Fluorescence detection and diagnosis of non‐melanoma skin cancer at an early stage

Abstract

Background: The occurrence of non-melanoma skin cancer (NMSC), including actinic keratosis (AK) is increasing all over the world. The detection and diagnosis of NMSC is not optimal in clinical practice. Complementary methods for detection and accurate demarcation of NMSC at an early stage are needed in order to limit the damage caused by tumours. Objective: The purpose of the present study was to use a large area skin fluorescence detection system to detect early NMSCs (clinical visible as well as non-visible lesions) in the face, neck, chest, back and hands of patients treated with UV and outdoor workers. Methods: Fluorescence detection with a purpose-made digital camera and software (Dyaderm 1 ) combined with 5-aminolevulinic acid (5-ALA) encapsulated in liposomes. Results: In 93 consecutively referred patients positive skin fluorescence was detected in 61 patients. After histological examination the positive fluorescence appeared to be correlated to benign lesions in 28 patients (sebaceous gland hyperplasia in 22 patients) and to (pre-) malignant lesions in 33 patients (actinic keratosis in 29, BCC in 3 and SCC in 1 patient). False negative fluorescence was found in only one lesion. In five patients the FD technique used in this study appeared to be more sensitive for the identification of (pre-) malignant lesions than the clinical examination. This is in contrast with FD techniques used in previous studies. Conclusion: Diagnostic skin fluorescence using liposomal encapsulated 5-ALA and a specialised computerised detection and visualisation system offers the possibility for detection of NMSC at an early, pre-clinical stage. The technique is well suited to examine large areas of skin. It also identifies areas of most interest for performing confirmatory skin biopsies, as well as pre-operative assessment of boundaries of skin malignancies, and finally, the technique is applicable in the control and follow-up of skin cancer treatment.

Development of a handheld fluorescence imaging device to investigate the characteristics of protoporphyrin IX fluorescence in healthy and diseased skin

“…In a proportion of the subjects in our study fluorescence developed within visible tumours with definition at tumour margins similar to that reported [20,13]. The cases where fluorescence developed in the areas close to the lesions but without any visible evidence of malignant skin disease is supportive of the pick up of subclinical disease and agrees with the study on wide field PpIX fluorescence imaging for early stage NMSC diagnostics 29 .…”

“…It has been reported that PpIX fluorescence does not have absolute correlation to PDT outcomes 11,12 , yet it has been successfully used to detect early stages of malignant changes in the skin 29,9,30 . Measurement of fluorescence is the most widely used method employed for non-invasive in-vivo imaging of PpIX metabolism, which in turn may be used as a surrogate to optimise PDT parameters.…”

Identification of skin lesions through aminolaevulinic acid-mediated photodynamic detection

“…The observed LOF from the abnormal skin has been also described in other studies [12,23,24], and this is mainly justified by the decrease in collagen fluorescence caused by fiber linkage breakdown [25]. Others skin components such as flavins do not have a great contribution due to the excitation wavelength, which is not within the absorption wavelengths of these components [26].…”

Microneedles rollers as a potential device to increase ALA diffusion and PpIX production: evaluations by wide-field fluorescence imaging and fluorescence spectroscopy

“…In these studies the researchers compared histopathological analysis with fluorescence analysis. The fluorescence imaging technique by Jaap de Leeuw et al (2009) was considered applicable in the diagnosis of non-Melanoma Skin Cancer at early stage, in the evaluation of limits as well as in the monitoring of treatment. [11] On the other hand, only a few studies have been made on the ALA-induced PpIX diffusion evaluation with this potential technique.…”