Is This the Future of Skin Cancer Treatment?
Summer’s almost over, which means we need to soak up every second of air-dried waves, sweaty outdoor runs, and smock dress weather that we can. Just one quick q as you tick the boxes on your summer bucket list—when was your last skin check?
It’s estimated that over 9,500 people are diagnosed with skin cancer every day (although that number could actually be much higher right now due to pandemic-related delays). While the vast majority of these cases are highly treatable non-melanomas like basal and squamous cell carcinomas, the experience still takes a physical and emotional toll, notes Orit Markowitz MD, a dermatologist at OptiSkin Medical and assistant professor of dermatology at Mount Sinai in New York City.
Typically, a dermatologist will biopsy anything suspicious they come across during a skin check. “You get a cut, have it sent to the lab, and then maybe the next week receive the results over the phone,” says Dr. Markowtiz. “If it needs treatment, then that’s another appointment to have it removed.”
But Dr. Markowitz has established a method for diagnosing, measuring, and clearing many skin cancers—in just one appointment.
To start, she performs a virtual biopsy instead of a surgical one via Reflectance Confocal Microscopy, or RCM. The optical imaging technique takes snapshots of skin at 30-fold magnification. “This way, you get an immediate diagnosis,” she notes.
If the lesion does turn out to be cancer, the gold standard for any nonmelanoma is Mohs Surgery. (It boasts a 99 percent cure rate, according to the Skin Cancer Foundation). Initially conceived by Frederic Mohs when he was just a medical student working in the University of Wisconsin’s zoology lab, the procedure involves surgically removing and inspecting skin tissue layer by layer. Extremely precise, it allows the surgeon to clear only the cancerous cells, leaving the healthy ones intact.
The downside? It’s surgery, says Dr. Markowitz—something most people would choose to avoid if given an option. “Sometimes the process leaves behind scarring or a hole in the skin that then needs to be reconstructed,” she adds. To circumvent surgery—or optimize it—Dr. Markowitz utilizes another advanced technique, Optical Coherence Tomography.
OCT uses infrared, broadband light to measure a tumor’s depth (sort of like an ultrasound) providing the doctor with the blueprint of what and how much needs to be removed. Research published in Experimental Dermatology and Case Reports in Dermatology, among other journals, indicate that using OCT accurately captures a tumor’s margin and, when used prior to surgery, reduces unnecessary cutting.
Depending on the case, Dr. Markowitz often completes her noninvasive protocol with laser therapy to remove the cancer, employing nonablative devices like pulsed dye or thermal resurfacing, which are lasers that are typically used to minimize signs of aging. A retrospective study—published in Cutis and led by Dr.Markowitz—found that, when compared to surgery, nonablative laser management was an effective alternative treatment for basal cell carcinoma with an improved cosmetic outcome, that included less downtime and reconstruction needed after the fact. “I had one patient who came in for a very extensive basal cell that spanned below her eye all the way down to her mid-cheek,” says Markowitz. “As we were treating her basal cell, the dark circles under that one eye had pretty much disappeared.”
At the present time, skin tech like RCM and OCT is primarily found at university medical centers, not dermatology offices. A survey in Dermatologic Clinics found that only 11 percent of dermatologists even sometimes incorporate emerging technologies like these into routine skin checks. In the U.S., they can be more costly for the dermatologist and for the patient—they necessitate specific training for doctors, and at the moment, OCT isn’t covered by insurance as it’s still considered to be in an investigational phase.
With continued research, however, Dr. Markowitz hopes to change that. In a small pilot study of her approach published in Cutis, 100 percent of basal cell carcinomas were cleared—82 percent in the same appointment they received diagnosis. “Back in 2008 when I began this protocol, I thought of this as an alternative to Mohs surgery,” says Markowitz. “Now I would consider Mohs surgery to be the alternative.”
One of the best ways to prevent skin cancer? Wear sunscreen:
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