Laser Technology Diagnoses Melanoma

[Whiskeyjack]

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I just read an article abt a new laser technique developed in Germany by LTB Lasertechnik Berlin thats looking very promising for diagnosing skin melanoma in vivo. They claim a near 100% sensitivity and 100%specificity ( n=100) so far including melanoma in situ. Not clear on the exact physics (I'm still struggling with dist=speed x time) but it involves the propensity for melanin in the tumour to fluorecse (diff from normal skin) when stimulated by laser wavelengths.
They've been working on it for a while and have apparently hit jackpot with a pulse length that drowns out the other fluorophores in the skin. it's said 90% of biopsy's for melanoma are neg. so you could see how this could be big business.
Question for DP's is the impact in numbers that lost tissue samples for melanoma query's will have cause I'm not under any illusions that this nifty piece of equipment will be headed straight for the front office in derm clinics and not our back office labs. Also depends I suppose on how brave dermies are in letting clinically suspicious tumours remain in situ w/o being ruled out by histo.
In general, pathology is in dire need of some technology boost cause there appears to be a shift away (in thinking if not practice) from the long held paradigm of surgeons and other clinicians that "tissue is the issue" when it comes to diagnosis. This is a problem for us because the way things stand, at present and in our immediate future, tissue is most definitely still
OUR issue(and I mean bread, butter, noodles and clothes for kids issue).

 

[djmd]

I just read an article abt a new laser technique developed in Germany by LTB Lasertechnik Berlin thats looking very promising for diagnosing skin melanoma in vivo. They claim a near 100% sensitivity and 100%specificity ( n=100) so far including melanoma in situ.

Hrmm maybe they could have made up better numbers to not look like total BS...

 

[yaah]

Early studies are always so promising. The probably looked at completely obviously clinically benign nevi vs very clinically atypical ones.

Any change in practice with these things, especially in the current litigious atmosphere of this country, is likely many many years off. People aren't going to trust machines when a pigmented lesion looks atypical. There are other things, don't forget, besides melanoma that can present as pigmented lesions. Do you ignore the pigmented basal cell or pigmented DFSP because it doesn't fluoresce like a melanoma?

 

[docbiohazard]

Blue nevus, anyone? I agree with djmd - the numbers sound far too good to be true, and with Yaah, they probably compared melanomatous skin to something completely benign. I'd love to see their actual published studies, if they exist.

Dermatologists LOVE cutting stuff off. I can't imagine private practice dermatologists wanting to invest money in a super expensive instrument (probably) that's only going to dictate if they cut off a mole or not, a relatively low reimbursement procedure I'm guessing... especially when the consequences of *missing* a melanoma or other skin cancer is gigantic in terms of legal liability. I don't see it happening. Now if it's a pulsed light instrument for those photofacials, well, they'll be all over it... 🙂

These guys should work on figuring out how to use their light device to target melanomatous cells with a photoactivated chemotherapy agent or something - there's a million dollar idea for ya.

BH

 

[Ale]

I just read an article abt a new laser technique developed in Germany by LTB Lasertechnik Berlin thats looking very promising ...

The people at Rice University are working with a similar thing in oral and gastrointestinal lesions. A friend worked for a very short time with a company from NY doing it in melanomas. Basically, they look at the lesions in different wavelengths and make a color map. They can detect and map in-situ lesions. What they can tell for sure is: the lesion begins here and ends here. Very promising results and cheap.

The people at Rice make the cameras with consumer electronics, ~$1000 for the hardware. So far they are very accurate in the “this is the benign tissue and this is the malignant tissue”. The group that was working on melanomas had also very good results.

Let’s see what happens with all the dysplastic nevi, leukoplakias, and reactive/inflammatory lesions. I am sure that if you can’t tell them apart on the microscope it is going to be very difficult to tell apart on imaging.

 

[Matte Kudesai]

These guys should work on figuring out how to use their light device to target melanomatous cells with a photoactivated chemotherapy agent or something - there's a million dollar idea for ya.
BH

Screw chemotherapy agents... How about a nanobot that targets the melanomatous cells and rides the light device like a wave to the lesion like the Silver Surfer...

(Just saw Iron Man and it was awesome)