By Daniel M. Siegel, MD
Dr. Siegel is cinical professor of dermatology and director, procedural dermatology fellowship, State University of New York Downstate.
Q: In the past six years I have had four surgeries – two for stage II melanoma, one for a precancerous mole, and most recently, one for a squamous cell carcinoma. I have great confidence in my doctor, but I can’t stand the endless repetition of search, cut, and biopsy. Are there any other methods by which someone like myself could be diagnosed, without enduring biopsies?
A: At present, examination by a skilled dermatologist followed by biopsy of suspicious lesions is the gold standard. With your melanoma history, examination every 3–6 months for three years, then every 4–12 months for two years, then annually for life is currently recommended by the National Comprehensive Cancer Network (http://www.nccn.org/). While biopsies are not fun, they are far less traumatic than surgery for advanced cancerous lesions. It sounds as if your dermatologist is on top of the problem; be thankful to him or her for finding these potentially life-threatening problems.
Nonetheless, several existing techniques may help your doctor decrease the need for biopsies:
Dermoscopy is a technique whereby the dermatologist examines a lesion using a hand-held instrument called a dermoscope, equipped with a special polarizing light and standard magnifying optics. (The lesion may or may not be placed in a fluid medium for better visualization.) The technique allows evaluation of specific, minute pigment patterns, enhancing differential diagnosis. Learn more about this technique at http://www.dermoscopy.org/.
MelaFind is another noninvasive instrument that can assist in early diagnosis of melanoma by providing physicians with a recommendation for whether a suspicious lesion should be biopsied. It uses light of multiple wavelengths to capture images of suspicious skin lesions and compares the data against a database of melanomas and benign lesions.
Electro-Optical Sciences, the company behind the development of MelaFind, has a binding Protocol Agreement with the FDA. The device is currently in pivotal clinical trials and could be generally available as of late 2008. If approved, MelaFind would be the first and only melanoma diagnostic device to be cleared for sale in the U.S. For more information, visit http://www.eosciences.com. UPDATE: In November 2011, MelaFind was approved for use in the US by the FDA.
Siascopy (http://www.astronclinica.com/technology/siascopy-explained.htm), or spectrophotometric intracutaneous analysis system, is yet another imaging process that may allow the physician to tell the difference between benign moles and melanoma. Like Melafind, it employs multiple wavelength illumination of clinical and dermoscopic images, but requires physician interpretation, while Melafind provides diagnosis in a completely automated system.
Other noninvasive diagnostic techniques are also in development, including confocal scanning microscopy, similar to ultrasound (which is also being explored for skin cancer diagnosis), except that it uses laser light instead of sound. These and other techniques are all being tested and refined. However, all lesions must be evaluated in the context of an entire clinical skin examination, and nothing substitutes for an experienced clinician’s knowledge and intuition in deciding which lesions must be investigated further. It would be impractical to evaluate every single pigmented lesion with these new techniques; only those considered different or suspicious should be subjected to such in-depth evaluation.