Article published in "Caras" Magazine
September, 12, 2014.
In Chile 10 of every 100 thousand people suffer from skin cancer. Faced with this reality, there is now a technology – a world first – to detect what lies underneath the lesion that doctors cannot see with the naked eye.
Various studies have shown that by 18, most Chileans have absorbed 80% of the solar radiation that they will receive over their whole lifetime. The thinning of the ozone layer and lack of awareness of the dangers of ultraviolet rays have caused skin cancer to increase over the years.
Skin cancer is the uncontrolled growth of anomalous cells. It arises from damage to the DNA of cells of the dermis, principally caused by ultraviolet radiation from the sun or solarium. This damage causes mutations or genetic defects, unleashing rapid multiplication of skin cells and leading to malignant tumors.
Dr. Ximena Wortsman, Director of the Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues (IDIEP) is a radiologist by profession. Over the past 12 years she has developed the use of ultrasound to gain information hidden in the depth of the lesions in the skin, which is not possible to obtain by a doctor's visual inspection or by biopsy.
The technique is named Color Doppler Ultrasound, as used in pregnancy but used by Dr. Wortsman only for dermatological purposes, using special equipment for the skin, nails and hair. This new application for the tool represents a contribution that has caused a revolution in dermatology, by showing the internal details of what we have always seen only externally.
“It's like taking a photo or video inside” the doctor explains. She adds that this examination allows us to know the exact depth of a benign or malignant skin tumor, and if it compromises another organ.
The patients who come to the IDIEP Center have all been referred there by other doctors: dermatologists, plastic surgeons, oncologists or internal medicine specialists, among others. “The majority of them arrive with a diagnosis already made, but using this examination we can go further”. “There are people who have arrived with a small lesion which turned out to be a tumor several centimeters deep, with a high degree of vascularization compromising deeper tissues such as cartilage, muscle or bone”. These data are important to know before planning the treatment, and can be extremely significant if occurring in a very visible place such as the face.
Benefits of Color Doppler Ultrasound
Thanks to this information, the treating doctor can:
-Properly plan the treatment according to the real situation of each patient.
-Decrease the probability of future recurrence.
-Reduce the possibility of multiple biopsies and/or scarring.
-Help the complete elimination of the tumor, by knowing its size, location, vascularization and real depth.
This imaging technique, furthermore, serves to detect and monitor other lesions of the skin such as vascular anomalies (hemangiomas or malformations) and inflammatory diseases (psoriasis, morphea (cutaneous scleroderma), among many others).
Cosmetic Use
In the cosmetics area it allows diagnostic support for complications, as for example ultrasound identifies and quantifies the type of cosmetic filler injected, which in many cases is not what the patient believes. In many cases, instead of Hyaluronic acid, silicone oil or another filler is injected.
Nails and Hair
This kind of ultrasound study also allows the observation of the nail to diagnose hidden tumors. Another application is the study of the scalp, analyzing the hair follicles in the dermis and some tumors or cysts which also, in some cases, produce hair loss.
The IDIEP Center is a world pioneer in this imaging technique, which can be carried out in patients of any age, with no radiation danger and no pain.
Source: 'Corporación Nacional del Cáncer, Conac' (National Cancer Corporation).
Follow the on line NEJM forum on skin ultrasound at : NEJM Journal Watch
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