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'Can the triage process be better?': Halifax study looks at ways to diagnose, treat skin cancers faster

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A dermatologist in Halifax is looking at new ways to better diagnose skin cancers and have them treated at an earlier stage.

According to Dr. Richard Langley, the Maritimes has the highest rates of certain types of skin cancer in the country.

He says Nova Scotia, New Brunswick, and Prince Edward Island in particular have the highest rates of melanoma – a type of cancer that starts in the melanocytes, which are cells that make the pigment that gives skin its colour.

"So we see this, we see it also increasing overtime, and it's occurring in young people. So, it's something that we're definitely aware of," said Langley, during an interview with CTV Atlantic's Todd Battis.

As far as why the rates are higher in the Maritimes, Langley points to several potential reasons.

"It hasn't been really well studied but some of the key risk factors for skin cancer are going to be people who burn easily, they have lighter skin pigmentation. Certainly historically, there's been a lot of Scottish, Irish and English immigrants here pre-disposed to it," he said.

"In addition to that... some of the studies recently coming out of the U.S. has shown that people are less concerned about skin cancer in younger generations. So, while many of us have heard the education, the public message, and are careful about wearing sunscreen and trying to avoid sunburns, tanning beds. Some places are getting a resurgence. Patients are maybe less frequently wearing sunscreen, not taking it seriously."

Langley says in recent years, there's been some misinformation around sunscreen on social media platforms.

"Through things like TikTok where they've been talking about things like, why you shouldn't wear sunscreens or minimizing the risks I think of sun exposure," he said.

As with many areas of the Maritimes' health-care system, it can be difficult to get into specialists for certain types of cancers.

Langley is now working on a study that he hopes could someday help fix that problem.

"One of the big changes in health care has been that the health-care team, it's not physician-centric anymore. The concept is that we're working as a team and that there are other members, nurse practitioners, there's now physician assistant programs that are just starting, the first class is just coming through. Pharmacists are doing things like vaccinations, and the question is: How can we work together as a team where there isn't enough dermatologists maybe to see every patient with a changing mole or spot," he said.

One of Langley's concepts based on research done before on the early diagnosis of skin cancer is: Can the triage process be better?

"If there are patients out there in the community who have a changing mole or a changing spot, not all of them are skin cancer. So, while we're all thinking about it and it's important, many people may have benign lesions or benign growths... or just a mole that maybe got irritated. Whereas there are other people who really have skin cancer and the question is: How could we triage those patients better?"

That's where technology could come in as a life-saving piece of equipment.

"The normal way that we diagnose skin cancer is we look at the lesion and even amongst experts, I've been doing work in melanoma for 25 years, I'm not right every single time. And we always have to maintain humility and we have to be able to do, when we're not sure, do a biopsy. Take a sample of the skin and analyze it," said Langley.

"So that's why, for example, dermoscopy, a very simple technique here, involves the use of polarized light or light that's put onto the skin with a magnifying glass that allows you to see through the skin. And there are patterns that you cannot see to the naked eye. So, that's been a huge advance in improving it."

However, Langley says in our broadened health-care system with nurse practitioners and family doctors, many don't have experience using this technology.

"So, one of the concepts I had was: How can we get those images to us to help us triage? And that's the idea. So, you could use the dermatoscope. But you can also use a dermatoscope, which can be attached to a phone or an iPad... and by doing that, you could then get those images and they could be transmitted securely... Those images could come with a letter."

"So, instead of a physician or a nurse practitioner thinking, 'Oh, I think this is a benign wart,' it might be something in these images that help us identify and say, 'This is something that needs to be seen sooner," he explained.

Langley says this technique would provide quicker and more accurate health-care results.

"And then the other question is: How can we deploy technology? So, I'm working with a group in the computer science department, some software engineers and such to use artificial intelligence as well, which might be able to help you triage. So, those images might have a couple points they can analyze before they get to me or maybe that would be an adjunct. Not a replacement but just as an adjunct."

As far as the studies on this concept, Langley says there will be medical students helping lead this project.

With files from CTV Atlantic's Todd Battis

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