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Ungureanu L, Vasilovici AF, Trufin II, Apostu AP, Halmágyi SR. Lentigo Maligna Treatment-An Update. J Clin Med 2024; 13:2527. [PMID: 38731056 PMCID: PMC11084749 DOI: 10.3390/jcm13092527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/06/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Lentigo maligna (LM) is a melanoma in situ that is prevalent in chronically sun-damaged skin. Characterized by a slow growth pattern and high mutation rates due to chronic UV exposure, LM poses diagnostic and therapeutic challenges, particularly given its tendency to mimic other skin lesions and its occurrence in cosmetically sensitive areas. Its diagnosis is based on an integrated approach using dermoscopy and reflectance confocal microscopy (RCM). Despite its slow progression, LM can evolve into lentigo maligna melanoma (LMM), making its treatment necessary. Treatment modalities encompass both surgical and non-surgical methods. Surgical treatments like Wide Local Excision (WLE) and Mohs Micrographic Surgery (MMS) aim for clear histological margins. WLE, a standard melanoma surgery, faces challenges from LM's subclinical extensions, which increase the recurrence risk. MMS, effective for large or poorly defined lesions, is defined by precise margin control while considering cosmetic outcomes. Non-surgical options, including radiotherapy and imiquimod, are alternatives for non-surgical candidates. Radiotherapy has been effective since the 1950s, offering good control and cosmetic results, especially for older patients. Imiquimod, an immunomodulator, shows promise in treating LM, though its application remains off-label. The increasing incidence of LM/LMM necessitates a balance in treatment choices to minimize recurrence and maintain cosmetic integrity. A multidisciplinary approach, integrating clinical examination with dermoscopy and RCM and histological assessment, is essential for accurate diagnosis and effective LM management.
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Affiliation(s)
- Loredana Ungureanu
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | - Alina Florentina Vasilovici
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | | | - Adina Patricia Apostu
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
- Clinical Hospital of Infectious Diseases, 400000 Cluj-Napoca, Romania
| | - Salomea-Ruth Halmágyi
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
- Clinical Hospital of Infectious Diseases, 400000 Cluj-Napoca, Romania
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Akella SS, Lee J, May JR, Puyana C, Kravets S, Dimitropolous V, Tsoukas M, Manwar R, Avanaki K. Using optical coherence tomography to optimize Mohs micrographic surgery. Sci Rep 2024; 14:8900. [PMID: 38632358 PMCID: PMC11024158 DOI: 10.1038/s41598-024-53457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/31/2024] [Indexed: 04/19/2024] Open
Abstract
Mohs micrographic surgery (MMS) is considered the gold standard for treating high-risk cutaneous basal cell carcinoma (BCC), but is expensive, time-consuming, and can be unpredictable as to how many stages will be required or how large the final lesion and corresponding surgical defect will be. This study is meant to investigate whether optical coherence tomography (OCT), a highly researched modality in dermatology, can be used preoperatively to map out the borders of BCC, resulting in fewer stages of MMS or a smaller final defect. In this prospective study, 22 patients with BCC undergoing surgical excision were enrolled at a single institution. All patients had previously received a diagnostic biopsy providing confirmation of BCC and had been referred to our center for excision with MMS. Immediately prior to performing MMS, OCT was used to map the borders of the lesion. MMS then proceeded according to standard protocol. OCT images were compared to histopathology for agreement. Histopathologic analysis of 7 of 22 MMS specimens (32%) revealed a total absence of BCC, indicating resolution of BCC after previous diagnostic biopsy. This outcome was correctly predicted by OCT imaging in 6 of 7 cases (86%). Nine tumors (9/22, 41%) had true BCC and required a single MMS stage, which was successfully predicted by pre-operative OCT analysis in 7 of 9 cases (78%). The final six tumors (27%) had true BCC and required two MMS stages for complete excision; preoperative OCT successfully predicted the need for a second stage in five cases (5/6, 83.3%). Overall, OCT diagnosed BCC with 95.5% accuracy (Cohen's kappa, κ = 0.89 (p-value = < 0.01) in the center of the lesion. Following a diagnostic biopsy, OCT can be used to verify the existence or absence of residual basal cell carcinoma. When residual tumor is present that requires excision with MMS, OCT can be used to predict tumor borders, optimize surgery and minimize the need for additional surgical stages.
