Multimodal Microscopy for Skin Cancer Diagnosis and Therapy Guidance

Abstract

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 affecting 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 disfigurement, loss of function (breathing, hearing, swallowing and vision) and psychological trauma. Quality of life thus becomes a significant 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 effective at completely removing cancer, with five-year cure rates of 97% to 99%. However, the preparation of frozen pathology is laborintensive 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].