Articles

Advances in imaging may help gather more datasets on tumor development from a single experiment.

Research Delves into Connection Between Melanoma and Parkinson’s Disease 

Software helps expedite access to dermatology appointments.

Skin monitoring app bridges care gap, battles burnout

Frozen primary tumor samples will allow researchers to track lesions as they evolve and better understand the characteristics and biomarkers that distinguish aggressive melanomas.

Melanoma bank supports prospective research

There is room for improvement in dermatology palliative care; training can help providers raise that standard.

Palliative Perspective:  Aligning Melanoma Treatment with Patient Goals

Sunscreen use is on the rise, but further education is needed. 

How to Ensure Outdoor Workers Use Sun Protection

Specifying histologic subtypes can drive better outcomes for patients and improve research. 

Morphology Drives Melanoma Risk 

Podcasts

Zoe Diana Draelos, MD, gives the details on sun protective clothing, including how it doesn't need to break the bank, how to test how protective clothing is, and a hat might be the most important piece of sun protection. 

The Cutaneous Connection: An In-depth Dive on Sun Protective Clothing

Scientists from Mount Sinai have reported that a mutation of the ARID2 gene may be a key factor in the risk of melanoma turning metastatic. 

Discovery: Gene Mutation Signals Aggressive Melanoma

Merck announced that pembrolizumab led to significant improvement in distant metastasis-free survival (DMFS) compared to placebo as adjuvant therapy for patients with resected stage IIB and IIC melanoma in the phase 3 KEYNOTE-716 trial.  

Pembrolizumab Demonstrates Improvement in IIB, IIC Melanoma    

Skin cancer dermoscopy is getting a hightech overhaul as the scope of innovation broadens from a singular focus on the stand-alone product to the development of a comprehensive medical, patient care, and workflow management platform.

Digital Device Aids Skin Cancer Diagnostics

Proscia recently released study results on new technology that uses artificial intelligence (AI) to automictically detect melanoma with a high degree of accuracy.

 These findings may demonstrate the ability of AI to deliver faster diagnoses of melanoma which can improve patient outcomes and lab economics in the routine practice of pathology. 

The trial was conducted at Thomas Jefferson University and the University of Florida, where the AI was used on an uncurated set of 1,422 sequential skin biopsies. The technology correctly identified invasive melanoma and melanoma in situ with a sensitivity of 93% and a specificity of 91%, according to the press release. 

It also classified basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with an AUC of .97 and .95, respectively, accounting for a combined 97% of all skin cancers. This study validated the results of a multi-site retrospective study of 12,784 images, which will be presented during the Computational Challenges in Digital Pathology Workshop at the 2021 International Conference on Computer Vision.

“The performance of Proscia’s technology in detecting melanoma and other malignant skin diseases is impressive,” said Kiran Motaparthi, MD, FAAD, director of dermatopathology and clinical associate professor of dermatology at the University of Florida. “This is an exciting development as pathologists increasingly look to unlock new sources of value from artificial intelligence.”

Proscia is also conducting research to demonstrate the potential benefits of AI in dermatology, such as

Delivering faster results to patients. If AI can automatically identify melanoma, it can show the pathologist a high-risk case and then lead to earlier diagnosis. This will help prioritize cases and begin treatment sooner. 

Consistency in the diagnosis of difficult melanoma cases. Melanoma can be challenging to diagnose and lead to interobserver variability among pathologists.3 The ability of AI to distinguish melanoma from other skin issues could serve as an adjunctive aid to the pathologist to increase diagnostic accuracy and improve patient outcomes.

Optimizing laboratory productivity to enhance profitability. More than 15 million skin biopsies are taken annually in the United States.4 AI that classifies and distinguishes melanoma and non-melanoma skin cancer could enable laboratories to optimize case distribution among specialists and non-specialists. This may result in efficiency gains that make it possible to process more case volume and partially overcome the impact of declining reimbursements.

“Proscia’s technology represents a significant advancement in our work on skin pathology,” said Julianna Ianni, PhD, Proscia vice president of AI research and development. “Our AI not only identifies melanoma, a difficult diagnosis, but also accounts for the high degree of variation in disease to push the boundaries of deep learning in medicine. In doing so, it holds great promise to help pathologists deliver faster, more consistent diagnoses and improve patient outcomes.”

The AI validated in the study expands upon the technology that powers 

, DermAI provides an AI-based classification for every skin case to drive efficiency and quality gains, the press release explained. The application’s performance was tested in a 

, and continues to be validated and deployed as part of Proscia’s ongoing work in AI.