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Affiliation(s)
- Sruti S Akella
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jenna Lee
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Julia Roma May
- School of Medicine, University of Illinois-Chicago, Chicago, IL, USA
| | - Carolina Puyana
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Sasha Kravets
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois-Chicago, Chicago, IL, USA
| | | | - Maria Tsoukas
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA
| | - Rayyan Manwar
- Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA
| | - Kamran Avanaki
- Department of Dermatology, University of Illinois-Chicago, Chicago, IL, USA.
- Department of Biomedical Engineering, University of Illinois-Chicago, Chicago, IL, USA.
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Wolswijk T, Nelemans PJ, Adan F, Abdul Hamid M, Mosterd K. 'Pitfalls for differentiating basal cell carcinoma from non-basal cell carcinoma on optical coherence tomography: A clinical series'. J Dermatol 2024; 51:40-47. [PMID: 37927296 DOI: 10.1111/1346-8138.17020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
Optical coherence tomography (OCT), a non-invasive diagnostic modality, may replace biopsy for diagnosing basal cell carcinoma (BCC) if a high-confidence BCC diagnosis can be established. In other cases, biopsy remains necessary to establish a histopathological diagnosis and treatment regimen. It is, therefore, essential that OCT assessors have a high specificity for differentiating BCC from non-BCC lesions. To establish high-confidence BCC diagnoses, specific morphological BCC characteristics on OCT are used. This study aimed to review several cases of non-BCC lesions that were misclassified as BCC by experienced OCT assessors, thereby providing insight into the causes of these misclassifications and how they may be prevented. The study population consisted of patients who had a histopathologically-verified non-BCC lesion. Patients from Maastricht University Medical Center+ from February 2021 to April 2021 were included in the study. Two independent OCT assessors assessed OCT scans. One OCT assessor recorded the presence or absence of validated morphological BCC characteristics. A false-positive OCT test result was defined as certainty of BCC presence in a non-BCC lesion. The frequency of misclassifications and the presence or absence of morphological BCC features are discussed. A total of 124 patients with non-BCC lesions were included. Six patients were misclassified by both OCT assessors and are discussed in more detail. Histopathological diagnoses were squamous cell carcinoma (n = 2/21), actinic keratosis (n = 2/29), squamous cell carcinoma in situ/Bowen's disease (n = 1/16), or interphase dermatitis (n = 1/4). In all misclassified cases, multiple, apparent morphological BCC characteristics on OCT were present. Most non-BCC lesions are recognized as such by OCT assessors. However, there remains a small risk that a high-confidence BCC diagnosis is established in non-BCC lesions wherein features mimicking validated BCC characteristics are present. Misclassification may be prevented by careful delineation of epidermal layers and good differentiation between dermal ovoid structures typical of BCC versus squamous cell carcinoma.
