Research Shows OCT Images Useful for Assessing Skin Cancer Thickness
Research conducted at Guy’s and St Thomas’ NHS Foundation Trust in London has shown that a new skin imaging technology (Optical Coherence Tomography, or ‘OCT’), could be used for assessing the depth, and therefore the degree of malignancy, of the most common type of skin cancer. The work could enable greater and more effective use of non-invasive treatments for skin cancer, as an alternative to surgery, which can leave unsightly scars.
The publicly funded research, published in the peer-reviewed journal Skin Research And Technology 1 (Wiley), was performed in a collaboration between the Medical Physics group, led by Dr Andrew Coleman, and clinicians from St John’s Institute of Dermatology at Guy’s and St Thomas’, using a Michelson Diagnostics VivoSight® OCT scanner. A total of 78 patients were scanned, and then the OCT images systematically correlated with pathology from biopsies of their lesions.
Key conclusions reported by the researchers are:
The depth of superficial basal cell carcinoma (BCC) lesions less than 1 mm thick can be measured accurately using OCT
OCT imaging also has clinical value in identifying the presence of ‘peripheral cell palisading’ (a key diagnostic indicator) in BCC lesions
Currently, the thickness of BCC lesions and confirmation of diagnosis can only be assessed by taking a ‘punch biopsy’ – a sample of skin tissue – and get it analysed in a pathology laboratory. The result is usually not known for days or weeks due to the backlog of biopsy results to be analysed, and the process is not pleasant for the patient and is expensive for the health service.
Dr Katie Lacy, consultant dermatologist at St John’s Institute of Dermatology and part of the research team, said "This research is significant because it shows that OCT gives dermatologists a quick and accurate way of assessing whether a basal cell carcinoma (the most common type of skin cancer) has deeply penetrated into the dermis, or is just confined to the surface skin layers, without having to take a biopsy. This is helpful because superficial basal cell carcinomas less than 1 mm thick are more likely to respond well to non-invasive, non-scarring treatments, whereas deeply penetrating cancers usually require surgery. There is also the potential to use OCT to monitor the progress of the treatment and to confirm that the tumours have been successfully destroyed."
The annual incidence of non-melanoma skin cancer in the UK is estimated to be around 100,000 cases per year 2 , representing 20% of all cancers, and costing the NHS in England Wales at estimated £1000 per lesion to diagnose and treat 3 .
OCT is an imaging technology newly available to dermatologists. It provides detailed real-time images of sub-surface skin tissue at much higher resolution than is possible with ultrasound or other standard imaging modalities, by using a low-power laser-scanning device. Scanning is quick, safe, requires no special preparation and there are no side-effects. The first practical OCT scanner, the VivoSight® OCT scanner, is commercially available from UK firm Michelson Diagnostics, and already has CE-mark and FDA clearance for medical use in Europe and the USA.
The work was supported by a grant from the National Institute for Health Research (NIHR) under its Invention for Innovation (i4i) Programme.
Coleman, A. J., Richardson, T. J., Orchard, G., Uddin, A., Choi, M. J. and Lacy, K. E. (2012), Histological correlates of optical coherence tomography in non-melanoma skin cancer. Skin Research and Technology. doi: 10.1111/j.1600-0846.2012.00626.x
Cancer Research UK publication "Skin Cancer in the UK – 2005"
S. Morris, B. Cox & N. Bosanquet (2009) "Cost of skin cancer in England" Eur J Health Econ, 10(3), pp. 267-73.
About Guy’s and St Thomas’ NHS Foundation Trust
Guy's and St Thomas' provides a million patient contacts in acute and specialist hospital services every year. As one of the biggest NHS Trusts in the UK, with an annual turnover of around £1 billion, we employ almost 12,000 staff. The Trust works in partnership with the Schools of Medicine, Dentistry, Nursing and Biomedical Sciences of King's College London and other Higher Education Institutes to deliver high quality education and research. www.guysandstthomas.nhs.uk
About Michelson Diagnostics Ltd:
Michelson Diagnostics is a rapidly growing medical device company which has developed and brought to market a scanning device used to improve and accelerate care for patients suffering from non-melanoma skin cancer. Michelson Diagnostics’ core product – the VivoSight OCT scanner – is used by dermatologists to see below the surface of the patient’s skin, allowing them to gather additional information about their patient’s condition, and is the first of its kind available to dermatologists. Founded in 2006, Michelson Diagnostics designs highly innovative instruments using multi-beam optical coherence tomography solutions. The company is headquartered in Kent, England with US operations in South Dartmouth, MA. Further information about Michelson Diagnostics is available on the Internet at www.md-ltd.co.uk or by email to firstname.lastname@example.org.
About the National Institute for Health Research
The National Institute for Health Research (NIHR) provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world-class facilities (both NHS and university), conducting leading-edge research focused on the needs of patients. www.nihr.ac.uk
About Octopus Investments
Octopus Investments Ltd (www.octopusinvestments.com) is an investor in Michelson Diagnostics. Octopus Investments, founded in 2000, is a leading investment specialist. We offer innovative core and satellite investment solutions to UK investors, and a wide range of funding options for exceptional companies. Our core investments include a discretionary management service and a range of multi-manager multi-asset OEICs. These are complemented by our range of satellite solutions, including venture capital trusts, enterprise investment schemes and inheritance tax products. Each product has been designed to solve specific problems faced by financial advisers and their clients. 10 Jul 2012 Page 3 of 3 Our funding solutions cover the entire capital structure, from equity through mezzanine to senior debt, and we seek out outstanding management teams in unlisted companies with whom we can partner. Octopus has built its business around three core pillars: customer led innovation, excellence in customer service and the quality of our people. We employ more than 200 people and currently have more than £2.5 billion in assets under management.
For clinical use in the US FDA 510(k) K093520 applies:
VivoSight is a Multi-Beam Optical Coherence Tomography (OCT) system indicated for use in the two-dimensional, cross-sectional, real-time imaging of external tissues of the human body. This indicated use allows imaging of tissue microstructure, including skin, to aid trained and competent clinicians in their assessment of a patient's clinical conditions. US Federal law restricts this device to sale by or on the order of a physician. The Michelson Diagnostics logo and the VivoSight® name are the trademarks of Michelson Diagnostics Ltd and are registered in the UK, the US & throughout the European Union. Further information about Michelson Diagnostics is available on the Internet at http://www.md-ltd.co.uk/ or by email to email@example.com