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. 2018 Nov;119(11):1339-1346.
doi: 10.1038/s41416-018-0257-9. Epub 2018 Nov 9.

Improving clinical diagnosis of early-stage cutaneous melanoma based on Raman spectroscopy

Inês P Santos  1 , Remco van Doorn  2 , Peter J Caspers  1 , Tom C Bakker Schut  1 , Elisa M Barroso  3 , Tamar E C Nijsten  1 , Vincent Noordhoek Hegt  4 , Senada Koljenović  4 , Gerwin J Puppels  5
Affiliations

Improving clinical diagnosis of early-stage cutaneous melanoma based on Raman spectroscopy

Inês P Santos et al. Br J Cancer. 2018 Nov.

Abstract

Background: Clinical diagnosis of early melanoma (Breslow thickness less than 0.8 mm) is crucial to disease-free survival. However, it is subjective and can be exceedingly difficult, leading to missed melanomas, or unnecessary excision of benign pigmented skin lesions. An objective technique is needed to improve the diagnosis of early melanoma.

Methods: We have developed a method to improve diagnosis of (thin) melanoma, based on Raman spectroscopy. In an ex vivo study in a tertiary referral (pigmented lesions) centre, high-wavenumber Raman spectra were collected from 174 freshly excised melanocytic lesions suspicious for melanoma. Measurements were performed on multiple locations within the lesions. A diagnostic model was developed and validated on an independent data set of 96 lesions.

Results: Approximately 60% of the melanomas included in this study were melanomas in situ. The invasive melanomas had an average Breslow thickness of 0.89 mm. The diagnostic model correctly classified all melanomas (including in situ) with a specificity of 43.8%, and showed a potential improvement of the number needed to treat from 6.0 to 2.7, at a sensitivity of 100%.

Conclusion: This work signifies an important step towards accurate and objective clinical diagnosis of melanoma and in particular melanoma with Breslow thickness <0.8 mm.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Schematic representation of specimen handling. a Clinical diagnosis was aided by dermoscopy (inset). b Lesions suspicious for melanoma were excised. c Specimen is inserted in the cartridge and multiple points were measured within the lesion (inset). d Routine histopathological evaluation (image from H&E slide)
Fig. 2
Fig. 2
a Division of lesions using the histopathological evaluation. The division was used to create the training sets for the diagnostic model (see section “Diagnostic model creation” and b). b Lesions used for diagnostic model creation (left), lesions used for the independent validation (middle) and dysplastic nevi on which diagnostic model was separately applied (right)
Fig. 3
Fig. 3
H&E-stained thin tissue sections. a Melanoma in situ with a thick stratum corneum (1200 µm); b combined melanocytic nevus with a thick stratum corneum (200 µm). N.B.: the Raman spectra of these lesions showed high contribution from keratin and were labeled “Not predicted” by the diagnostic model
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