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Affiliation(s)
- Tom Wolswijk
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Fieke Adan
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Myrurgia Abdul Hamid
- Department of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Bozsányi S, Boostani M, Farkas K, Hamilton-Meikle P, Varga NN, Szabó B, Vasanits F, Kuroli E, Meznerics FA, Lőrincz K, Holló P, Bánvölgyi A, Wikonkál NM, Paragh G, Kiss N. Optically Guided High-Frequency Ultrasound to Differentiate High-Risk Basal Cell Carcinoma Subtypes: A Single-Centre Prospective Study. J Clin Med 2023; 12:6910. [PMID: 37959375 PMCID: PMC10648659 DOI: 10.3390/jcm12216910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common type of skin cancer in the Caucasian population. Currently, invasive biopsy is the only way of establishing the histological subtype (HST) that determines the treatment options. Our study aimed to evaluate whether optically guided high-frequency ultrasound (OG-HFUS) imaging could differentiate aggressive HST BCCs from low-risk tumors. METHODS We conducted prospective clinical and dermoscopic examinations of BCCs, followed by 33 MHz OG-HFUS imaging, surgical excision, and a histological analysis. We enrolled 75 patients with 78 BCCs. In total, 63 BCCs were utilized to establish a novel OG-HFUS risk classification algorithm, while 15 were employed for the validation of this algorithm. The mean age of the patients was 72.9 ± 11.2 years. Histology identified 16 lesions as aggressive HST (infiltrative or micronodular subtypes) and 47 as low-risk HST (superficial or nodular subtypes). To assess the data, we used a one-sided Fisher's exact test for a categorical analysis and a Receiver Operating Characteristic (ROC) curve analysis to evaluate the diagnostic accuracy. RESULTS OG-HFUS distinguished aggressive BCC HSTs by their irregular shape (p < 0.0001), ill-defined margins (p < 0.0001), and non-homogeneous internal echoes (p = 0.004). We developed a risk-categorizing algorithm that differentiated aggressive HSTs from low-risk HSTs with a higher sensitivity (82.4%) and specificity (91.3%) than a combined macroscopic and dermoscopic evaluation (sensitivity: 40.1% and specificity: 73.1%). The positive and negative predictive values (PPV and NPV, respectively) for dermoscopy were 30.2% and 76.8%, respectively. In comparison, the OG-HFUS-based algorithm demonstrated a PPV of 94.7% and an NPV of 78.6%. We verified the algorithm using an independent image set, n = 15, including 12 low-risk and 3 high-risk (high-risk) with two blinded evaluators, where we found a sensitivity of 83.33% and specificity of 91.66%. CONCLUSIONS Our study shows that OG-HFUS can identify aggressive BCC HSTs based on easily identifiable morphological parameters, supporting early therapeutic decision making.
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Affiliation(s)
- Szabolcs Bozsányi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
| | - Mehdi Boostani
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Klára Farkas
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Phyllida Hamilton-Meikle
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Noémi Nóra Varga
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Boglárka Szabó
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Flóra Vasanits
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Enikő Kuroli
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Fanni Adél Meznerics
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Kende Lőrincz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Péter Holló
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Norbert M. Wikonkál
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
| | - Gyorgy Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
| | - Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (S.B.); (M.B.); (K.F.); (P.H.-M.); (N.N.V.); (B.S.); (F.V.); (E.K.); (F.A.M.); (K.L.); (P.H.); (A.B.); (N.M.W.)
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Wolswijk T, Adan F, Nelemans PJ, Mosterd K. A cohort study on detection and subtyping of basal cell carcinoma with optical coherence tomography: The additional value of distant diagnosis by an expert. J Am Acad Dermatol 2023; 88:871-872. [PMID: 36228944 DOI: 10.1016/j.jaad.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Tom Wolswijk
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Fieke Adan
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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Perwein MKE, Welzel J, De Carvalho N, Pellacani G, Schuh S. Dynamic Optical Coherence Tomography: A Non-Invasive Imaging Tool for the Distinction of Nevi and Melanomas. Cancers (Basel) 2022; 15. [PMID: 36612016 DOI: 10.3390/cancers15010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Along with the rising melanoma incidence in recent decades and bad prognoses resulting from late diagnoses, distinguishing between benign and malignant melanocytic lesions has become essential. Unclear cases may require the aid of non-invasive imaging to reduce unnecessary biopsies. This multicentric, case-control study evaluated the potential of dynamic optical coherence tomography (D-OCT) to identify distinguishing microvascular features in nevi. A total of 167 nevi, including dysplastic ones, on 130 participants of all ages and sexes were examined by D-OCT and dermoscopy with a histological reference. Three blinded analyzers evaluated the lesions. Then, we compared the features to those in 159 melanomas of a prior D-OCT study and determined if a differential diagnosis was possible. We identified specific microvascular features in nevi and a differential diagnosis of melanomas and nevi was achieved with excellent predictive values. We conclude that D-OCT overcomes OCT´s inability to distinguish melanocytic lesions based on its focus on microvascularization. To determine if an addition to the gold standard of a clinical-dermoscopic examination improves the diagnosis of unclear lesions, further studies, including a larger sample of dysplastic nevi and artificial intelligence, should be conducted.
