For the trained clinician, an experienced eye can provide guidance to address developing skin conditions. But for doctors like Elaine Gilmore, a practicing dermatologist for 15 years who has seen skin cancer cases rising, the final answer usually comes from histopathology — the identification of cells and tissues under a microscope. Given that this is labor-intensive and time-consuming, imaging technologies can make this process more efficient, so that skin clinic personnel can triage when a biopsy of a lesion is necessary.
And yet, moving a new technology into a dermatologist’s workflow is no easy task. Gilmore said she sees anywhere between 40 and 50 patients a day, so any required specialty training or bulky equipment can inhibit the usefulness of a new technology. She was involved in a study during which she and other doctors collected images via reflectance confocal microscopy of numerous conditions, such as pigmented lesions, nonmelanoma skin cancers, and more. While Gilmore was not directly involved in the analysis of those images, she noted it is apparent that certain conditions are increasing, such as basal cell carcinoma and squamous cell carcinoma, as well as inflammatory conditions, such as periorificial dermatitis, an acne-like condition around the mouth, eyes, and nose.
It isn’t always easy to differentiate benign neoplasms from malignant lesions, and that identification is essential for expediting treatment. Some researchers see artificial intelligence (AI) as a tool to make these decisions more seamless, which I describe in my feature on AI in dermatology. Gilmore sees AI as potentially useful but believes it can also lead to erroneous conclusions by those who don’t understand the context of a patient’s overall skin health. So, researchers at institutions like UCLA and the Memorial Sloan Kettering Cancer Center are trying to develop effective virtual staining methods and image databases that can provide valuable guidance, often with the aid of software algorithms and hand-held devices, while allowing clinicians to make the final diagnosis. Read more here.
Other features in this issue cover imaging techniques that can help guide real-time decisions in dermatology. A team from the University of Nottingham is combining Raman spectroscopy with autofluorescence imaging to guide successful surgery of basal cell carcinoma; learn about this approach here. And Adam Wax and David Miller discuss the evolution of systems designed to bring optical coherence tomography — long at use in ophthalmology — into the dermatological space to evaluate the structure of the skin; find these developments here.
Given that laser technology is often used for the direct treatment of the skin, a group from the University of Applied Sciences Zwickau has created a reproducible method for evaluating skin damage from common methods in laser therapy; read about their experiments on here. The use of lasers to treat acne scarring is the subject of 3 Questions with Eric Bernstein from the Main Line Center for Laser Surgery.
Enjoy the issue!
Douglas J. Farmer
