| 1. |
- Ericson, Marica B, 1974, et al.
(författare)
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Two-photon laser-scanning fluorescence microscopy applied for studies of human skin
- 2008
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Ingår i: Journal of Biophotonics. - : Wiley. - 1864-0648 .- 1864-063X. ; 1:4, s. 320-330
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Tidskriftsartikel (refereegranskat)abstract
- Two-photon laser scanning fluorescence microscopy (TPM) has been shown to be advantageous for imaging optically turbid media such as human skin. The ability of performing three-dimensional imaging without presectioning of the samples makes the technique not only suitable for noninvasive diagnostics but also for studies of topical delivery of xenobiotics. Here, TPM is used as a method to visualize both autofluorescent and exogenous fluorophores in skin. Samples exposed to sulforhodamine B have been scanned from two directions to investigate attenuation effects. It is shown that optical effects play a major role. Thus, TPM is excellent for visualizing the localization and distribution of fluorophores in human skin, although quantification might be difficult. Furthermore, an image-analysis algorithm has been implemented to facilitate interpretation of TPM images of autofluorescent features of nonmelanoma skin cancer obtained ex vivo. The algorithm was designed to detect cell nuclei and currently has a sensitivity and specificity of 82% and 78% to single cell nuclei. However, in order to detect multinucleated cells, the algorithm needs further development. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)
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| 2. |
- Ericson, Marica B, 1974, et al.
(författare)
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Two-photon microscopy of non-melanoma skin cancer: initial experience and diagnostic criteria ex vivo
- 2007
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Ingår i: Proc. SPIE. - : SPIE. ; 6630
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Konferensbidrag (refereegranskat)abstract
- Multiphoton microscopy is an interesting optical technique, which allows for non-invasive imaging of highly light scattering media such as human skin. Recent reports have showed the potential of applying this technique for 3D visualisation of cell structures of biological tissue without previous sectioning of the tissue samples. In this study, we have applied two-photon microscopy on excised lesions of human non-melanoma skin cancer ex vivo in order to find diagnostic criteria using this technique. The skin samples have been investigated by a multiphoton microscopy system based on a fs-pulsed Ti:sapphire laser connected to a confocal microscope. The autofluorescence of the skin was detected using excitation at 780 nm. The cell nuclei distribution turned out to be one important parameter, which can be used for discriminating between tumour and normal tissue. We are now developing a technique for automatic detection and characterisation of tissue, based on an image analysis algorithm. The detection of cell nuclei has been found crucial for this purpose. The goal is to develop a fast characterisation algorithm that can be used on line in connection to in vivo investigations. This would allow for a true non-invasive biopsy technique in the future.
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| 3. |
- Halldin, Christina, 1957, et al.
(författare)
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Nerve blocks enable adequate pain relief during topical photodynamic therapy of field cancerization on the forehead and scalp
- 2009
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Ingår i: British Journal of Dermatology. - 1365-2133. ; 160:4, s. 795-800
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Topical photodynamic therapy (PDT) is an effective method when treating extensive areas of sun-damaged skin with multiple actinic keratoses (AKs) (field cancerization) on areas such as the forehead and scalp, and offers excellent cosmetic outcome. The major side-effect of PDT is the pain experienced during treatment. OBJECTIVES: To investigate whether nerve blocks could provide adequate pain relief during PDT of AKs on the forehead and scalp. METHODS: Ten men with symmetrically distributed and extensive AKs on the forehead and scalp were included in the study. Prior to PDT one side of the forehead and scalp was anaesthetized by nerve blocks while the other side served as control. RESULTS: The mean visual analogue scale (VAS) score on the anaesthetized side was 1 compared with 6.4 on the nonanaesthetized side during PDT. This difference was significant (P<0.0001), implying that nerve blocks reduce VAS scores during PDT. CONCLUSIONS: The results of the study support the use of nerve blocks as pain relief during PDT of field cancerization on the forehead and scalp, although individual considerations must be taken into account to find the most adequate pain-relieving method for each patient.
