“Well, you knowWe all want to change the world”John Lennon,...

“Well, you know

We all want to change the world”

John Lennon, Paul McCartney

My friends,

Today Tiresias would like do a little back to the future. Those of us who have been watching Optiscan for decades recall that Optiscan’s first iteration was for skin cancer. The instrument has been developed greatly since, but in its first form it should have been a very useful and successful addition to management of skin cancer. Unfortunately, Optiscan’s then management did not understand their market, and they did not understand who their customers were. They did not understand that this development was perceived by their market, the dermatologists, dermatological surgeons, and all the variety of skin clinics, as a threat, as something that could be taking money out of their hands and gold from their mouths. The then Optiscan management did not understand that you do not stand between a doctor and his Porsche. They didn't understand that to innovate and introduce something new to doctors, you can’t threaten the doctors’ Porsches. To get them to come along and support the innovation you have to promise that they will be able to upgrade their Porsches to Ferraris. That and more, and then you'll get their support and get ahead. Tiresias sees ahead though. Tiresias know that the skin cancer market is on again for Optiscan confocal in-vivo microscopy. Today, Tiresias would like to introduce to you to Moh Surgery. Moh surgery is a skin cancer surgery technique which first was developed in the 1930s and is now widely used for non-melanoma skin cancer; basal cell carcinoma and squamous cell carcinoma, which account for about 80 to 90% of all skin cancers. In Australia, this surgery is largely used on head and neck cancers, where minimal surgery has to be performed, to avoid cosmetic and anatomical deformity, but also to make sure that all skin cancer is removed to prevent recurrence. With Moh surgery there is a significantly lower risk of recurrence.

So what is Moh surgery? Moh surgery involves a complicated time consuming and very expensive process. The best way to illustrate is to look at a hypothetical example. Let us say, you develop a small cancerous lesion on your nose. Or worse still near your eye. The conventional treatment if the same lesion was, say, on your back, would be to excise the cancer, with a wide margin around the lesion, to reduce the risk of growth and recurrence. On your back, or leg this is not a problem, unless it is a larger lesion a large cancer or is some other way complicated. To cut out with a large margin near your eye, is not feasible. Surgery has to be minimal, but minimal surgery significantly increases the risk cancer recurrence. You see, these cancers can be considered like a viable tree stump, with living roots underneath. The roots can go quite deep and infiltrate along blood vessels and especially along nerves. So the dermatological surgeon, using the Moh technique, starts by cutting the cancer out, under local anaesthetic, cutting or scraping to the edge of the visible cancer. The excised specimen is immediately placed on a microscope slide, and sent to a histopathologist. The pathologist then stains with “ink” stains, slices it up into very thin sections, and then examines is it under a microscope. If there are any tumour cells at the edges, or undersurface, he reports back to the surgeon, who then has to cut further and deeper for another slice, which is then again sent for further histopathological examination, until finally each the specimens are clear of cancer. Each round of pathological examination takes between an hour and an hour and a half, and this can repeated up to four or five times. The whole procedure can take anywhere from 3 to 6 or 7 hours and can cost anywhere between $2000 and $7,000. Not surprisingly, this is very popular with the dermatological surgeons, plastic surgeons, and pathologists. And this is increasing in popularity in North America, so that made much of skin cancer surgery, not just head and neck, is being done like this.

So, what will Optiscan can bring to the skin cancer table, this time around? Very simple! The whole back and forth palaver can stop, and everything can be done with real-time in vivo digital histopathology, in a fraction of the time, with better accuracy, and almost certainly reduced risk of cancer recurrence. Although it will need to be subject to trials, Tiresias is in no doubt about the science. What is in doubt is how to appear not to be standing between the operating dermatological surgeons and the lucre they see themselves entitled to. How to convince them that they may even get a Ferrari out of this. Well the usual ways are what will suffice. The carrot and the stick. You don't actually have to give them the Ferrari, you just have to imply that they might not get their new model Porsches, if they don't get aboard the new wave. This can be done subtly and on a number of fronts. Implication that theold-fashioned methods are out of date. Every doctor is desperate to staycurrent. Social media, especially through cancer associations and patientpressure groups with patients demanding the new digital in-vivo biopsy better surgeryand not the old-fashioned surgery. Patients too want the new. New is best! Does Opti scan management understand all this and more that needs and can be done. Can they implement this? The first iteration of the Stratum instrument showed that they did not. But that was a long time ago, and that was a different, very a different management. Tiresias thinks that the new management, with the power, knowledge and financial clout of the new shareholders, and their understanding of the medical markets indicate that this time it is all different.

But how important is this for Optiscan? Replacement of Moh surgery will only be actually a small part of Optiscan’s revolution in cancer surgery. Screening for like oral cancer, ear nose and throat cancer, cervical cancer will be much much bigger fish, each one on their own company makers. Intraoperative in-vivo digital histopathology with AI, as in neurosurgery, breast surgery and almost all other cancer surgery will be much much bigger. However, no area should be left unturned. Re-entering the skin cancer surgery area will be a demonstration of Optiscan’s ability to read the market, and sell to that market by understanding the importance of incentives and imperative of the buyers. This will finally prove to the market that Optiscan has learnt all its lessons and this time it truly is different.