School of Medicine

Wayne State University School of Medicine

SOM resident develops ultrasound technique that accurately identifies skin cancer

Bahar Dasgeb, M.D.

Bahar Dasgeb, M.D.

When a patient with a suspicious skin growth visits a dermatologist, the physician has little choice but to perform a biopsy to determine whether the lesion is indeed malignant. That entails numbing the area, discomfort when the physician shaves off a portion of the lesion for testing and 10 to 14 days of anxiety while the patient awaits the test results.

Two researchers, one a dermatologist with the Wayne State University School of Medicine, have tested a method that shows promise in bypassing the current biopsy practice and providing immediate results. Their study indicated that high-frequency ultrasound with elastography measurement of skin can determine cancerous skin growths.

"Dermatologists tend to biopsy any lesions that seem visually suspicious for disease," said co-investigator Bahar Dasgeb, M.D., a resident in the Department of Dermatology at the Wayne State University School of Medicine and the Pinkus Dermatopathology Lab in Monroe, Mich. "Consequently, many benign lesions are needlessly biopsied in order to avoid the risk of missing a potentially deadly melanoma."

According to the American Cancer Society, physicians diagnose more than 1 million cases of skin cancer annually in the United States. The most serious form of skin cancer – melanoma – is responsible for 68,720 of those cases, and killed approximately 11,590 people in 2009.

"High-frequency ultrasound with elastography has the potential to improve the efficiency of skin cancer diagnosis," said lead author Eliot L. Siegel, M.D., vice chairman of the Department of Radiology at the University of Maryland School of Medicine. "It successfully delineated the extent of lesions and was able to provide measurable differentiation among a variety of benign and malignant lesions."

Dr. Dasgeb, also a radiologist, trained as a resident with Dr. Siegel. They presented their findings at the annual meeting of the Radiological Society of North America in December.

The study involved testing 56 lesions from 48 patients in the Detroit area. For the purposes of comparison, the lesions were measured with the ultrasound technique and samples were taken with conventional biopsy methods. In each case, Dr. Dasgeb said, the ultrasound technology matched the findings of the biopsy.

“It’s very rare to find a 100 percent match, so we were very surprised,” she said. “We don’t expect to see that rate in our next study group, but anything in the high 80s and 90s will indicate we have something that works.”

The ultrasound technology used by Drs. Siegel and Dasgeb was designed to examine muscle and bone, she explained. Hitachi, the maker of the device, is now interested in additional, broader studies, with an eye toward developing a higher-powered ultrasound technology designed for skin lesion differentiation and measuring.

The pair also established a scale of elastography – or skin elasticity – to distinguish between malignant and benign lesions. Cystic lesions (non-malignant) showed high levels of elasticity. Malignant lesions were significantly less elastic.

The combination of high-frequency ultrasound and elastography also appears to allow accurate measurement of the extent and depth of lesions below the skin’s surface.

The procedure is non-invasive, can be performed in a physician’s office and offers immediate results, which can lead to immediate treatment in the case of malignancies and the end of anxious waits for biopsy results.

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