Multimodal spectral histopathology (MSH), an optical technique combining tissue auto-fluorescence (AF) imaging and Raman micro-spectroscopy (RMS), was previously proposed for detection of residual basal cell carcinoma (BCC) at the surface of surgically-resected skin tissue. Here we report the development of a fully-automated prototype instrument based on MSH designed to be used in the clinic and operated by a non-specialist spectroscopy user. The algorithms for the AF image processing and Raman spectroscopy classification had been first optimised on a manually-operated laboratory instrument and then validated on the automated prototype using skin samples from independent patients. We present results on a range of skin samples excised during Mohs micrographic surgery, and demonstrate consistent diagnosis obtained in repeat test measurement, in agreement with the reference histopathology diagnosis. We also show that the prototype instrument can be operated by clinical users (a skin surgeon and a core medical trainee, after only 1-8 hours of training) to obtain consistent results in agreement with histopathology. The development of the new automated prototype and demonstration of inter-instrument transferability of the diagnosis models are important steps on the clinical translation path: it allows the testing of the MSH technology in a relevant clinical environment in order to evaluate its performance on a sufficiently large number of patients.

A woman who had undergone haematopoietic stem cell transplantation presented with cutaneous features suggestive of graft‐versus‐host disease. Histopathological examination revealed a diffuse dermal infiltration of atypical monomorphic cells with a high proliferative index. Immunohistochemistry revealed positivity for monocytic markers, but negativity for T‐cell markers.

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Electrochemotherapy (ECT) has gained recognition as an effective treatment that uses electrical pulses to permeabilize cell membranes in tumours, enhancing the cytotoxicity of anticancer agents. The National Institute for Health and Care Excellence suggests use of ECT for the management of primary basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in selected patients after discussion within a specialist skin cancer multidisciplinary team. It also supports ECT as a palliative treatment for metastases in the skin from tumours of nonskin origin and malignant melanoma (MM). The objective of the study was to evaluate the outcomes and complications of ECT with bleomycin when used for palliative and curative intent. A retrospective cohort study of all patients who underwent ECT in a UK tertiary centre was performed between June 2016 and December 2022. Seventy-one patients (28 men and 43 women) with a total of 89 tumours were included in the study (mean age 69 years; range 29–99). Prior treatments included surgery (n = 9; 13%), immunotherapy (n = 14; 20%), radiotherapy (n = 26; 37%) and chemotherapy (n = 18; 25%). The linear array electrode was used in most cases with median sequence of 47 (range 1–500). Electrochemotherapy was used for palliative intent in 73% (n = 52) and for curative intent in 27% (n = 19). For palliation, ECT was used to treat patients with MM (n = 18/52; 35%), SCC (n = 17/52; 33%) and breast cancer metastases (n = 11/52; 21%), often in patients who had progressed despite conventional management. The most common site treated was the lower limb (n = 16/52; 31%). Twenty-two patients in this group had a good or partial response, with reduction in tumour size, and 52% had improvement in their symptoms (n = 27/52). The crude 1-year survival in this group was 83% (n = 43/52). Complications of ECT when used for palliation included pain, ulceration, tonic–clonic seizure and pneumothorax. In those where ECT was used for curative intent, the majority had ECT for BCCs (n = 12/19; 63%). The most common site treated was the head and neck. Resolution was reported in 58% (n = 11/19) and partial response in 11% (n = 2/19), while two patients underwent excision following recurrence. Complications when used for curative intent included ectropion, indented scarring, nerve palsy, ulceration, pain and webbing. In our opinion, ECT may represent a robust and efficacious treatment option particularly for smaller, lower-risk tumours which may produce improved outcomes. Electrochemotherapy may serve as an alternative to surgical intervention, particularly in patients with multiple comorbidities, and can be used for primary tumour management.