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| 4. |
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| 5. |
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| 6. |
- Paoli, John, 1975, et al.
(författare)
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Multiphoton laser scanning microscopy-a novel diagnostic method for superficial skin cancers
- 2009
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Ingår i: Seminars in Cutaneous Medicine and Surgery. - 1558-0768. ; 28:3, s. 190-5
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Tidskriftsartikel (refereegranskat)abstract
- The increasing incidence of skin cancer and the importance of early diagnosis is a challenge, which requires the development of reliable, cost-effective, noninvasive, diagnostic techniques. Several such methods based on optical imaging techniques are available and currently being investigated. A novel method in this field is multiphoton laser scanning microscopy (MPLSM). This technique is based on the nonlinear process of 2-photon excitation of endogenous fluorophores, which can be used to acquire horizontal optical sectioning of intact biological tissue samples. When studying human skin, MPLSM provides high-resolution fluorescence imaging, allowing visualization of cellular and subcellular structures of the epidermis and upper dermis. This review covers the application of MPLSM as a diagnostic tool for superficial skin cancers, such as basal cell carcinomas, squamous cell carcinoma in situ, and melanomas. MPLSM has also been applied in other research areas related to skin, which will be mentioned briefly. The morphologic features observed in MPLSM images of skin tumors are comparable to traditional histopathology. Safety issues, limitations, and further improvements are discussed. Although further investigations are required to make MPLSM a mainstream clinical diagnostic tool, MPLSM has the potential of becoming a noninvasive, bedside, histopathologic technique for the diagnosis of superficial skin cancers.
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| 7. |
- Paoli, John, 1975, et al.
(författare)
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Multiphoton laser scanning microscopy on non-melanoma skin cancer: morphologic features for future non-invasive diagnostics.
- 2008
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Ingår i: The Journal of investigative dermatology. - : Elsevier BV. - 1523-1747 .- 0022-202X. ; 128:5, s. 1248-55
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Tidskriftsartikel (refereegranskat)abstract
- This study describes the morphologic features of human non-melanoma skin cancer obtained using multiphoton laser scanning microscopy (MPLSM) on freshly excised specimens from 14 patients. Optical sectioning parallel to the tissue surface was performed, resulting in en face autofluorescence images of the epidermis and upper dermis, reaching tissue depths of 135 microm. The microscopy was carried out ex vivo using a femtosecond pulsed laser at 780 nm and a x 40/0.8 objective. The autofluorescence was detected in the range of 450-530 nm. Traditional histopathological criteria such as bowenoid dysplasia, multinucleated cells, or hyperkeratosis in squamous cell carcinoma in situ (SCCIS) (five specimens), and peripheral palisading of tumor cells in superficial basal cell carcinoma (SBCC) (six specimens) were clearly discerned. The morphologic features differed significantly between these lesions and perilesional skin. However, characteristic tumor aggregates were found in only one of the three investigated nodular basal cell carcinomas (NBCCs) due to limited imaging depth. In addition, speckled perinuclear fluorescence was observed in both lesions and normal perilesional skin. In conclusion, MPLSM could potentially be applied for non-invasive diagnostics of SCCIS and SBCC, whereas the ability to characterize NBCC is unclear at this point.
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| 8. |
- Paoli, John, 1975, et al.
