Easier Access Key to Early Detection

From the Summer 2018 edition of Vanderbilt Medicine Magazine

The American Cancer Society estimates about 91,270 new melanomas will be diagnosed in 2018. About 9,320 people are expected to die of melanoma, the rates of which have been rising for the last 30 years. Vanderbilt’s Department of Dermatology has a few important initiatives in play to diagnose it and other types of skin cancer at their earliest stages.

A clinic just for skin imaging — Plans are underway to open a skin imaging clinic dedicated to evaluating skin lesions that will allow both new and return patients to get high resolution photographic images of suspicious skin lesions that will be reviewed by Vanderbilt dermatologists within a day or two. An assessment will be communicated back to patient in short order, says John Zic, MD, professor of Dermatology. “If we see something worrisome, we can bring the patient in quickly to perform a skin biopsy. On the other hand, if we suspect it’s a completely benign skin lesion, we can give the patient some reassurance right away rather than have them wait.”

An alternative to biopsy — Confocal laser scanning microscopy (CLSM or LSCM) is a technique for obtaining high-resolution optical images. The key feature of confocal microscopy is its ability to produce in-focus images of thick specimens, a process known as optical sectioning. Images are acquired point-by-point and reconstructed with a computer, allowing three-dimensional reconstructions of topologically-complex objects. Eric Tkaczyk, MD, PhD, director of the Cutaneous Imaging Clinic, is using CLSM to look deeper into the skin to get more information on suspicious moles or lesions. “Most of the time when you go to a dermatologist and there is something that you need to know exactly what it is, like a suspicious mole, I’d have to cut it out and make slides with it so we can provide a diagnosis with pathology. The confocal microscope is portable, and we place it on your lesion and obtain microscopic images that way, reducing the need for biopsy.”

Remote access — Vanderbilt dermatologists practicing at the VA have been using teledermatology for two years. Veterans have images of skin conditions taken at community-based outpatient clinics in Tennessee and Kentucky that are uploaded to electronic health records and reviewed by VA dermatologists in Nashville. Vanderbilt hopes to launch an outpatient pediatric teledermatology clinic soon. Children who present to the general pediatric clinic with skin conditions can have images taken that will then be uploaded to the electronic health record for pediatric dermatologist Sharon Albers, MD, to review. “This will increase access for patients, particularly those on TennCare, and allow feedback to the pediatrician quickly,” Zic said. “We are still working out details, but we are very excited about this. We hope to make it more convenient for parents so they don’t have to take an additional day off from work to come to the pediatric dermatology clinic to get an opinion on what’s going on with their child’s skin.”