Multimodal Microscopy for Skin Cancer Diagnosis and Therapy Guidance Nicusor Iftimia 1* and Milind Rajadhyaksha 2 1 Physical Sciences, Inc., 20 New England Business Ctr. Drive, Andover, MA-01810, USA 2 Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60 th Street, New York, NY 10022, USA *Corresponding author: Nicusor Iftimia, Physical Sciences, Inc., 20 New England Business Ctr. Drive, Andover, MA-01810, USA, Tel: +9786890003 E-mail: nicusor.iftimia@gmail.com Rec Date: Oct 17, 2017, Acc Date: Oct 19, 2017, Pub Date: Oct 20, 2017 Copyright: © 2017 Iftimia N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Editorial Skin cancer is an increasing burden on people of all ages. Among various types of skin cancers, basal cell carcinomas (BCCs) have the highest occurrence. About 2.5 million new cases of BCCs are diagnosed every year in the USA and another 500,000 in Europe and Australia [1,2]. BCCs occur most commonly in middle-aged and older people, but, lately, skin cancers are increasingly afecting younger people, too [3]. Approximately 80% to 90% of the cases occur on the head-and-neck, including 65% on the face, in high-risk anatomical areas such as on or near the nose, eyes, ears or mouth. Although not fatal, BCCs can cause large-scale anatomical destruction, resulting in morbidity, physical disfgurement, loss of function (breathing, hearing, swallowing and vision) and psychological trauma. Quality of life thus becomes a signifcant issue for these patients. Consequently, Mohs surgery guided by frozen pathology is performed to precisely remove the cancer with minimal damage to the surrounding normal skin [4]. Because Mohs surgery is guided by frozen pathology, the procedure is very efective at completely removing cancer, with fve-year cure rates of 97% to 99%. However, the preparation of frozen pathology is labor- intensive and time-consuming, which results in the overall Mohs procedure being expensive. As incidence rates of skin cancer continue to increase, the number of physician visits and the number of Mohs surgeries in the USA nearly doubled during the last decade. Currently, an estimated 1.5 million surgeries are performed every year, with treatments costs exceeding $3 billion [5]. Te increasing incidence and prevalence of BCCs, especially in an increasingly older population, combined with increasing costs has led to the search for and increasing adoption of newer alternative non- surgical treatments that can be less invasive and far less expensive. Such treatments include curettage-and-electrodessication, topical drug therapy, cryotherapy, photodynamic therapy, radio therapy, and laser ablation and/or coagulation [6,7]. Te latest guidelines for the use of these alternative non-surgical treatments were issued by the National Comprehensive Cancer Network. Similar “appropriate use” guidelines were also issued by the American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Mohs Surgery and American College of Mohs Surgery. Non-surgical treatments are particularly well suited for superfcial and nodular types of BCCs, which are shallow (depth ~ 200-500 µm) and less aggressive compared to the other deeper and more aggressive types (micronodular, infltrative, sclerosing). Te superfcial and early nodular BCCs constitute about 40% of Mohs surgical cases (about 600,000 per year in the USA, another 200,000 in Europe and Australia) [8]. An important challenge for dermatologists is to accurately triage patients based on cancer type and stage (invasion depth), such that appropriate therapy can be applied. Superfcial and early nodular BCCS are good candidates for non-surgical therapy [9-11]. However, non-surgical treatments do not produce tissue for pathological confrmation of clearance. Furthermore, due to the lack of traditional post-treatment pathology, the treatments are monitored with periodic clinical follow-up examination. Tis approach is reasonably taken because superfcial and nodular BCCs are low-risk, slow growing, non- aggressive and non-metastatic cancers. However, the lack of pathological feedback results in variable long-term recurrence rates for non-surgical treatments (61% to 90%) [9-11]. Not surprisingly, the resulting variable efcacy and variable cure rates are major barriers against further advances toward routine and widespread use of these emerging alternative non-surgical treatments. To address this challenge, non-invasive methods for real-time and reliable assessment of the lesion stage, and thus for triaging patients, guiding therapy and monitoring its efectiveness are needed. Many studies have shown that optical imaging may help in improving the diagnosis of BCCs. Among various optical modalities, Optical Coherence Tomography (OCT) and Refectance Confocal Microscopy (RCM) have shown the highest promise in BCC diagnosis. RCM provides cellular-level resolution images and therefore it can be used to accurately detect the morphological features of superfcial and nodular BCCs and provide high diagnostic accuracy. RCM can also determine lateral margins.. On the other hand, OCT images deeper, to depth of ~1 mm into the reticular dermis, and can be used to detect deeper tumors that are beyond the reach of RCM, and delineate their deep margins. When used individually and independently, both OCT and RCM can noninvasively detect superfcial and nodular BCCs with sensitivities and specifcities in the range 80% to 95% and 70% to 90%, respectively [12-14]. Furthermore, other studies have reported the ability of OCT to reliably detect the depth of BCCs in vivo [15-20]. However, RCM images to a depth of ~200 µm, and determination of margins is possible only for tumors at the dermal-epidermal junction and within the papillary dermis in skin, while OCT sensitivity and specifcity is yet to be validated in larger trials for accuracy and repeatability. Terefore, a new "game changing" approach is to combine these two modalities within the same instrument and beneft by the synergistic capabilities of both technologies. Tis approach has been recently demonstrated with high success by scientists and clinicians at Physical Sciences Inc. and Memorial Sloan Kettering Cancer Center (MSKCC) (see photograph of the instrument and RCM/OCT images in Figure 1) [21]. A study on over 100 cases has demonstrated the capability of this technology to provide 3-dimensional volumetric assessment of tumor morphology, at high resolution in real-time. Te new multimodal imaging modality has demonstrated the possibility of RCM-OCT to guide triage of BCC types before treatment and confrmation of J o u r n a l o f M o l ec u l a r I m a g i n g & D y n a m i c s ISSN: 2155-9937 Journal of Molecular Imaging & Dynamics Iftimia and Rajadhyaksha, J Mol Imag Dynamic 2017, 7:2 DOI: 10.4172/2155-9937.1000e105 Editorial Open Access J Mol Imag Dynamic, an open access journal ISSN:2155-9937 Volume 7 • Issue 2 • 1000e105