Researchers at the University of Arizona Health Sciences have developed – and are continuing to improve – a handheld device to bring the next generation of skin cancer prevention and treatment options into more patient-care settings.

Described as a “portable confocal microscope” (PCM), the device is a modernized and more practical use of reflective confocal microscopy (RCM) – technology that provides non-invasive imaging of the skin. In RCM, the microscope directs a narrow laser light on a specific spot on the skin with vertical and horizontal scanning capability. This results in a real-time diagnosis that, in some cases, can bypass the need for a biopsy and lead to same-day treatment for malignant lesions.

Clara Curiel-Lewandrowski, MD, the Alan and Janice Levin Family Endowed Chair for Excellence in Cancer Research, co-director of the Skin Cancer Institute at the UArizona Cancer Center, and professor and interim chief of the Division of Dermatology, College of Medicine – Tucson, brought the technology to the university. Thanks to funding from the UArizona Technology and Research Initiative Fund (TRIF), Dr. Curiel purchased a commercial instrument for her clinical practice in 2014.

“The commercial insturment we purchased has three lasers, which allows us to expand into studies evaluating fluorescent properties,” Dr. Curiel said. “One of the benefits of having our own instrument is that other investigators can compare their imaging technology to an industry “Gold Standard”, holding FDA approval for skin assessment. That provides us the capability to provide feedback to the investigators and improve the technology.”

Dongkyun Kang, PhD, co-leader of the Cancer Imaging Program, an assistant professor of optical sciences and biomedical engineering, BIO5 Institute member, joined the UArizona Health Sciences in 2017 with the goal to design a handheld or larger portable version of the technology that not only would be easier for clinicians to use, but would be more affordable for wider use in the patient-care setting. A commercial instrument today generally costs more than $80,000, making it too expensive for many practices and, therefore, unavailable to a large number of patients.

Although existing RCM technology is made with very sophisticated electrical and optical components, Dr. Kang’s lab focused on lowering manufacturing costs by developing the PCM device using an inexpensive near-infrared LED as the light source. Recent results appearing in Applied Optics, which publishes in-depth, peer-reviewed content about applications-centered research in optics, suggest the PCM device provides better image contrast and enhanced imaging depth compared to a previous smartphone-based device. That earlier device was tested to determine feasibility of using the instrument at the Infectious Diseases Institute at Makerere University in Kampala, Uganda, as a smartphone attachment to remotely diagnose Karposi’s sarcoma (involving purplish lesions on the legs, feet or face) and cervical cancer.

Based on the prelimiary success of the latest PCM innovation, Dr. Kang’s lab licencsed three intellectual properties through Tech Launch Arizona, the commercialization arm of the UArizona, to a startup company in California last year. Commercial versions of the newest device could look something like a large pen and would cost closer to $1,000, said Dr. Kang.

“The goal is to make it widely available to dermatologists and practitioners around the world.” Dr. Kang said. “Collaboration is very important, so we are making this technology work in the context of the patient-care setting. I work very closely with Dr. Curiel and also my collaborators in Uganda to see what we can improve.”

Drs. Curiel and Kang continue to advance the PCM device, routinely testing and comparing its performance to the commercial RCM unit and other available technologies. This process is a prime example of effective collaboration between clinicians and engineers developing novel medical technologies.

“I view confocal microscopy as the ‘future is now,’” Dr. Curiel said. “We are poised to be the institution that changes the standard of care in skin cancer prevention, diagnosis and minimally invasive therapeutics. Our advantages are that we have a large number of skin cancer cases and we have the technology to initiate the shift in practice. Now we must embrace the change.”

By Blair Willis