Dermatologic surgery innovations continue

"Dermatologic surgery is one of the most innovative fields in all of surgery," says Hayes B. Gladstone, M.D., director, division of dermatologic surgery, Stanford University School of Medicine, and course director for "Innovations in Dermatologic Surgery" at the American Academy of Dermatology's Academy '05 meeting here.

In the area of skin cancer, optical coherent tomography (OCT) provides a noninvasive option for diagnosis, while confocal microscopy can help with diagnosis and treatment. John Strasswimmer, M.D., Ph.D., a former fellow at the Wellman Institute of Photobiology, presented the lecture on noninvasive imaging.

Confocal microscopy

Confocal microscopy, a technique with which dermatologists have been experimenting for about a decade, involves passing light through tissues to visualize structures within.

"In theory, one could use this technology to diagnose skin cancer or tell if margins for Mohs surgery or excisions are clear," Dr. Gladstone says. In the recent history of confocal microscopy, he adds, "The key has been to increase resolution and definition to make it easier to actually identify structures."

OCT also shows promise.

"One of the limitations of confocal microscopy is the depth," Dr. Gladstone says. In contrast, he says, OCT may allow clinicians to view deeper slices of tissue.

Although some clinicians have begun using OCT and confocal microscopy, such technologies might not fit into a typical dermatologist's practice in the near term.

"A lot of these technologies for optical imaging are pretty large," Dr. Gladstone explains. "But we're beginning to miniaturize them so they'll actually be of use in the clinical setting."

Currently, medical centers at both Stanford and Harvard universities are working with OCT, a technology that Dr. Gladstone predicts will be in widespread use within five years.

New technique

At the same time, researchers at Stanford have begun studying a technique called dual axis confocal microscopy.

By using two axes instead of one, Dr. Gladstone explains, "We're able to get greater resolution and depth. What we've seen at Stanford is that resolution probably doubles."

For facial rejuvenation, nonablative light treatments represent a hot topic these days, Dr. Gladstone says. "These include photodynamic therapy (PDT) and different wavelengths that will change the nature of and reform collagen without destroying the epidermis. This way, patients experience much less downtime."

Nonablative light treatments also can help with skin cancer, while newer, one-pass laser resurfacing techniques offer far less downtime than traditional resurfacing.

The key to nonablative rejuvenation procedures, he says, is picking the right patient - one who has mild photodamage, doesn't want any downtime, and has been educated to have realistic expectations. Murad Alam, M.D., director of cutaneous and cosmetic surgery at Northwestern University, discussed these issues.

"One of the oldest areas of our field is phlebology," Dr. Gladstone adds. "But one of the newest advances is doing endovenous laser ablation of varicose veins."