And here’s where that first kind of innovation - the planned innovation - puts another W on the scoreboard, but only after early struggles. Dr. Chachisvilis put his mind to a problem: how can we use our knowledge of capillary refill rates? At first, the problem of dehydration seemed ideal. Athletes and the military would probably be excited to know how dehydrated they were. But, it turned out that there were already patents in this area and not much had come from them.
 

He spent a year brainstorming applications when he had an insight:

“We know that cancer involves pathological angiogenesis, which creates abnormal vasculature, which means that blood flow must be different, so capillary refill should be different. Maybe we can apply our measurement of capillary refill differential to the detection of cancer.”
 

Well, when you put it like that, it seems obvious.
 

He had studied blood flow at the microscopic level in skin, understanding how it changes, and specifically, how it is cut off and then refills in response to pressure. It’s not just that blood vessels fill up when the pressure is relaxed. The body needs a way to respond to continuous pressure, like standing on your feet or sitting on a rock. Blood vessels dilate in response to pressure and lack of oxygen. But, we’re talking about very small, very fast changes. And, then when the pressure is relaxed, blood flow returns, of course. The key here is that cancer blood vessels respond slightly differently than blood vessels in normal tissue. Not very differently, but slightly differently, in how they dilate and respond.
 

It’s enough of a difference that if you could measure blood flow to an area very accurately, and if you could plot that data over time and measure not just the amount of blood flow but the rate of change of the blood flow, then you could identify cancer cells. And, it looks like the responsiveness of blood flow to pressure is actually a better indicator of malignancy than the appearance, color, shape and other physical attributes of skin anomalies. In other words, this is better than trained physicians using magnifying glasses, better than AI algorithms looking at pictures.
 

Sounds great in theory. However, you’re going to need some clinical trial data to get much further. So, Dr. Chachisvilis went into the garage and pieced together some optical sensors, a desktop computer and some other scientific equipment on a rolling cart. He tapped his friends and fellow scientists Eugene Tu and Carl Edman, Ph.D. to help with setting up a clinical study. They paired up with Dr. Shane Hamman, a young up-and-coming dermatologist with practices in La Jolla, CA, and Yuma, AZ, and they made trips out to Yuma to gather data.
 

They wheeled the prototype around Yuma Dermatology and asked politely to gather data. Senior citizens, who are generally nice, helpful and covered in barnacles, were the perfect audience. One patient stuck out in Dr. Chachivilis’ mind. An older man had to be dragged to the dermatologist by his wife. She was concerned that his shirts were constantly dotted with blood. He had five lesions that, when they saw them, they realized were almost certainly cancerous. It brought home the end goal of their work: making detection easier, painless, non-invasive and commonplace. If identifying cancer was much, much easier than it currently is, maybe he would have been diagnosed years earlier.
 

Initial results showed 100% sensitivity and 94% specificity. To put that in context, nothing gets close to that. Trained dermatologists with imaging devices (Dermascope) get 90%/70%, and plenty of other devices and systems have been tried and fared much, much worse. Dr. Chachisvilis, having plenty of experience applying for NIH grants, landed a $1.9 million grant to develop a portable device.
 

Enter Nelson Quintana, an engineer who had worked with Dexcom. He spent two and a half years with Veriskin developing the product that they have today. It’s smaller than a teacup. It uses gentle pressure and optical sensors to gauge blood flow, and it displays results on an Apple watch-style screen. Small, affordable, noninvasive and very, very effective.