Electrical stimulation increases blood flow and haemoglobin levels in acute cutaneous wounds without affecting wound closure time: evidenced by non-invasive assessment of temporal biopsy wounds in human volunteers.

Recent studies highlighted the beneficial effects of a novel electrical stimulation waveform, the degenerate wave (DW), on skin fibroblasts and symptomatic skin scarring. However, no study to date has investigated the role of DW on acute cutaneous wounds. Therefore, we evaluated this in a trial using a temporal punch biopsy model. Twenty healthy volunteers had a biopsy performed on day 0 (left arm) and day 14 (right arm). On day 14, DW was applied. Participants were randomised into two groups. Objective non-invasive assessments were performed on days 0, 7, 14, 60 and 90 using spectrophotometric intracutaneous analysis and full-field laser perfusion imaging. There were statistically significant increases in mean flux on day 14 (P = 0.027) in the post-DW arm. Haemoglobin levels increased on day 7 for the post-DW arm compared to without DW (P = 0.088). Differences in melanin levels were higher post-DW on the left arm between randomised groups on day 90 (P = 0.033). Haemoglobin levels in the vascular ring increased significantly from day 7 to 90 (P < 0.001 for post-DW and without DW arms). This study, for the first time, shows that DW increases blood flow and haemoglobin levels in acute healing wounds without affecting wound closure time and may have potential application in enhancing acute cutaneous healing.

Spectrophotometric intracutaneous analysis as an early non-invasive predictor of efficacy in the phototherapy of psoriasis.

BACKGROUND: Phototherapy is generally effective for psoriasis but individual responsiveness and optimal treatment duration for disease clearance are unpredictable. However, easy, rapid and non-invasive plaque assessment by spectrophotometric intracutaneous analysis (SIAscopy), a novel multispectral skin imaging technique, may now make prediction feasible. OBJECTIVES: The early prediction of psoriatic plaque clearance during phototherapy by SIAscopy. METHODS: Sixteen psoriatic plaques in 10 psoriasis patients were serially assessed SIAscopically during phototherapy for punctate dots representing the dilated papillary dermal blood vessels characteristic of active psoriasis, and the results compared with the clinical findings. RESULTS: All plaques showing full SIAscopic clearance at early follow-up also showed complete or almost complete clinical clearance, and remained the same thereafter. All showing no SIAscopic clearance at early follow-up showed at most partial clinical clearance, and also remained the same thereafter. All showing only partial SIAscopic clearance at early follow-up also showed just partial clinical clearance, but then generally progressed to full SIAscopic and clinical clearance. CONCLUSIONS: SIAscopy of psoriatic plaques at early follow-up during patient phototherapy enables good prediction of likely later clinical clearance, thereby potentially avoiding unnecessary further treatment. A larger confirmatory study is now needed.

Evaluation of the MoleMate training program for assessment of suspicious pigmented lesions in primary care.

BACKGROUND: Pigmented skin lesions or 'moles' are a common presenting problem in general practice consultations: while the majority are benign, a minority are malignant melanomas. The MoleMate system is a novel diagnostic tool which incorporates spectrophotometric intracutaneous analysis (SIAscopy) within a non-invasive scanning technique and utilises a diagnostic algorithm specifically developed for use in primary care. The MoleMate training program is a short, computer-based course developed to train primary care practitioners to operate the MoleMate diagnostic tool. OBJECTIVES: This pre-trial study used mixed methods to assess the effectiveness and acceptability of a computer-based training program CD-ROM, developed to teach primary care practitioners to identify the seven features of suspicious pigmented lesions (SPLs) seen with the MoleMate system. METHOD: Twenty-five practitioners worked through the MoleMate training program: data on feature recognition and time taken to conduct the assessment of each lesion were collected. Acceptability of the training program and the MoleMate system in general was assessed by questionnaire. RESULTS: The MoleMate training program improved users' feature recognition by 10% (pre-test median 73.8%, p<0.001), and reduced the time taken to complete assessment of 30 SPLs (pre-test median 21 minutes 53 seconds, median improvement 3 minutes 17 seconds, p<0.001). All practitioners' feature recognition improved (21/21), with most also improving their time (18/21). Practitioners rated the training program as effective and easy to use. CONCLUSION: The MoleMate training program is a potentially effective and acceptable informatics tool to teach practitioners to recognise the features of SPLs identified by the MoleMate system. It will be used as part of the intervention in a randomised controlled trial to compare the diagnostic accuracy and appropriate referral rates of practitioners using the MoleMate system with best practice in primary care.