The company is also collaborating with academic and commercial laboratories, including LabPON, Johns Hopkins School of Medicine, Unilabs, University Medical Center Utrecht, and University of California, San Francisco, to accelerate the adoption of AI in pathology.

To learn more about Proscia’s prospective study, watch the webinar, “

Automated Detection of Melanoma and Non-Melanoma Skin Cancer with Artificial Intelligence: Prospective Study & Real-World Impact

1. Proscia announces artificial intelligence breakthrough in melanoma detection. Proscia. Press release. Published October 5, 2021. Accessed October 14, 2021. 

https://proscia.com/proscia-announces-artificial-intelligence-breakthrough-in-melanoma-detection/

2. Sankarapandian, S. Kohn, S., Spurrier, V., et al. A Pathology Deep Learning System Capable of Triage of Melanoma Specimens Utilizing Dermatopathologist Consensus as Ground Truth. To be presented at CDPath Workshop at ICCV 2021. 

3. Elmore, J. G., Barnhill, R. L., Elder, D. E., et al. (2017). Pathologists’ diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study. BMJ (Clinical research ed.), 357, j2813. doi:10.1136/bmj.j2813

4. Klipp, J. (2019). The U.S. Anatomic Pathology Market: Forecast & Trends 2019-2021. Laboratory Economics. Poughkeepsie, NY.

Proscia announces new study data on artificial intelligence’s ability to detect melanoma. 

AI Breakthrough in Melanoma Detection

It has been 20 years since the FDA approved a new sunscreen filter. However, positive outcomes in a recent murine study evaluating curcumin’s anti-inflammatory, antioxidant, and wound-healing properties could change that.

Delivered in encapsulated nanoparticles in a vehicle developed by the authors, this component of turmeric demonstrated efficacy in decreasing UV-induced cellular damage, oxidative stress, and inflammation, according to Adam Friedman, MD, FAAD, professor and chair of dermatology at George Washington University School of Medicine and Health Sciences in Washington, DC, and one of the study’s authors.

Friedman detailed the importance of the findings and what they could mean in the fight against skin cancer in an exclusive interview with

Q: What first sparked your interest in exploring curcumin in relation to skin cancer? 

 My first foray into the amazing world of curcumin was with wound healing and skin and soft tissue infections. I found that there was already an incredible body of knowledge. Curcumin, or diferuloylmethane, is a crystalline compound which gives the East Asian spice turmeric its bright orange-yellow color. The medicinal qualities of curcumin have been established for thousands of years and references to this spice have been seen in numerous countries and cultures throughout the world. 

Today there is growing scientific evidence suggesting curcumin’s utility in the treatment of chronic pain, osteoarthritis, and inflammatory dermatoses such as psoriasis; acceleration of wound closure; and bacterial, fungal, and viral skin infections, as well as cosmetic ailments such as dyspigmentation.

Although turmeric is commonly used in alternative medicine, curcumin has yet to emerge as a component of our mainstream dermatologic therapeutic armamentarium. Curcumin exerts its impact through a number of different pathways in the body. It is currently being investigated for therapeutic uses in various disease states ranging from cancer to autoimmune or inflammatory disorders. In addition, results from numerous studies have elucidated the protective effects of curcumin against various pollutants and cytotoxic agents, which also indicates that curcumin may be beneficial in a mitigatory or prophylactic role.

 As curcumin is a potent anti-inflammatory and antioxidant, it would only make sense that it could protect [against] and mitigate injury from ultraviolet radiation. 

Q: Given its long history, why wasn’t curcumin at the forefront of adjuvant photoprotective treatment?

 Prior studies showed that curcumin decreased UV-induced inflammation, apoptotic changes in human keratinocytes and dermal fibroblasts, and the expression of matrix metalloproteinases. The problem was that its utility was hindered by poor aqueous solubility and rapid degradation in vivo. And, too, there was staining from the bright yellow-orange color. To overcome these limitations, we synthesized curcumin nanoparticles. That approach offered sustained topical delivery and enhanced bioavailability.

Q: You and your fellow authors developed and investigated nanoformulation curcumin (curc-np) in previous preclinical studies2-4 that focused on wound healing, infection, and oxidative stress. What brought about the decision to evaluate this compound’s potential in photoprotection?

The data demonstrating its efficacy in wound healing, infection, and oxidative stress were factored into our decision to undertake this evaluation. So did the state of the industry. We’re seeing demands for an overhaul of the sunscreen industry, spiraling skin cancer rates, and increasing consumer interest in and understanding of the benefits of photoaging prevention. As we pointed out in the study background, the FDA recognizes only zinc oxide and titanium dioxide OTC sunscreens as safe, effective, and properly labeled.

