Photodiagnosis and Photodynamic Therapy of Cutaneous Melanoma (original) (raw)
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7 Photodiagnosis and Photodynamic Therapy of Cutaneous Melanoma
2018
Skin cancer is one of the most widespread tumours. However, despite the progress achieved in all clinical diagnostic techniques, the most severe of those tumours cutaneous melanoma, continues to be an important problem of social health. A large number of optical techniques have been recently applied in the clinical practice in view of obtaining qualitatively and quantitatively new data from cutaneous neoplasia. Due to their high sensitivity in detecting small changes, spectroscopic techniques are now widely used for detection of early changes in biological tissues. Fluorescence detection of normal and abnormal tissues is among the most promising such approaches as it makes use of naturally existing fluorescent molecules (in the case of autofluorescence) or added fluorescent markers (in the case of exogenous fluorescence) of high importance. Fluorescent markers are introduced wherever native fluorescence is not informative enough to be used for diagnostic goals due to the absence or ...
Journal of Investigative Dermatology, 2001
Multicenter study of the diagnostic parameters was conducted by three groups in Poland to determine if in situ¯uorescence detection of human cutaneous melanoma based on digital imaging of spectrally resolved auto¯uorescence can be used as a tool for a preliminary selection of patients at increased risk of the disease. Fluorescence examinations were performed for 7228 pigmented lesions in 4079 subjects. Histopathologic examinations showed 56 cases of melanoma. A sensitivity of¯uorescence detection of melanoma was 82.7% in agreement with 82.5% found in earlier work. Using as a reference only the results of histopathologic examinations obtained for 568 cases we found a speci®city of 59.9% and a positive predictive value of 17.5% (melanomas versus all pigmented lesions) or 24% (melanomas versus common and dysplastic naevi). The speci®city and positive predictive value found in this work are signi®cantly lower than reported earlier but still comparable with those reported for typical screening programs. In conclusion, the¯uorescence method of in situ detection of melanoma can be used in screening large populations of patients for a selection of patients who should be examined by specialists. Key words: auto¯uorescence/ digital imaging/in situ detection/melanoma/naevi. J Invest Dermatol 117: 1449±1451, 2001 C linical diagnosis of melanoma is based on morphologic criteria of a qualitative nature. Therefore it is often dif®cult to differentiate on the basis of clinical aspects between melanoma and a wide range of other pigmented skin lesions. estimate that up to 50% of early melanomas may be misdiagnosed during routine clinical examination, whereas experts achieve a sensitivity of 80%± 90%. According to Miller and Ackerman (1992) dermatologists do not detect 32% of melanomas. A retrospective study of 44,258 histopathologically examined skin neoplasms including 529 melanomas (Wolf et al, 1998) showed that the referring physicians correctly diagnosed 70.1% of melanomas. Analyses of ef®cacy of screening programs show that only between 35% and 50% of clinically diagnosed melanomas are con®rmed by histopathologic examinations . Better sensitivity of detection is possible with epiluminescence microscopy but the improvement depends to a large extent on the experience of the examiner (Bilek and Braun-Falco, 1990).
In Vivo Fluorescence Spectroscopy and Imaging of Human Skin Tumors
Dermatologic Surgery, 1995
The feasibility of using in vivo auto fluorescence for the diagnosis of skin cancer was evaluated. In vivo fluorescence measurements were performed on healthy human volunteers, and patients with different types of benign and malignant skin turnouts. Fluorescence spectra as well as fluorescence images were acquired. The excitation-emission matrix of normal skin (n=3) showed a broad peak at the shortest excitation wavelength (365 nm) and at 440 nm fluorescence wavelength, smoothly decreasing towards longer excitation and fluorescence wavelengths. Non-melanoma skin tumours (n=31) and control skin excited with 375nm showed a broad fluorescence band from 400 to 700 nm, peaking around 436 nm. No significant differences in measurements between tumours and the corresponding control sites were found. A large spatial variation in the fluorescence intensity was observed both in the tumours and in the control sites. Standard deviations found ranged from 0.15 to 1.5 times the mean fluorescence. Fluorescence images, excited with 375 nm and taken with an image intensified CCD camera, on eight malignant melanomas and eight benign pigmented lesions did not indicate any fluorescence intensity distribution specific to the malignancy of the lesion. Neither the shape of the fluorescence spectra, nor the spatial distribution of the fluorescence intensity showed any signature specific to the histopathological nature of the lesions investigated. Optical diagnostics of skin tumours using the autofluorescence does not seem to be feasible at the present time.
