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Optical biopsy may combine skin cancer diagnosis and therapy

10 Feb 2017

Laser-based reflectance confocal microscopy offers combination of real-time diagnostics and triage.

by Ford Burkhart
Reflectance confocal microscopy (RCM) is gaining new prominence as a non-invasive optical imaging option on the frontiers of diagnosis of skin cancers.

That’s according to Manu Jain, a research pathologist and optical imaging specialist at the Memorial Sloan Kettering Cancer Center (MSK) in New York City, who is leading the effort to study its potential and train a new generation of physicians to incorporate the technology into routine clinical workflow.

Jain is hoping to one day expand RCM’s strengths and looking to the possibility of a future “dream machine” capable of real-time diagnosis and triage of skin lesions.

RCM promises improved detection of basal cell skin cancers in vivo, in the form of an optical biopsy, Main told a conference dedicated to optics-based translational technologies at last week’s BiOS Symposium, part of the wider Photonics West event in San Francisco.

“There has been nothing quite like RCM for in vivo diagnosis of skin cancers in clinics,” she said during the “Optical Biopsy: Pathway to Clinical Translation” session.

Traditionally, diagnosis and management of skin cancers relies on a histopathological confirmation via an invasive biopsy that can also cause complications like bleeding and infection, making repeated biopsies undesirable.

RCM provides a way for physicians to perform a non-invasive diagnosis in real-time, and to triage skin lesions for subsequent management.

In the clinic, RCM provides a whole-field of view of lesions and allows imaging at a depth up to 200 µm.

“It makes for a smart laser technology,” added Milind Rajadhyaksha, a mechanical and optical engineer and researcher in the Optical Imaging Laboratory, part of the Dermatology Service at MSK. “In the past, the laser was used to simply burn out the lesion, but with RCM you can ask how deep you need to burn,” he said. It allows for more selective ablation by combining diagnostics and therapy.

Training required
RCM has recently been granted the required “current procedural terminology” (CPT) reimbursement code, a billing code required for procedures in clinical use, although currently it is used in only a few select centers, like MSK, Jain said.

“As a novel technology, physicians needs to be trained to read RCM images and integrate this technology successfully in clinics” she added. Jain will herself train new generations of residents and fellows to make a better diagnosis and improve patient care.

To further improve the diagnostic capability of RCM, Jain said she is working with a team of engineers at MSK on new devices on the path to creating her “dream machine”.

About the Author

Ford Burkhart is a writer based in Tucson, Arizona.

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