pascale guitera

A skin cancer clinic is trialling emerging technology that helps identify skin cancers without the need for patients to go under the knife.

Vin Rajeswaran decided to import the new machine, knowing the apprehension many of his patients felt at the thought of walking into his clinic.

“People don’t understand how much of a scary situation it is unless you’re a needle-phobe like me,” Dr Rajeswaran said.

Conventional skin pathology usually involves cutting a lesion for a biopsy that can lead to scarring, even when a suspicious mark proves not to be cancerous.

Developments in medical imaging instead use low-powered lasers to scan skin lesions, allowing doctors a 3D view of potential tumours before they decide whether they need to be cut.

Dr Rajeswaran said the technology would significantly reduce the need for needles, bleeding and scarring, and “change the way we practice skin cancer medicine in a big way”.

“You can see the cells in real time,” he said.

“We’re not waiting for seven days or 10 days for [a biopsy sample] to be sent to a pathology lab [and] for the results to come back.

“If you’re a young woman or man and the biopsy is supposed to be done on the tip of your nose, we can stop the scarring from happening because it could be a benign lesion.”

Can AI save taxpayers money?

Australia has one of the world’s highest rates of skin cancer, with Cancer Council figures showing 99 per cent of cases are either basal cell or squamous cell carcinomas.

In addition to allowing doctors to view a 3D image of a potential cancer, the diagnostic machine, called Deep Live, can also identify basal cell carcinomas using artificial intelligence.

Dr Rajeswaran said the machine could “accurately map where the carcinoma stops”, so when it was removed, doctors were “not cutting too much or too little”.

However, Medicare does not subsidise its use, meaning patients who prefer a scan to a biopsy will not be eligible for a government rebate.

The Melanoma Institute of Australia is contributing to international research into non-invasive diagnostic tools, including AI.

It is also developing a national screening road map, which will be critical in building a case for the federal government to subsidise these options under Medicare and recommending when non-invasive options should be used.

Professor Pascale Guitera, a world-leading dermatologist and Melanoma Institute director, said that process, which included randomised trials and cost-benefit analyses, would likely take about five years.

“One of the things we want is not only to find the nasty [cancers] quicker, but we also want to reduce the amount of unnecessary biopsies,” she said.

Professor Guitera said AI was being trained to distinguish melanomas from moles, with the technology “getting there in terms of accuracy” although not quite ready to be used at an expert level.

“At the moment, we think AI will be very useful in particular for primary practice, the nurses, who are triaging patients,” she said.

“[AI] can be quite lost when [melanoma] are very early stage and very small, or completely pink.”

Professor Guitera said the technology would also help ease pressure on a stretched workforce by equipping more medical staff “to be able to triage lesions, find lesions of concern and refer appropriately”.

“The whole planet is looking at what we’re doing, in particular with this road map, because depending on the decision taken there, I think we’ll have a lot of governments looking and maybe copying what we put in place,” she said.

‘Passion’ for regions

As Dr Rajeswaran’s Cairns clinic gets used to the new technology, the few other machines available in Australia are all for research, not walk-in patients.

Adam Jacobson, a medical imaging technologist who works for Deep Live’s manufacturer Damae Medical, said the technology had become commercially available in the past three years, after almost a decade in development.

“There’s one going into Perth to look at the skin of premature babies and there’s one going into the Princess Alexandra Hospital in Brisbane,” Mr Jacobson said.

Dr Rajeswaran said he was investigating ways of taking the machine to his patients in isolated towns, such as Weipa, more than 800 kilometres north of Cairns.

“Normally these machines come to Sydney, Melbourne or Brisbane first and then it gets spread out to the rest of the place, and my passion is to bring it to regional towns,” he said.

With no rebate available, he is looking at charging patients between $50 and $100 for scans, depending on lesion size.

However, Dr Rajeswaran said it was “unlikely” many clinics would adopt the technology “purely for commercial purposes” without Medicare subsidies.

“There has to be more focus on patient benefit and outcome, rather than how much we can make out of this machine,” he said.