In vivo fluorescence spectroscopy and imaging of human skin tumours
Lasers in Medical Science, 1994
The feasibility of using in vivo autofluorescence for the diagnosis of skin cancer was evaluated. In vivo fluorescence measurements were performed on healthy human volunteers, and patients with different types of benign and malignant skin tumours. Fluorescence spectra as well as fluorescence images were acquired. The excitation-emission matrix of normal skin (n=3) showed a broad peak at the shortest excitation wavelength (365 nm) and at 440 nm fluorescence wavelength, smoothly decreasing towards longer excitation and fluorescence wavelengths. Non-melanoma skin tumours (n=31) and control skin excited with 375 nm showed a broad fluorescence band from 400 to 700 nm, peaking around 436 nm. No significant differences in measurements between tumours and the corresponding control sites were found. A large spatial variation in the fluorescence intensity was observed both in the tumours and in the control sites. Standard deviations found ranged from 0.15 to 1.5 times the mean fluorescence. Fluorescence images, excited with 375 nm and taken with an image intensified CCD camera, on eight malignant melanomas and eight benign pigmented lesions did not indicate any fluorescence intensity distribution specific to the malignancy of the lesion. Neither the shape of the fluorescence spectra, nor the spatial distribution of the fluorescence intensity showed any signature specific to the histopathological nature of the lesions investigated. Optical diagnostics of skin tumours using the autofluorescence does not seem to be feasible at the present time.
Oncology and Therapy, 2016
Introduction: Non-melanoma skin cancer is the most common malignancy worldwide. Differentiating between malignant and benign skin tumors, however, can be challenging. As a result, various auxiliary tools have been developed to aid in the diagnosis of cutaneous neoplasms. Here, skin tumors were investigated through analysis of their digital image histograms and spectroscopic response under ultraviolet (UV) and white light-emitting diodes (LEDs). Methods: Fifty tumoral lesions were spectroscopically and histologically studied. For optical studies, UV at 375 nm and white LEDs were used to illuminate the lesions. Commercial cameras were used for imaging, and a miniature spectrometer with a bifurcated optical fiber was used for spectroscopic measurements. Results: In this study, the intensity histograms of the images taken under white and UV illumination and the spectroscopic response under white light showed clear differences between pigmented basal cell carcinoma (BCC), intradermal melanocytic nevus (IDN), and melanoma lesions for skin phototypes III and IV. However, there was little difference in their spectroscopic response to the UV LED. Conclusion: We found differences in the intensity and shape of diffuse reflectance spectra of pigmented BCC, IDN, and melanoma lesions in patients with skin phototypes III and IV. Also, images taken under UV and white light were helpful for differentiation of these pigmented lesions. Additional research is Enhanced Content To view enhanced content for this article go to
Time-resolved fluorescence lifetime for cutaneous melanoma detection
Biomedical Optics Express, 2014
Melanoma is the most aggressive skin cancer type. It is characterized by pigmented lesions with high tissue invasion and metastatic potential. The early detection of melanoma is extremely important to improve patient prognosis and survival rate, since it can progress to the deadly metastatic stage. Presently, the melanoma diagnosis is based on the clinical analysis of the macroscopic lesion characteristics such as shape, color, borders following the ABCD rules. The aim of this study is to evaluate the time-resolved fluorescence lifetime of NADH and FAD molecules to detect cutaneous melanoma in an experimental in vivo model. Forty-two lesions were analyzed and the data was classified using linear discriminant analysis, a sensitivity of 99.4%, specificity of 97.4% and accuracy of 98.4% were achieved. These results show the potential of this fluorescence spectroscopy for melanoma detection.
