Dreaming of a ‘spot clinic’: Scanning for skin cancer can speed up the diagnostic process

Dreaming of a ‘spot clinic’: Scanning for skin cancer can speed up the diagnostic process

The societal impact of UM research

11-03-2024 · Interview

In today’s world, the societal impact of research findings seems more important than getting published in an academic journal like Nature or The Lancet. What impact has research conducted at UM had in recent years? This week: a device that can scan suspicious-looking spots for skin cancer and provide an immediate diagnosis.

If you find a suspicious spot on your skin, your doctor will likely refer you to a dermatologist. If the spot looks like it could be skin cancer, the dermatologist will do a biopsy: they will remove a small sample of tissue and send it to a pathologist to be checked for cancer cells. Several weeks later, you’ll find out whether you have cancer or not. Dermatologist and researcher Professor Klara Mosterd thought there had to be a way to speed up this diagnostic process. With her team at MUMC+, she tested a device that can detect skin cancer on the spot.

Sun exposure

Skin cancer is on the rise, and not just among older people. “We’re seeing more young patients with spots on their faces and chests, for example”, says Mosterd. “Sun exposure is the primary cause.” Thankfully, the majority of cases involve a relatively mild form of skin cancer known as basal cell carcinoma. “Basal cell carcinoma accounts for about 80 per cent of skin cancer cases. It’s highly treatable; half the time, surgical intervention isn’t necessary and a cream will do the job. More patients are opting for this treatment. While surgery can remove all the cancer and reduce the chance of recurrence, a cream can be used to treat multiple spots at the same time. And it leaves no scars – that’s important to patients, too.”

Scanner

Several years ago, Mosterd came across an OCT scanner (optical coherence tomography) at a dermatology conference. She knew of its use by optometrists: “OCT is a great way to get a very detailed image of the eye. It has limited penetration depth, but that doesn’t matter – the eye’s retina, like the skin, is a superficial organ. MRI can provide more depth, but less detailed images.”

The scanner uses light waves to see up to 1.5 mm into the skin. Mosterd sketches a cross-section, explaining, “The top layer of the skin is the epidermis. With basal cell carcinoma, we typically see little round tumours extending from the epidermis, sometimes into the layer below: the dermis. It’s when we see spiky dots that we begin to worry – those require surgical removal.”

But as depth increases, resolution decreases, explains Mosterd. Doesn’t this mean that a biopsy, which goes deeper into the skin, would provide better results? “Not necessarily. A biopsy doesn’t show everything, either. With a biopsy, you use an instrument that looks like a tiny apple corer to remove a small sample of tissue. A scan shows the whole spot.”

Spot clinic

To Mosterd’s team, the scanner seemed to offer an efficient way to diagnose skin cancer on the spot. Its widespread adoption could save considerable time and resources. First, however, they had to verify its accuracy. “We can’t have false or missed diagnoses.” Research showed that a scan alone provided a conclusive diagnosis in 65 per cent of cases. The remaining 35 per cent of patients still needed a biopsy. “If we are not sure, we will still take a biopsy.”

So, the device proved effective. Its use in dermatology is already recommended by international guidelines, and it will soon be included in the Dutch guidelines for basal cell carcinoma, says Mosterd. Health insurance companies have also shown interest, recognising its cost-saving potential. While the scanner itself costs roughly 75,000 euros, it accelerates the diagnostic process and frees up worker time. “And it can be operated by either a doctor or a nurse.” The researchers have already spoken with one health insurance company, VGZ, which has identified the method as a best practice. However, there are still some steps to take before it can be put into widespread use. “Only a handful of people in the country know how to operate the device, and they’re all here. Maastricht is a leading centre for skin cancer treatment and research in the Netherlands.” To train more people, an online training programme has been developed.

Hospitals will also need to make room for the scanner, and departments are often pressed for space. “Setting up separate ‘spot clinics’ – outpatient clinics dedicated to skin cancer scanning – could be a solution.”

With the new method, patients will be spared a biopsy with a three-millimetre “apple corer”. And rather than spending weeks waiting for a phone call from their dermatologist, they will receive their results almost immediately after the scan. If they turn out to have basal cell carcinoma, 50 per cent of cases can be treated with a cream. These patients will be able to leave the clinic with a prescription in hand.

Photo: Ellen Oosterhof

Categories: news_top, Science
Tags: dermatology,skin cancer,scanner,MUMC+,instagram

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