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.

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A 59-year-old man with a long-standing colostomy presented with a 3-year history of progressive change around his stoma site. His colostomy had been performed as an emergency procedure 2 days after his birth, owing to an imperforate anus. The patient's stoma had functioned well for 56 years. However, over the past 3 years, the stoma had begun to leak slightly, and an indurated lesion had developed at the superior pole of the stoma on the skin surface. The peristomal area was irritated as a result of the adhesive surface of the colostomy bag and the leaking of the bowel contents. A progressive increase in tissue bulk at the superior aspect of the stoma had developed, associated with bleeding from fissures.On physical examination, the stoma was seen to be situated on the left lower abdomen. The surrounding skin appeared irritated, with skin changes of an illdefined erythema and fissuring, in a 30-mm area around the stoma. At the superior pole of the stoma, an irregular friable lesion, 30 9 15 mm in size, was visible. The lesion was well-demarcated, raised, and papillomatous, with evidence of bleeding (Fig. 1a,b). Histopathological findingsOn histopathological examination, curetted fragments were seen, which showed polypoid large bowel mucosa that appeared inflamed. Focal surface ulceration was present, and mucous-secreting glands were identified in the submucosa. There was no evidence of dysplasia or malignancy. Fragments of epidermis were visible in the lower part of the field (Fig. 2a). In a higher power view of one of the curretted fragments, the surface ulceration and inflammation was clearly visible (Fig. 2b). Squamous epithelium (black arrow) adjacent to colonic epithelium (grey arrow) was visible at even higher power (Fig. 2c). Figure 1 (a) Clinical image of an irregular friable lesion at the superior pole of the stoma. (b) A close up view of the friable lesion showing polypoid features. ª 2014 British Association of Dermatologists