After exclusions, the AI autonomously discharged 31% of patients at one hospital and 25% at the other, with no clinician involved. Teledermatologists then discharged a further 24% and 25% respectively.

The autonomous pathway performed better than standard care on several system-level measures. It cut the proportion of patients needing routine follow-up from 27% to 12% compared with standard teledermatology. Biopsy rates also fell: 27% under the AI-supported pathway versus 43% for conventional face-to-face care.

In total, the researchers estimate the autonomous pathway saved 2,851 hours of clinician time compared with a traditional face-to-face pathway—a gain of roughly 62% in clinical capacity. Based on 20-minute consultations, that saving translates into more than 8,500 additional face-to-face appointments over the 16-month study period.

Safety monitoring and limitations

Safety monitoring formed a central part of the study. In a national dataset that included both study sites, the system's sensitivity exceeded 98% for invasive melanoma, squamous cell carcinoma and basal cell carcinoma. Specificity—the proportion of benign cases correctly identified as such—was 72.1%.

Six false-negative cases were discharged from the pathway: five basal cell carcinomas and one melanoma in situ, meaning an early-stage melanoma confined to the outer layer of skin. Post-market surveillance caught all six. No adverse outcomes emerged within the available follow-up period, though the researchers acknowledge that follow-up was limited.

Dr. Lucy Thomas, the study's lead author, said: "We believe the greatest value of autonomous AI lies not in the technology itself, but in the specialist capacity it unlocks. Every hour saved reviewing low-risk lesions can be reinvested in patients with skin cancer, helping them access timely treatment to improve prognosis, and in patients with severe inflammatory skin disease, where earlier access to specialist care and effective treatments can transform quality of life."

She also stressed that safety is an ongoing process rather than a checkbox. "One of the key lessons for us is that deploying an AI system safely isn't a one-off exercise," Thomas said. "You need to keep monitoring it, understand when things go wrong, learn from those cases and make sure patients themselves know what to look out for."

The findings come from two hospitals in one health system, and the results remain preliminary until peer-reviewed publication and replication elsewhere. Thomas framed the technology as a complement to specialists rather than a replacement: "If these findings are replicated across larger populations and different health care settings, autonomous AI could become an important part of creating a more sustainable dermatology service—not by replacing dermatologists, but by allowing scarce specialist expertise to be focused where it can make the greatest difference to patients' lives."