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Confocal microscopy of skin cancers: technology, clinical advances, early impact on patient care

Milind Rajadhyaksha, PhD

Reflectance confocal microscopy (RCM) images nuclear, cellular and morphologic detail in human skin in vivo, and can detect melanocytic and non-melanocytic skin lesions with sensitivity of ~90% and specificity of ~70%. When RCM imaging is combined with dermoscopy to noninvasively guide the diagnosis of melanoma and basal cell carcinomas, the specificity increases by ~2X and the benign-to-malignant biopsy ratio decreases by ~2X, compared to that with dermoscopy alone. Dermoscopy combined with RCM imaging is now being implemented to rule out malignancy and biopsy, sparing patients from biopsies of benign lesions. In January, 2016, following more than two decades of technology development, commercialization and clinical research, RCM imaging was granted current procedural terminology (CPT) reimbursement codes by the US Center for Medicare and Medicaid Services. In this seminar, we will briefly review the current state of the field, including early impact on skin cancer care, and then review the latest progress in the emerging area of peri-operative RCM imaging of margins to guide treatment.

Milind Rajadhyaksha develops and translates confocal microscopes for noninvasively guiding diagnosis and therapy of skin cancers. His work spans the entire spectrum from laboratory bench-top research through commercialization through translational and clinical studies to clinical implementation, and he enjoys working in the so-called "valley of death" (and living through near-death experiences) between laboratory and clinic and between academia and industry. Two of his microscopes have been commercialized (VivaScopes, Caliber Imaging and Diagnostics), one for imaging skin in vivo to guide diagnosis and one for imaging margins ex vivo to guide surgery, and are now being used in clinics, with promising early impact on patient care. He wildly fantasizes about a future in which multimodal optical imaging, performed directly on patients and/or excised fresh tissue at the bedside, may routinely guide an integrated "one stop shop" diagnosis-and-treatment approach (which is already being demonstrated in a couple of settings).

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