(författare)
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Nerve blocks provide effective pain relief during topical photodynamic therapy for extensive facial actinic keratoses
- 2008
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Ingår i: Clinical and Experimental Dermatology. - : Oxford University Press (OUP). - 1365-2230 .- 0307-6938. ; 33:5, s. 559-64
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Photodynamic therapy (PDT) is a first-line therapeutic option for skin areas with multiple actinic keratoses (AKs). Its main drawback is the pain perceived during the irradiative phase, especially when treating field cancerization in the facial area. Effective pain-relieving strategies are needed. AIM: To determine the effectiveness of peripheral nerve blocks in achieving pain relief during PDT for extensive facial AKs. METHODS: In total, 16 patients with symmetrically distributed facial AKs, mainly on the forehead, were enrolled in the study. Nerve blocks were applied unilaterally, and the nonanaesthetized side of the treatment area served as control. Maximum pain during PDT was evaluated using a visual analogue scale (VAS). Pain experienced after PDT was evaluated by telephone interview within 2 weeks of treatment. Cure rates were assessed at follow-up at least 4 weeks after treatment. RESULTS: Pain was significantly reduced on the anaesthetized side (P < 10(-8)). The mean +/- SEM VAS score on the blocked side of the face was 1.3 +/- 0.3 compared with 7.5 +/- 0.5 on the nonanaesthetized side. Pain relief persisted 1-2 h after PDT. The nerve block was generally not experienced as painful (14/16 patients). Almost all patients (15/16 patients) would like to receive nerve blocks bilaterally if future PDT were needed. Excellent clinical results were observed in all patients after 4-20 weeks. CONCLUSION: Nerve blocks provide efficient pain relief during PDT when treating patients with field cancerization of the forehead. Nerve blocks were not found to affect the clinical outcome of PDT, and were generally well tolerated by the patients.
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| 9. |
- Paoli, John, 1975, et al.
(författare)
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Penile intraepithelial neoplasia: results of photodynamic therapy
- 2006
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Ingår i: Acta Derm Venereol. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 86:5, s. 418-21
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Tidskriftsartikel (refereegranskat)abstract
- Failure of response to treatment or recurrent disease is often noted in patients with penile intraepithelial neoplasia. Photodynamic therapy has recently been added to the list of treatment modalities used for this diagnosis. Our primary objective was to study the results of photodynamic therapy in the treatment of penile intraepithelial neoplasia in men over the age of 40 years. Ten patients aged 42-82 years with histopathologically confirmed lesions were studied. Lesions initially responded to photo-dynamic therapy in 7 out of 10 patients. Four of these patients presented no recurrences during a mean follow-up of 35 months, and were completely cleared after 2-8 treatments (mean 4.5 treatments). Three patients presented recurrences after treatment. No patient developed invasive penile cancer (mean follow-up 46.5 months). Photodynamic therapy is an alternative in the treatment of penile intraepithelial neoplasia, although prospective randomized trials are required to provide therapeutic guidelines.
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| 10. |
- Paoli, John, 1975, et al.
(författare)
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Results of the 'Euromelanoma Day' screening campaign in Sweden 2008
- 2009
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Ingår i: Journal of the European Academy of Dermatology and Venereology. - : Wiley. - 1468-3083 .- 0926-9959. ; 23:11, s. 1304-1310
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background The 'Euromelanoma Day' skin cancer screening campaign is organized annually in several European countries since the year 2000. The national results have not been analysed in a Scandinavian country. Objective Our objective was to analyse the demographic characteristics and risk factors of the screened population during the 'Euromelanoma Day' in Sweden 2008. We also aimed to describe the clinical diagnoses found, the melanomas confirmed histopathologically and the treatments performed. Methods A public health education campaign to promote awareness of skin cancer risk factors and warning signs was carried out. Patients with suspicious lesions were advised to attend the screening. Questionnaires were used to collect relevant demographic, epidemiological and clinical data. Results In total, 2659 patients were screened. Women accounted for 62.3% of all patients; the median age was 57 years (range: 5-100 years); and 91.2% had skin phototypes II-III. Previous skin cancer was reported by 18.4% of all patients and 14.8% had a family history of melanoma. In total, 456 patients were diagnosed clinically with non-melanoma skin cancer. Twenty-four patients had histopathologically confirmed melanomas. Ten were in situ and 8 of the 14 invasive melanomas had a Breslow thickness that was less than 1 mm. Treatment or future medical care was carried out in 45.4% of all patients. Conclusion The 'Euromelanoma Day' campaign attracted many individuals at risk for skin cancer. The detection rate of non-melanoma skin cancer and melanoma was relatively high compared to similar campaigns in other European countries. Most melanomas found had a favourable prognosis. Conflicts of interest None declared.
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