The Committee considered the evidence on using the VivaScope systems after dermoscopy, to inform decisions on biopsy and excision of equivocal skin lesions in people with suspected melanoma and in people with suspected BCC. The Committee noted that the 2 studies (Alarcon et al. 2014, see section 5.12; Pellacani et al. 2014, see section 5.13) considered most representative of NHS clinical practice for melanoma diagnosis reported similar sensitivity values, but higher specificity values for the VivaScope systems compared with dermoscopy alone. However, the Committee also noted that the reported specificity values differed substantially between the 2 studies. The Committee considered the 1 representative study (Castro et al. 2014, see section 5.26) for BCC diagnosis and noted that although the reported sensitivity and specificity values were good, the study was small and at risk of bias because of patient recruitment and the lack of independent reviews of images. The Committee concluded that the evidence suggested that imaging using the VivaScope systems after dermoscopy had a higher negative predictive value than dermoscopy alone, but there is uncertainty in the actual accuracy values, particularly for BCC.