Spectrophotometric intracutaneous analysis in the diagnosis of basal cell carcinoma: a pilot study.

BACKGROUND: The SIAscope is a portable imaging device that uses a hand-held unit to emit light of varying wavelengths when placed on the skin. The components of skin absorb light to known extents and any reflected light is received by the hand-held unit. This information is processed by the SIAscope software to produce images on a computer screen, displaying the melanin, blood, and collagen in the area of concern. Hypothesis/aims Previous research has shown the SIAscope to be both highly sensitive and specific for melanoma diagnosis. The SIAscope has not, however, been previously investigated for nonmelanoma skin cancer diagnosis. We therefore conducted a pilot study to investigate such potential. METHODS: Having gained ethical approval, 20 consecutive lesions were scanned using the SIAscope, and the images were examined for features that may be indicative of nonmelanoma skin cancer. RESULTS: The findings of branched vessels and vascular "flare" were indicative of a lesion being a basal cell carcinoma. Focal paleness and collagen changes were less specific in this study, but may prove to be valuable features in further studies. CONCLUSIONS: This pilot study implies that the SIAscope may indeed provide an accurate method for basal cell carcinoma diagnosis by identifying features specific for such lesions. Further studies to investigate nonmelanoma skin cancer diagnosis, and to explore any potential to differentiate between basal cell carcinomas and squamous cell carcinomas and between superficial and thicker basal cell carcinomas by the SIAscope, are warranted.

A prospective comparison of spectrophotometric intracutaneous analysis to clinical judgment in the diagnosis of nonmelanoma skin cancer.

INTRODUCTION: Research indicates that spectrophotometric intracutaneous analysis (SIAscopy) may be a useful adjunct in nonmelanoma skin cancer (NMSC) diagnosis. A study was performed to prospectively assess the accuracy of NMSC diagnosis by the SIAscope as compared with a clinician. METHODS: Prior to excision, 323 consecutive lesions were examined and diagnosed by a clinician. SIAgraphs were then taken of the lesions and examined blindly at a later date. Diagnostic accuracy for the clinician and SIAscope was compared between the clinician and SIAscope and to histology. RESULTS: Sensitivity, specificity, positive and negative predictive values for clinical diagnoses were 95.6%, 75.8%, 0.79, and 0.95, respectively. Results for SIA diagnoses were 97.5%, 86.7%, 0.88, and 0.97. Statistical comparison revealed comparable sensitivities for the 2 groups but significantly better specificity for the SIAscope at the 95% confidence level. CONCLUSION: This study indicates that the SIAscope may be useful in NMSC diagnosis, with accuracies comparable to a clinician.

From colour to tissue histology: Physics-based interpretation of images of pigmented skin lesions.

Through an understanding of the image formation process, diagnostically important facts about the internal structure and composition of pigmented skin lesions can be derived from their colour images. A physics-based model of tissue colouration provides a cross-reference between image colours and the underlying histological parameters. It is constructed by computing the spectral composition of light remitted from the skin given parameters specifying its structure and optical properties. The model is representative of all the normal human skin colours, irrespective of racial origin, age or gender. Abnormal skin colours do not conform to this model and thus can be detected. Once the model is constructed, for each pixel in a colour image its histological parameters are computed from the model. Represented as images, these 'parametric maps' show the concentration of dermal and epidermal melanin, blood and collagen thickness across the imaged skin as well as locations where abnormal colouration exists. In a clinical study the parametric maps were used by a clinician to detect the presence of malignant melanoma in a set of 348 pigmented lesions imaged using a commercial device, the SIAscope. Logistic regression identified the presence of melanin in the dermis, the abnormal distribution of blood within the lesion and the lesion size as the most diagnostically informative features. Classification based on these features showed 80.1% sensitivity and 82.7% specificity in melanoma detection.