Diagnosing skin cancer usually includes cutting into a suspicious spot and then waiting anxiously for the sample to be sent, examined under a microscope, and reported. But a new and painless imaging procedure takes less than an hour.
Post editors interviewed dermatology specialist Babar K. Rao, M.D., of The Skin & Cancer Center of New York, The American Skin & Cancer Center, NJ, and West Coast Skin & Cancer Medical Center, California, to find out more about VivaScope laser technology to diagnose basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma, the most deadly of all skin cancers.
The advanced device system, in use in a growing number of clinical dermatology practices across the country, provides more accurate examination of deep skin layers than previously possible without removing tissue. Post editors asked Dr. Rao about the type of worrisome skin lesions that might still require pathologist-read biopsies:
Dr. Rao: Current limitations of the current VivaScope device are related to lesion position and thickness. Many lesions that concern dermatologists or patients are located in easy-to-reach places on the skin. Sometimes, however, skin cancer occurs on the ears and sides of the nostrils—locations that are hard to access with any instrument, including the VivaScope. Future modifications of the device are expected to make it easier to manage these areas. In addition, some lesions may be too thick to visualize with the VivaScope. But most early skin lesions seen by dermatologists are thin.
Post: Is the new technology covered by insurance providers?
Dr. Rao: Medical insurance reimbursement is a complicated system. There are two facets to this technology: imaging and reading. To date, no insurers make payments for the imaging, so patients pay for this from their own pockets. But some insurers are paying for reading the images as the process is very similar to today’s standard; both involve looking directly at cells. The device maker is actively working to help experts understand the imaging and reading components to ensure that patients have access to this technology in the short term.
Post: Is it difficult for physicians to learn how to utilize VivaScope technology?
Dr. Rao: A physician or his assistant can learn within a few days to acquire what we call “confocal” images. In contrast, reading these images and using them to make a diagnosis is not for all physicians. In general, a skin pathologist would have the expertise to interpret these cases. The training curve involves becoming familiar enough with the equipment to feel confident in making the diagnosis, so it’s important that the image reader gain as much experience as possible.
We will be hosting a CME-accredited training course in confocal image interpretation at the UDMNJ Robert Wood Johnson School of Medicine in May of 2011 that will assist skin pathologists and dermatologists to further their education and experience. A variety of other education options exist today, including online training, in-person training courses and lectures and discussions at the American Academy of Dermatology society meetings.
Post: What do patients think of the new technology?
Dr. Rao: Patients are very excited and curious and they want to know more about it. Given the option, most people prefer to avoid being cut. Many patients with a history of skin cancer have had numerous biopsies and I’m happy that my practice can offer an alternative to some of them.
Post: Are there any misconceptions about the device that you can address?
Dr. Rao: There is a general feeling among dermatologists that the VivaScope tool is too expensive for use in the private-practice. This simply isn’t true. I have two VivaScopes, one in my Manhattan practice and one in my Fresno practice. The Company has made it quite easy for me to access, use, and grow my practice with this device.
Another misconception is that this noninvasive imaging tool is still in development, but the VivaScope has been FDA-cleared since 2008, and its manufacturer has since been further refining the device system to fit within the current workflow of the practice.
Post: What advantages does the new technology offer to you as a dermatologist?
Dr. Rao: Personally, for the first time in my dermatology experience, I can see cellular details of disease versus normal tissue without cutting. I know when I must excise a lesion and when I can be confident in leaving one alone. Early detection is the key to management of skin cancer and this device is changing the way that we detect, follow, and manage the disease.
Only your physician can determine whether VivaScope technology from Lucid, Inc., is best for you. For more, interested readers can find a doctor in their area who utilizes the advanced imaging system or request an information packet for their doctor.