org/2023/1/e39544
• Murchie, P., Constable, L., Hall, S., Brant, W., Allan, J., Johnston, M., Masthoff, J., Lee, A., Treweek, S., Ayansina, D., Proby, C., Rahman, K., Walter, F., Burrows, N., Durrani, A. & Maclennan, G. The Achieving Self-directed Integrated Cancer Aftercare Intervention for Detection of Recurrent and Second Primary Melanoma in Survivors of Melanoma: Pilot Randomized Controlled Trial. JMIR Cancer. 2022; 8 (3) e37539. DOI: https://doi.org/10.2196/37539 - https://cancer.jmir.org/2022/3/e37539
• Allan, J. L., Johnston, D. W., Johnston, M. & Murchie, P. Describing, predicting and explaining adherence to total skin self-examination (TSSE) in people with melanoma: a 12-month longitudinal study. BMJ Open. 2022; 12 (8) e056755. DOI: https://doi.org/10.1136/bmjopen-2021-056755 https://bmjopen.bmj.com/content/12/8/e056755
• Reilly, F., Constable, L., Brant, W., Rahman, K., Durrani, A., Burrows, N., Proby, C., Allan, J., Johnston, M., Johnston, D., Walter, F. & Murchie, P. Achieving Integrated Self-Directed Cancer Aftercare (ASICA) for melanoma: How a digital intervention to support total skin self-examination was used by people treated for cutaneous melanoma. BMC Cancer. 2021; 21 (15) 1217. DOI: https://doi.org/10.1186/s12885-021-08959-2 - https://bmccancer.biomedcentral.com/articles/10.1186/s12885-021-08959-2
• Murchie P, Masthoff J, Walter FM, Rahman K, Allan JL, Burrows N, Proby C, Lee AJ, Johnston M, Durrani A, Depasquale I, Brant B, Neilson A, Meredith F, Treweek S, Hall S, McDonald A. Achieving Self-Directed Integrated Cancer Aftercare (ASICA) in melanoma: protocol for a randomised patient-focused pilot trial of delivering the ASICA intervention as a means to earlier detection of recurrent and second primary melanoma. Trials 2019; 20: 318 https://doi.org/10.1186/s13063-019-3453-x - https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3453-x
• Adam R, McMichael D, Powell D, Murchie P. Publicly available apps for cancer survivors: a scoping review. BMJ Open 2019; 9 (9) e032510. DOI: https://doi.org/10.1136/bmjopen-2019-032510 - https://doi.org/10.1136/bmjopen-2019-032510
• Johnston M, Allan J, Brant B, Dennis M, Hall S, Masthoff J, Walter FM, Murchie P. Increasing skin self-examination after melanoma: an intervention using text and tablet delivery. F1000Research 2016,5:302(poster) DOI: https://doi.org/10.7490/f1000research.1111394.1 - https://f1000research.com/posters/5-302
• Murchie, P., Allan, JL., Brant, W., Dennis, M., Hall, S., Masthoff, J., Walter, FM. & Johnston, M. (2015). 'Total skin self-examination at home for people treated for cutaneous melanoma: development and pilot of a digital intervention'. BMJ Open 2015; 5 (8) e007993. DOI: https://doi.org/10.1136/bmjopen-2015-007993 - https://bmjopen.bmj.com/content/5/8/e007993

In the course of our work to develop ASICA we have become involved in two key international collaborations:

• The MELSELF project, of which Prof Murchie is a co-investigator, is being led by the University of Sydney, Australia and is investigating how smartphone technologies can support melanoma Australian patients to do regular skin checks. We have contributed our instructional videos in support of the project.
• We are also working with a team from Augusta University, Georgia, USA to determine whether a simplified version of ASICA developed for both android and apple phones can support melanoma patients living in rural areas of Georgia and South Carolina to remember to conduct a monthly skin check.