More Viva Scope: Fewer Biopsies

Skin cancer is the most common form of cancer in the United States. Often, people have concerns and if the doctor isn't sure, a biopsy is ordered, meaning a piece of skin must be removed. Now, doctors can use a new device that checks for cancer just beneath the surface allowing patients to save face.

Joseph Donnelly has been here before with Babar K. Rao, MD, FAAD, Dermatologist, Rutgers Robert Wood Johnson Medical School, checking out the moles on his face. Donnelly has had two moles that were cancerous in the past and he is about to get the verdict on a new one.

"Absolutely no need to do surgery, or no need to do cutting," Dr. Rao told Ivanhoe.

No surgery, no cutting from a biopsy, thanks to the device Dr. Rao held in his hand… a Viva Scope.

"It will take just a few images, which then will be visible on a monitor and I can tell right away if it is good or not good," Dr. Rao said.

The Viva Scope is applied directly to any part of the body. It takes only sixty seconds to look beneath the skin's surface. A certain image means cancer and an operation for total removal is needed. But, a different image says it's nothing and no biopsy is needed.

"I think it will become much more common. I think I know it will save lives," Donnelly told Ivanhoe.

At 70, Donnelly can walk away knowing he won't have unnecessary scars just to be sure he is skin cancer free.

BACKGROUND: Skin cancer is the abnormal growth of skin cells. According to the Skin Cancer Foundation, skin cancer is the most common form of cancer in the United States. Every year, more than three point five million cancers in over two million people are diagnosed. Each year, there are more new cases of skin cancer compared to breast, prostate, lung and colon combined. Treatment of non-melanoma skin cancers increased by nearly 77 percent between 1992 and 2006. (Source: http://www.skincancer.org/skin-cancer-information/skin-cancer-facts)

SIGNS/SYMPTOMS: About 90 percent of non-melanoma skin cancers are associated with exposure to ultraviolet radiation from the sun. It develops on the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But, sometimes the cancer is found in a place that hasn't been exposed to the sun. Researchers think other factors could be involved. For example, exposure to toxic substances or a weakened immune system. Risk factors may include: fair skin, history of sunburns, and excessive sun exposure. (Source: http://www.mayoclinic.org/diseases-conditions/skin-cancer/basics/causes/con-20031606)

NEW TECHNOLOGY: Viva Scope mole detection allows dermatologists to examine and diagnose tissues non-invasively. This means unnecessary scars, biopsies and excisions are avoided. This also means the unaltered skin is still available for accurate analysis, if need be. The images can be saved, so if the patient needs to be monitored the images will be available for comparison. The Viva Scope hand held unit can reach skin regions that are difficult to examine. It can be applied to any part of the body and look beneath the skin's surface. Images appear on a monitor and the doctor can usually determine immediately if it is problematic. According to the National Institutes of Health there are barriers with new technologies, like the Viva Scope. Some of those barriers are cost, time needed to become competent, and lack of insurance reimbursement. (Source: http://www.vivascope.de/en/medical/applications/in-vivo/melanocytic-lesions.html) For further information, visit www.raodermatology.com.


Babar K. Roa, MD, FAAD

Professor, Department of Dermatology

Rutgers Robert Wood Johnson Medical School

Office: 212-949-0393


Babar K. Rao, MD, FAAD, Department of Dermatology at Rutgers Robert Wood Johnson Medical School talks about a new device that checks for cancer just beneath the surface of the skin.

What are the concerns of doctors who are not using this procedure?

Dr. Rao: The number one concern is they're not sure if they can bill insurances to get paid for this or not. And then obviously they are not. There is training involved.

Was there a study and who funded the study?

Dr. Rao: So there have been many. I'm doing many studies now and nobody is funding. I'm funding myself. But there have been many studies to see the validity or accuracy of the scope.

Are you directly or indirectly compensated by the manufacturer for your involvement with this procedure or product?

Dr. Rao: I am on their advisory board, scientific advisory board and I am their consultant also. So yes at times I do get compensated for my time.

Will your hospital or organization benefit financially?

Dr. Rao: No.

Would you use this procedure or product if you were not compensated?

Dr. Rao: I actually already use it.

Talk to us about this viva scope what exactly is it and why is it so important to use today?

Dr. Rao: It is an imaging device where a little laser light shining on the skin can capture images and look at cellular details to tell good from bad or cancerous from not cancerous lesions. I think it's important to use it in patients were the lesions are on the aesthetically important sites such as face or chest or arms or in children who basically hate getting cut by biopsies by their doctors and many of the times their moles are benign. So in that it's a great use, or anybody who has like 500 moles which all look bad you can't cut all of them so it's a great use for those patients.

So normally without this kind of viva scope what would happen? You would see something suspicious and then what would you do?  

Dr. Rao: We'll see something and if we think it's suspicious then we'll biopsy it which means we have to numb then we have to surgically remove the lesion and send it to lab. So that involves scarring and then also you have to wait some time to get the biopsy report back. So other than just scarring also there is an anxiety and waiting period.

So by using this viva scope you can avoid cutting if something turns out not to be cancer?

Dr. Rao: Yes, actually in majority of the cases many of the lesions they can look brown or black and worrisome like a skin cancer but most of the time when you biopsy actually the majority of the time they are benign. So in this case then, if they are benign to start with, then you can avoid a lot of those biopsies.

And conversely if it is cancer how does this benefit?

Dr. Rao: There will be cases where if it is suspicious and use a confocal if it is suspicious you'll have a little more confirmation that it is maybe cancerous. It will confirm if clinically it looks suspicious or not suspicious and use the confocal then it may help you to know to move forward and do the surgery.

What's been the response from your patients, I don't know how bad scarring is, but how bad is the scarring as you look and try to decide what's cancerous and what's not?

Dr. Rao: Well I think if my patients have a choice or if I have a choice that all insurance companies would pay for this procedure I probably wouldn't do biopsy on any of them. I would either do this first and then the one which looks bad I'll remove them rather than doing first biopsy and then cutting again. But because some people cannot afford or their insurance doesn't pay, I obviously use it as needed. But if I had a choice I would use on every lesion, especially cancer or not cancer before I cut.

How much is the use of it, is it very expensive?

Dr. Rao: To buy the scope it is around I think 60 K plus or minus.

I mean for the patient to have the test or for you to use.

Dr. Rao:  It won't be more than $300.

Three hundred dollars for piece of mind, if you could describe exactly how it works and why it's so effective.

Dr. Rao: If you have a mole anywhere on the skin we'll put a little drop of oil there and then it's a little handheld device that we'll put on the skin and within a few minutes, after pushing a button it will just take a few images which then will be visible on a monitor and then I can tell right away it's good or not good. So a few minutes, without any pain, just a little drop of oil which you can clean it with a tissue.

Is this a fascinating breakthrough?

Dr. Rao: This is a new procedure. I really don't make too much income with it but I'm so excited about it that I just wrote a book already. I'm just using it all the time.

So this has basically changed the way one can examine for skin cancer.

Dr. Rao:  It definitely changed that way and traditional biopsy or histology where you look at this microscope that was invented in 1883 or something. So it's been hundreds of years we need a new technology.

And now you have it.

Dr. Rao: Yes.

I called it a viva scope and you said confocal.

Dr. Rao: Yes, so actually the actual science part is confocal but it's better to say viva scope. So confocal is more of a scientific name but the brand name viva scope.