My thoughts on VivoSight – 1 year on
I’ve had my VivoSight OCT for just over 12 months and it has found its place in my practice.
I use it to confirm BCCs instantly and without the need for a biopsy. Patients immediately seem very satisfied that I can quickly scan a lesion to confirm the diagnosis and plan out their treatment. I can also assess the subsurface characteristics and measure the depth of lesions. I treat many superficial and thin nodular lesions with PDT. Knowing the precise depth of the deepest point of the tumour is very important to determine suitability for PDT. OCT provides me with this information whereas a biopsy will not. The presence or absence of infiltrating features is also important in determining suitability for PDT and this is quickly achieved with a scan.
Having an accurate depth measurement also means that I can remove a BCC using curettage, laser or cryotherapy with more precision and this translates to a better cosmetic outcome.
I also use OCT post-treatment following curettage & cautery (C&C) removals of BCCs and SCCs (keratinocyte skin cancers (KSCs). The scans are performed about 3-6 weeks following removal (allowing enough time for wound healing).
C&C is an underutilised treatment for KSCs. It is a very simple and effective treatment for the majority of small KSCs. It is a very quick treatment to perform compared to excision and wound complications are less common. Scarring can be kept very minimal too with proper technique. There is a reluctance by skin cancer providers to remove KSCs by C&C as verification of clearance is not obtained as it is with excision. OCT changes that!
I have found that I am performing more and more C&C’s on the run now. Patients appreciate the immediate treatment and it is also excellent for generating practice revenue. I am very comfortable with the knowledge that the patient can return in a few weeks so that I can verify and document the absence of residual tumour.
A final benefit is that I’m now getting more referrals for skin cancers. GPs seem very satisfied with the results we are getting and are very appreciative that we have invested in this technology.
I’m now at a stage where I can’t go back to practising without it! To my practice, it provides a new “gold standard” for the assessment and management of certain non-melanoma cancers.
Dr Welzel has written about using OCT for Mohs surgery – the ‘white paper’ can be seen here
“We often use it to decide whether we can treat non-invasively or if we need to do surgery”
“The most important factor is speed…. If we can also avoid an operation then that is important too”
“OCT Justification: “Dermatoscopes are a help and they are used every day. A lot of BCCs you can see it, and you do not need OCT, but it’s the suspicious pink patches when you simply don’t know that is when it is really powerful.”
“If you don’t care that much then that’s fine, but if you want to look after your patients well, and avoid operating on them unnecessarily or avoiding missing early BCC then you need OCT.”
“One patient I had had 35 BCCs! All his suspicious pink patches were basal cell carcinomas. For me it wasn’t just enough just to guess – I could only tell and treat appropriately using OCT – otherwise I’m either over-treating or under-treating.”
“Especially important if you’re someone who uses a lot of conservative treatments such as Aldara (Imiquimod), 5-FU or PDT. You want to make sure there is not a single germ of BCC left in the whole area, and OCT allows you to do that. There is no other method you can use.”
“A BCC – It may not be a really dangerous tumour, but in my opinion, it does make a difference – that reassurance that it has gone. It’s about how you want to treat your patients – do you want to offer them the best? If so, you need OCT”
“OCT allows us to have an exact diagnosis and treat it accordingly.”
“I am even getting referrals from other dermatologists who know I have the VivoSight machine”
“It also saves the patient 2-3 weeks of waiting for a biopsy result (this is typical in Germany). With the OCT it is all on the same day. When the patient arrives, I immediately recommended the OCT and they get it done on the same day – patients much prefer that.”
“There are 3-4 doctors in our practice and we all do the OCT scanning – this is totally manageable.”
“Nurses could do the scan, but rarely do – the scan is so quick it rarely saves me more than a little time.”
“I got up to speed to a good standard within 1-2 weeks which was great. I’m still learning now but I was competent in no time at all.”
“I am a trained morphologist (dermatopathologist) so I am used to seeing BCCs on the slides so I could transfer that knowledge to OCT interpretation without any problems”
“Confocal is so complicated and hard to learn – takes so much time – more than 15 mins just to generate the scan. It’s just so slow compared to OCT.”
“Different amounts are charged for private and non-private insurance patients to make it affordable for all.”
“OCT scans are charged slightly less than a biopsy, but the trick is we can do way more of them in the same time, which means we generate a lot more revenue now, whilst giving the patients a much better service – it’s a win-win situation”.
“As well as this, we also save money and waste of consumables such as scalpels, sutures and sterile sponges which can cost EUR €10-15 per biopsy”.
“To start with, doing just an average of 20 scans per week meant VivoSight easily paid itself off within about 10 months.”
“We also use it for nail conditions such as Onychomycosis. This also drives numbers up and makes the return on investment even more appealing than it already is”
Clinic: Dr. med. Jens Würker, Bonn, Germany
● Specialist Skin Cancer with a high proportion of privately insured patients
Patient numbers and charges:
● 40-80 oncologic patients per day with NMSC, up to 20 of which I choose to scan with
OCT mostly BCC.
● Each patient has 1-5 scans on average. We charge 1 examination per patient
according to GOÄ procedures
How we use OCT:
“I don’t tend to advertise OCT much to the patients. I just explain to them in the consulting
room and almost all patients go for it.”
“Our doctors do the scanning themselves so we can directly explain to the patients the structural changes, the sort of basalioma and the treatment options. The patients love to see the pictures and get the explanation on the screen.
“My main use for it is replacing biopsies in diagnostics. OCT is so much quicker than biopsies and for the very small BCCs, it’s actually a lot better too, because we can see the whole lesion. I also use it quite a lot as margin mapping before surgery or as a follow up after non-surgical treatment.”
Ease of Learning?
“I used to use other technologies like Confocal Microscopy but it was very slow and very hard to use. Here in Bonn, we deal with a lot of Non-melanoma skin cancer so OCT is perfect and has been easy to learn and to adopt in the clinical workflow.”
“In summary, I couldn’t run my clinic without it any more, it has become integral to my clinic
workflow. I’m so happy with it. Also: The aftersale support of Vivosight is outstanding.”