 For some products, formulation instability is a problem. There are also safety concerns centering on organic filters.

Clearly there is a need to explore new ingredients for skin protection and new vehicles to deliver them effectively.

Q: Did you find implications for curcumin beyond combating cancer?

 Actually, we focused more on preventive strategies. There was an incredible dearth of data examining whether curcumin could be used as an antineoplastic therapy. We have done studies looking at glioblastoma multiplex with our nanoparticles, for example, so there could be an opportunity there as well. 

Q: Do you see this as part of a growing trend to incorporate more natural therapies?

Although the advantageous properties of curcumin in medicine are well established, its therapeutic potential thus far has been limited because of its poor bioavailability [soluble in water-based vehicles only up to 1 mg/mL] and its incredible ability to stain everything bright yellow-orange. This is why we turned to nanoparticle encapsulation to improve the cosmesis, enhance skin penetration, and allow for the sustained release of curcumin over time. I think there are many “natural” ingredients that have therapeutic potential but they may have limitations such as photolability, poor solubility, susceptibility to oxidation, or poor skin penetration or cell uptake, just to name a few.

It’s all about purposeful design and delivery. Without that, you hit a brick wall. Nanotechnology is one of several opportunities to capitalize on these high-drama ingredients. To deliver the undeliverable is the name of the game. 

Q: What would dermatologists need to consider when weighing curcumin as part of a treatment or prevention regimen? 

 Ideally this would be incorporated into a sunscreen or a moisturizer that would be used in conjunction with a sunscreen. 

The other unique opportunity we found in our animal experiments is that application of the curcumin nanoparticles post UVB exposure had a similar protective impact based on skin histology and cytokine profiling. This formulation could be used as a do-over, because let’s face it, we all forget to wear sunscreen here and there. I also see a curcumin formulation in the same vein as some of the products which function as photoprotection adjuvants to be used with sunscreen, like polypodium leucotomos or SunSpheres in L’Oréal sunscreens.

Q: What surprised you most about the results? What still needs to be studied to maximize outcomes? 

What I was most surprised by was how little the curcumin in coconut oil, not in nanoparticles, did for these animals. Once again, that highlights the importance of vehicles. I also was impressed by how the nanoparticles minimized the yellow-orange discoloration. 

 Mouse studies are but a small step forward. The good news is both curcumin and the nanoparticle platform I codesigned have an exceedingly high amount of safety data—even some human phase 1-like toxicity studies. To take this to the next level always requires one thing…funding.

Friedman is an inventor of the described technology, which has been licensed to Zylo Therapeutics for commercial development.

1. Adusumilli NC, Mordorski B, Nosanchuk J, Friedman JM, Friedman AJ. Curcumin nanoparticles as a photoprotective adjuvant. Exp Dermatol. 2021;30(5):705-709. doi:10.1111/exd.14282

2. Liang H, Friedman JM, Nacharaju P. Fabrication of biodegradable PEG-PLA nanospheres for solubility, stabilization, and delivery of curcumin. Artif Cells Nanomed Biotechnol. 2017;45(2):297-304. doi:10.3109/21691401.2016.1146736 

3. Krausz AE, Adler BL, Cabral V, et al. Curcumin-encapsulated nanoparticles as innovative antimicrobial and wound healing agent. Nanomedicine. 2015;11(1):195-206. doi:10.1016/j.nano.2014.09.004

4. Baltazar LM, Krausz AE, Souza ACO, et al. Trichophyton rubrum is inhibited by free and nanoparticle encapsulated curcumin by induction of nitrosative stress after photodynamic activation. PLoS One. 2015;10(3):e0120179. doi:10.1371/journal.pone.0120179

5. Sunscreen drug products for over-the-counter human use. Federal Register. February 26, 2019. Accessed June 18, 2021. 

6. Mancebo SE, Hu JY, Wang SQ. Sunscreens: a review of health benefits, regulations, and controversies. Dermatol Clin. 2014;32(3):427-438, x. doi:10.1016/j.det.2014.03.011

It has been 20 years since the FDA approved a new sunscreen filter. However, a recent study evaluating curcumin could change that.

Curcumin Shows Promise as New Sunscreen Filter

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Delve into the headline-making research, clinical trials, and FDA pipeline reports that are adding life-saving options for medical professionals caring for patients with melanoma.

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