Journal of Photochemistry and Photobiology B: Biology, 1996
Recently, the use of optical spectroscopy for non invasive diagnosis of malignant melanoma has been suggested. The reliability of such optical measurements can be seriously compromised by spatial variations in optical properties of the tissue that are not related to malignancy. In the present paper we report on a novel approach to fluorescence spectroscopy which allows for elimination of spatial variations in the optical properties of the tissue investigated. To test this concept we performed fluorescence and colour measurements on moles and unpigmented control skin in human volunteers before and after topical application of S-aminolevulinic acid (ALA). Two types of fluorescence data analysis were investigated; a Single Ratio technique based on the ratio of the red and yellow fluorescence (660nm-750nm/550nm-600nm) at 405 nm excitation and a Double Ratio technique, the red/yellow ratio at 405 nm excitation divided by the red/yellow ratio at 435 nm excitation. The two excitation wavelengths were selected to be located close to the maximum and at some distance from the Soret excitation band of the porphyrins. The Single Ratio showed a significant correlation between fluorescence and colour. The Double Ratio was independent of the colour of the lesion. These findings indicate that the Double Ratio technique is suitable for in vivo detection of local differences in concentration of fluorescent tumour localising drugs in pigmented lesions. This enables in vivo studies of the pharmacokinetics of tumour localising agents in pigmented lesions, and may significantly contribute to the development of a non invasive diagnostic tool for malignant melanoma.
Cutaneous melanin exhibiting fluorescence emission under near-infrared light excitation
Journal of Biomedical Optics, 2006
Under ultraviolet and visible light excitation, melanin is essentially a nonfluorescent substance. This work reports our study on near-infrared ͑NIR͒ fluorescence properties of melanins, and explores potential applications of NIR fluorescence techniques for evaluating skin disorders involving melanin. The NIR fluorescence spectrum is obtained using a fiber optic NIR spectrometer under 785-nm laser excitation. In vitro measurements are performed on synthetic dihydroxyphenylalanine ͑DOPA͒ melanin, melanin extracted from Sepia ink sacs, human hair, animal fur, and bird feathers. Paired spectral comparisons of white and black skin appendages show that melanization of hair, fur, or feathers more than doubles the NIR fluorescence. In vivo NIR autofluorescence of normal dorsal and volar forearm skin of 52 volunteers is measured. Dorsal forearm skin, which is darker than volar skin, exhibits significantly greater NIR fluorescence. Patients with vitiligo ͑n =4͒, compound nevus ͑n =3͒, nevus of Ota ͑n =1͒, superficial spreading melanoma ͑n =3͒, and postinflammatory hyperpigmentation ͑n =1͒ are also evaluated. NIR fluorescence is greater within the lesion than the surrounding normal skin for all these conditions except vitiligo, where the converse was true. The observed melanin NIR fluorescence provides a new approach to in vitro and in vivo melanin detection and quantification that may be particularly useful for evaluating pigmented skin lesions.
Skin and mucosal fluorescence diagnosis with different light sources
European journal of dermatology : EJD
At the laboratory of Laser and Photodynamic Treatment (Institute of Oncology, Vilnius University) 98 patients with various kinds of skin and mucosal malignant, pre-malignant and benign lesions underwent 5-aminolevulinic acid (ALA) or its methyl ester (methyl aminolevulinate)-induced protoporphyrin IX (PpIX), or hematoporphyrin derivate (HpD) fluorescence imaging. Intensity and all other changes of fluorescence were evaluated and compared with the pathological findings. Margins of tumours were clearly outlined under fluorescent vision, giving a helpful contribution to diagnosis and therapy, even in clinically non-visible tumours. Most of the malignant tumours were found to be fluorescent, whereas no fluorescence was observed in normal skin and mucosa. In the blue light mode, there is background blue fluorescence in normal tissue and red fluorescence in malignant areas. The suitability of different light wavelengths for fluorescence diagnosis (FD) was compared. From our data the most ...
Fluorescence detection of superficial skin cancers
Journal of Modern Optics, 2000
We present a simple¯uorescent diagnosis system for the demarcation of skin cancers. 5-aminolaevulinic acid (ALA) cream is applied to the suspicious area resulting in the accumulation of the photosensitizer Protoporphyrin IX (PpIX) in the cancerous tissue. When excited at 400 nm using a ® ltered mercury arc lamp, the PpIX¯uoresces at 635 nm. Our imaging system acquires four spectrally speci® c images at 635, 540, 470 and 400 nm for the PpIX¯uorescence, natural skin auto¯uorescence and illumination respectively. Subsequent image processing combines these images into a single display showing clearly the localization and extent of the tumour.