Addressing health equity challenges with digital innovation
On October 23, 2021, a 22-year-old female medical student was attending a hockey game between Vancouver Canucks and Seattle Kraken when she spotted what she believed could be a cancerous mole on the neck of an assistant equipment manager for the Canucks. After the game, she tried to get his attention by writing a note on her phone and holding it up to plexiglass for him to see.
Due to her persistence, Brian “Red” Hamilton, the assistant equipment manager in question, paid attention and went to see a doctor. His mole was biopsied and he was diagnosed with malignant melanoma in stage II. According to his doctor, early detection saved his life. “You have an angel in your life because if you didn’t get that thing out in five years, you would not be here,” the doctor added. Popovici, the medical student, was the angel.
Melanoma is the most invasive skin cancer with the highest death risk, arising from melanocytes, the skin cells responsible for the production of melanin. It is highly aggressive and can spread to any organ.
This cancer can develop anywhere on the body, even from a normal mole that a person already has on their skin. Melanoma can grow deep into the skin and invade the blood vessels, through which it metastasizes.
Taking a biopsy of the suspicious skin area is the surest way to make a diagnosis and classify the malignancy into stages. Based on severity, melanoma is staged from 0-IV.
Once detected, surgical resection is the most frequently used method. However, surgeons often err on the side of caution and remove a large portion of tissue, including the normal tissue surrounding the original tumour, to make sure that they have excised all the cancer and help to prevent a recurrence. Due to delayed healing resulting from this, therapeutic methods such as chemotherapy and immunotherapy are being combined with surgical procedures. However, these targeted therapies used in the treatment of cutaneous melanoma are reported to be easy for tumour cells to develop resistance to and exhibit limited effectiveness; immunotherapies are only used for advanced (stage IV) melanoma, which cannot be surgically removed. Another option is the use of photothermal therapy.
In photothermal therapy, the resection site is exposed to light and a photothermal agent converts the energy from the light to heat, thereby killing the residual cells. If effectively performed, this approach could potentially help surgeons to be more conservative in their resection.
Surgical dressings are basically to cover the postoperative trauma to protect the defective tissue, nevertheless, traditional surgical dressings such as gauzes and pads tend to be inert and have no function in stimulating anti-tumor activity, nor aiding healing. Consequently, a perfect surgical dressing for the treatment of melanoma would precisely offer photothermal therapy to eliminate residual tumor cells, inhibit tumor recurrence, and reduce the expanded area of resection, while at the same time causing angiogenesis and regenerating tissues.
At the University of Nottingham, the United Kingdom, Scientists have created a surgical dressing that is precisely designed to facilitate and enhance photothermal therapy following melanoma resection. The dressing permits near-infrared photothermal therapy that lasts just 15 seconds every 48 hours. The idea involves killing any remaining melanoma cells while helping healthy cells to regenerate within the resection site.
The dressing contains graphene oxide, a photothermal agent which converts the energy from light to heat and consequently kills cancer cells, elastin, and ethanol. The combination of graphene oxide with elastin reduces its cytotoxicity, that is, it does not pose a threat to healthy cells, but still allows photothermal therapy to kill residual melanoma cells. The ethanol helps to chemically reduce the graphene oxide, rendering photothermal therapy more efficient, and also forming an antiseptic component of the dressing. These dressings could lead to smaller surgical resections and practical post-surgery treatments that are non-invasive and could be delivered at home.
Another alternative would have been to deliver photothermal agents to tumors through the bloodstream, however, some of them can have negative effects on healthy cells. Also, the blood supply and tortuosity of the vasculature are unpredictable, and this should be considered.
This latest technology seeks to place the photothermal agent directly onto the resection site. In this case, the photothermal agent is reduced graphene oxide.
The scientists have shown that the dressings only require 15 seconds of irradiation with near-infrared light every 48 hours to produce effective PTT. Patients could even administer the light therapy by themselves wherever they are.
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