OCT Technology Improves Diagnosis of Skin Cancer

MedicalResearch.com Interview with:

Orit Markowitz, MD Director of Pigmented Lesions and Skin Cancer The Mount Sinai Hospital and Assistant Professor of Dermatology Icahn School of Medicine at Mount Sinai Director of Pigmented lesions clinic Brooklyn VA, Brooklyn, NY Adjunct Professor, Dermatology SUNY Downstate Medical Center, Brooklyn, NY Chief of Dermatology Queens General Hospital, Jamaica, NY

Dr. Orit Markowitz

Orit Markowitz, MD
Director of Pigmented Lesions and Skin Cancer
The Mount Sinai Hospital and
Assistant Professor of Dermatology
Icahn School of Medicine at Mount Sinai
Director of Pigmented lesions clinic
Brooklyn VA,
Adjunct Professor, Dermatology
SUNY Downstate Medical Center, Brooklyn, NY
Chief of Dermatology
Queens General Hospital, Jamaica, NY

MedicalResearch.com Editors’ Note: As part of an ongoing series of occasional article on cancer prevention, Dr. Markowitz from The Mount Sinai Hospital discusses skin cancer and the use Optical Coherence Tomography in skin cancer diagnosis and treatment.

MedicalResearch.com: How common is the problem of non-melanoma skin cancer? Are they difficult to detect and treat?

Dr. Markowitz: Skin cancer is the most commonly diagnosed cancer in the United States. Non melanoma skin cancers, including basal cell carcinomas and squamous cell carcinomas, are the most common malignancies of the skin, constituting around 80 percent of all skin cancers. The annual cost of treating skin cancers in the U.S. is estimated at $8.1 billion, with $3.3 billion for melanoma.

MedicalResearch.com: Are you seeing more invasive skin cancers with the advent of biologic therapies or in transplant patients?

Dr. Markowitz: Any immunosuppressive such as those given to transplant patients or even biologic therapies such as those used to treat psoriasis lower one’s immunity and thereby increases their risk of developing skin cancers. These patients at times are covered in non-melanoma skin cancers and require more aggressive treatment as well as benefit from non-invasive monitoring since they have such an extensive tumor burden. See below a transplant patient we treated with disseminated pre-cancers and skin cancers.

Majdy Albahhar MD, Juliya Fisher, and Orit Markowitz MD “A case of Disseminated Superficial Actinic Porokeratosis (DSAP) successfully treated with a combination topical therapy” American Academy of Dermatology; Summer Meeting, 2011.

MedicalResearch.com: What is Optical Coherence Tomography? How does it help dermatologists detects, monitor and treat skin cancer?

Dr. Markowitz: Noninvasive imaging techniques, including optical coherence tomography (OCT) are increasingly being used in research and clinical settings to assist in the diagnosis and treatment of a variety of skin conditions. OCT is appealing because it enables real-time in-vivo vertical and cross-sectional visualization of the tissue microarchitecture down to a depth of 2mm.4 There are many reports in the literature showing the usefulness of OCT in the diagnosis and treatment of non-melanocytic lesions of the skin, including basal cell carcinomas, squamous cell carcinomas and actinic keratosis.

Markowitz, Orit, Michelle Schwartz, Eleanor Feldman, Amanda Bienenfeld, Amy Katlowitz Bieber, Jeffery Ellis, Usha Alapati, Mark Lebwohl, and Daniel Siegel. Evaluation of Optical Coherence Tomography as a Means of Identifying Earlier Stage Basal Cell Carcinomas While Reducing the Use of Diagnostic Biopsy. The Journal of Clinical and Aesthetic Dermatology 8.10 (2015): 14-20. Web.

MedicalResearch.com: How does OCT reduce the amount of tissue needed to completely excise a BCC or SCC?

Dr. Markowitz: OCT has been shown to increase the sensitivity and thus improve the false positive rate of correct diagnosis over clinical examination alone, thereby reducing the costs and cosmetic concerns associated with unnecessary and invasive excisions of suspicious skin lesions.4 The use of OCT has also been shown to be useful in defining tumor margins of non-melanoma skin cancers beyond the clinically apparent extent of tumor prior to resection.

  1.  Pomerantz R, Zell D, Mckenzie G, Siegel DM. Optical Coherence Tomography Used as a Modality to Delineate Basal Cell Carcinoma prior to Mohs Micrographic Surgery. Case Rep Dermatol Case Reports in Dermatology. 2011;3(3):212-218. doi:10.1159/000333000.
  2.  Wang KX, Meekings A, Fluhr JW, McKenzie G, Lee DA, Fisher J, Markowitz O, Siegel DM.Optical coherence tomography-based optimization of mohs micrographic surgery of Basal cell carcinoma: a pilot study. Dermatol Surg. 2013 Apr;39(4):627-33. doi: 10.1111/dsu.12093.
  3.  Alawi SA, Kuck M, Wahrlich C, et al. Optical coherence tomography for presurgical margin assessment of non-melanoma skin cancer – a practical approach. Experimental Dermatology Exp Dermatol. 2013;22(8):547-551. doi:10.1111/exd.12196.

MedicalResearch.com: Is OCT readily available? Complicated to use? Expensive? Covered by insurance?

Dr. Markowitz: It is more available in Europe where there is compensation by insurance for non-invasive imaging. It is fairly easy to use but does require additional training. The cost of the device is similar to other laser devices and is not covered by insurance.

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