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biomedical engineering

A diagnosis on the surface of the skin

A system for the analysis of lesions allows for an early detection of skin cancer

A company from São José dos Campos has developed a computerized system for the analysis of skin lesions that will help to carry out an objective and early diagnosis of skin cancer, which the most common cancer in Brazil. “The problem is that a diagnosis of this type of cancer is very subjective”, explains the electrical engineer Antônio Francisco Junior, a partner-director of Atonus Engenharia de Sistemas, which has developed the system after three years of research. “Only in less than 40% of cases is the doctor capable of stating with certainty, through a clinical exam, if the lesion is or is not malignant. Our system will help the specialist in his or her diagnosis.” It also decreases the number of biopsies, principally in cases in which it is necessary to accompany the lesion over a long period of time.

Video Dermatoscope
The Video Dermatoscope System (VDS) of the company Atonus consists of a special camera – the video dermatoscope – that uses light from a fiber optics cable as well as a piece of software and a remote data bank on the Internet. The video dermatoscope works like a microscope on the skin, with a micro camera and a special lighting system. In contact with the epidermis, it films the lesion and transmits the colored image to a computer where a capturing plaque digitalizes the image. Thereupon the software, called VisualMed, morphologically analyzes the lesion based on the ABCD ruling of dermatoscopy and stores the data using a diagnostic method with check-ups on seven aspects – the seven point-checklist.

For the ABCD ruling, the following attributes of the lesion are extracted by the computer: asymmetry, irregularity on the edge and the diameter of the lesion. Another item is the detection of colors and of differentiated structure, aspects verified by the doctor and manually inserted into the program. Then the seven point-checklist method considers the following occurrences on the lesion: an itch, greater than 1 centimeter in diameter, growth history or other changes, irregular configuration, varied and irregular, hemorrhaging and inflammation of the edge or close to it.

When the parameters of the ABCD rules have been evaluated, the program automatically calculates the value of a pre-established dermatology point score called TDS. Based on the value of the TDS, the program determines if a lesion is benign, malignant or if a doubt still exists. In all cases, the doctor still has the option of sending the digitalized images of the lesions, via the Internet, to another specialist for a second opinion.

Debates through the Internet
The system created by Atonus forecasts the establishment on the Internet of a forum of debates between professionals in the epidermis area and of a large data bank about skin cancer in the country. It will be an embryo of tele-dermatology in Brazil. The site: www.visualmed.com.br is already up, but has not as yet been well-stocked with the images of skin lesions, since the VDS is only now being put on the market. The VDS also allows for an accompaniment of a lesion by way of juxtaposition of the images captured at different dates. “We know that a comparative analysis of a lesion is essential for the emission of a secure diagnosis”, says Francisco Junior.

With two VDS instruments already working, at the Brazilian Institute of Cancer Control (IBCC) and at the São Paulo School of Medicine of the Federal University of São Paulo (Unifesp), the Atonus company is gearing up for full scale commercialization. “We hope to place on the market an average fifteen units per year”, says Francisco Junior. The VDS is the first of its kind in the country and was developed with national technology. “Some first world countries, such as the United States, Germany and Austria, master this technology”, says the engineer. The Atonus instrument costs almost half the price of its competitors.

The project began in 1998 and was concluded in the first semester of this year through the Small Business Innovation Research (PIPE) of FAPESP. “The resources received were essentially used in the payment of the workforce as we had hired a large team for the development of the video dermatoscope, the software and the Internet site”, explains the Atonus director. Located in the town of São José dos Campos, the company was founded in 1995 and acted above all in the area of computerized vision, creating systems that had components for the capture and analysis of images. It had already developed optical and software equipment for the analysis of human semen.

“With the VDS we developed not only an instrument, but a system, which will allow for the remote exchange of information and images related to a serious public health problem”, underlines the engineer. “With this inter-exchange of images, our objective is to reduce the degree of subjectivity of the diagnoses of skin lesions.”

A higher incidence
Close to 57,000 of the 305,000 new cases of cancer estimated for this year in the country will have as their first localization the epidermis, considerably overtaking the cases of breast cancer (31,000), stomach (22,000) and prostrate (20,000). This data is from the National Cancer Institute (Inca), of the Ministry of Health. The roots of the problem are the reduction of the planet’s ozone layer, the carelessness of the population in exposing themselves to the sun and cases of the illness in a family. Of the new reports of skin cancer, close to 5% should be of melanoma, the most serious.

It gets to the melanocytes – the cells that produce melanoma, a substance that determines skin color and, depending on the seriousness, can reach the lymphatic duct and the internal organs, causing metastasis and death. “Fortunately, though the notifications of the illness, especially that of melanoma, have been increasing over the last few years, the chances of curing skin cancer are much higher. When the diagnosis is done in the early stages, the success of the treatments runs to 98% of the cases” explains the dermatologist Aldo Toschi, of the IBCC.

For this reason, the instrument is being received with enthusiasm. “The SVD will be a valuable ally in the fight against skin cancer. The apparatus is very good and is equivalent to similar foreign instruments in terms of image capture and software analysis” says the dermatologist. “The great advantage of the system is in the storage of the images, which allows for the patients to be catalogued”, completes Sérgio Yamada, a dermatology professor at Unifesp who has been using the SVD prototype for a year.

“We are going to have a reliable tool to follow up people who have multiple lesions and whose diagnosis is not precise. The patients, for their part, will become more confident knowing that their pigmented lesions are being closely monitored”, evaluates Toschi. The Atonus company is preparing another innovative instrument: the Subsystem of Pathological Anatomy (SPA). “It consists of a microscope set up for the analysis of pathological anatomy, connected to a video camera, a plaque for capturing images, a computer with monitor, a scanner, a printer and an Internet connection. The software available in this subsystem will have the functions of capturing, pre-processing and storing in a data bank the images of the tissue removed from the skin lesions”, anticipates Francisco Junior.

The Project
A Computerized System for the Analysis of Skin Lesions (nº 97/07390-4); Modality Program of Innovative Technology in Small Companies (PIPE); Coordinator Antônio Francisco Junior – Atonus Engenharia de Sistemas; Investment R$ 106,164.00

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