please note that you can click on the pictures above to freeze the transitioning
OCT- GUIDED SKIN CANCER REMOVALS & "BIPHASIC PDT"
Not all skin cancers need to be surgically removed. Many basal cell cancers (BCC) and some types of squamous cell cancer (SCC) can be removed without surgery.
Standard surgical removal is in fact a poor option for some superficial types of BCC and SCC.
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We offer optical coherence tomography (OCT) scanning of skin lesions. A scan takes less than 20 seconds. With this device, we can make a diagnosis of skin cancer and can accurately determine its depth. We can then remove the skin cancer and can repeat the scan after the removal to check it has been cleared.
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The OCT technology is extremely useful when paired up with non-invasive treatments,
particularly photodynamic therapy (PDT).
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PHOTODYNAMIC THERAPY & OCT
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Photodynamic treatment of skin cancers has been around for almost 20 years (see a demonstration video here). The treatment involves loading the skin cancer cells with a photoactive drug (applied in a cream) and then activating the drug with a strong light source.
PDT is a remarkable non-invasive treatment but recurrences have been an issue with the conventional protocol. We think the conventional protocol is now out-dated. There are 2 common reasons why conventional treatment fails:
1. Failure in the assessment of appropriate lesions to treat (too often skin cancers are thicker than they appear). 2. Inadequate delivery of light to tumour cells when using the standard red LED (Aktilite) lamp alone.
PDT can only be an effective treatment if light can reach all parts of the tumour. This will depend on optical properties of the actual tumour and of the overlying skin. The depth of the tumour is also extremely important.
This is where the OCT technology is extremely valuable: An OCT scan can assess the optical properties of tumour (and overlying skin) and can accurately measure the true depth of the entire skin cancer instantly. A biopsy will not do this - a biopsy will only look at a small section of the cancer and the processing involved in preparing the tissue for histological analysis will distort the sample leading to a false depth reading.
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This is how photodynamic treatment of skin cancer is undertaken at our clinic:
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1. ASSESSMENT
An OCT scan is performed to confirm a diagnosis of skin cancer - a biopsy is generally not required. The scan will show the precise depth of the cancer down to 1/100th of a millimetre (see the image above). Other aspects of the tumour (that are recognisable on OCT) will determine if biphasic photodynamic treatment is suitable.
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2. INCUBATION WITH PHOTOSENSITISER
A special photosensitising cream is applied to the tumour and this is left under a dressing for a few hours. The ingredient in the cream will be taken up by skin cancer cells, not by normal healthy cells.
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3. ACTIVATION WITH LIGHT
Two types of intense light source will then be used to illuminate the area ("biphasic activation"):
The first light is a high intensity red lamp which is used for about 5 minutes. The red light will begin activation and will also increase oxygenation to tumour (oxygen is essential for successful PDT).
The skin will then flush and this can be a problem as extra blood and haemoglobin will interfere with the passage of light to the tumour cells. This is the point when the light source is switched to an intense pulsed light device (IPL). Additional high fluence light is then delivered with mechanical pressure onto the skin. The mechanical pressure is in order to drain the skin of blood whilst light is being delivered. Removing blood at the tumour site will dramatically increase the passage of light to tumour cells. This second phase of light takes less than 30 seconds to complete. This is demonstrated in the video below.
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It is during the illumination process that a chemical reaction occurs within the tumour cells. They are destroyed. The normal healthy cells are spared. This means tumour removal with faster healing and less scarring.
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We believe that...
1. OCT assessment of tumour suitability, and
2. The above modification to the way that light is delivered to tumour
makes the world of difference to the photodynamic treatment outcomes (see some before & after pictures above).
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in addition...
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The OCT technology combined with biphasic PDT (incorporating compression) makes it possible for skin cancer diagnosis and removal on the same day...
without any needles, without any cutting, without any stitches and with minimal (if any) scarring.
If the tumour is not suitable for biphasic PDT then we can still excise it in our rooms or we can map it out for excision by a plastic surgeon if you prefer. Some tumours are best treated by a combination of biphasic PDT followed by surgery.
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Please note that a referral to Dr Stephens will be needed for OCT-guided removals
or any type of photodynamic treatment.
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