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Welzel J. [Will medical decisions be made by artificial intelligence in the future? : The tricorder from Star Trek takes charge of the bridge]. Dermatologie (Heidelb) 2022; 73:656-658. [PMID: 35267043 DOI: 10.1007/s00105-022-04975-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Medizincampus Süd, Sauerbruchstr. 6, 86179, Augsburg, Deutschland.
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Schuh S, Ruini C, Perwein MKE, Daxenberger F, Gust C, Sattler EC, Welzel J. Line-Field Confocal Optical Coherence Tomography: A New Tool for the Differentiation between Nevi and Melanomas? Cancers (Basel) 2022; 14:1140. [PMID: 35267448 DOI: 10.3390/cancers14051140] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023] Open
Abstract
Until now, the clinical differentiation between a nevus and a melanoma is still challenging in some cases. Line-field confocal optical coherence tomography (LC-OCT) is a new tool with the aim to change that. The aim of the study was to evaluate LC-OCT for the discrimination between nevi and melanomas. A total of 84 melanocytic lesions were examined with LC-OCT and 36 were also imaged with RCM. The observers recorded the diagnoses, and the presence or absence of the 18 most common imaging parameters for melanocytic lesions, nevi, and melanomas in the LC-OCT images. Their confidence in diagnosis and the image quality of LC-OCT and RCM were evaluated. The most useful criteria, the sensitivity and specificity of LC-OCT vs. RCM vs. histology, to differentiate a (dysplastic) nevus from a melanoma were analyzed. Good image quality correlated with better diagnostic performance (Spearman correlation: 0.4). LC-OCT had a 93% sensitivity and 100% specificity compared to RCM (93% sensitivity, 95% specificity) for diagnosing a melanoma (vs. all types of nevi). No difference in performance between RCM and LC-OCT was observed (McNemar's p value = 1). Both devices falsely diagnosed dysplastic nevi as non-dysplastic (43% sensitivity for dysplastic nevus diagnosis). The most significant criteria for diagnosing a melanoma with LC-OCT were irregular honeycombed patterns (92% occurrence rate; 31.7 odds ratio (OR)), the presence of pagetoid spread (89% occurrence rate; 23.6 OR) and the absence of dermal nests (23% occurrence rate, 0.02 OR). In conclusion LC-OCT is useful for the discrimination between melanomas and nevi.
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Fuchs CSK, Ortner VK, Mogensen M, Rossi AM, Pellacani G, Welzel J, Mosterd K, Guitera P, Nayahangan LJ, Johnsson VL, Haedersdal M, Tolsgaard MG. 2021 international consensus statement on optical coherence tomography for basal cell carcinoma: image characteristics, terminology and educational needs. J Eur Acad Dermatol Venereol 2022; 36:772-778. [PMID: 35141952 DOI: 10.1111/jdv.17969] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite the widespread use of optical coherence tomography (OCT) for imaging of keratinocyte carcinoma, we lack an expert consensus on the characteristic OCT features of basal cell carcinoma (BCC), an internationally vetted set of OCT terms to describe various BCC subtypes, and an educational needs assessment. OBJECTIVES To identify relevant BCC features in OCT images, propose terminology based on inputs from an expert panel and identify content for a BCC-specific curriculum for OCT trainees. METHODS Over three rounds, we conducted a Delphi consensus study on BCC features and terminology between March and September 2020. In the first round, experts were asked to propose BCC subtypes discriminable by OCT, provide OCT image features for each proposed BCC subtypes and suggest content for a BCC-specific OCT training curriculum. If agreement on a BCC-OCT feature exceeded 67%, the feature was accepted and included in a final review. In the second round, experts had to re-evaluate features with less than 67% agreement and rank the ten most relevant BCC OCT image features for superficial BCC, nodular BCC and infiltrative and morpheaphorm BCC subtypes. In the final round, experts received the OCT-BCC consensus list for a final review, comments and confirmation. RESULTS The Delphi included six key opinion leaders and 22 experts. Consensus was found on terminology for three OCT BCC image features: (i) hyporeflective areas, (ii) hyperreflective areas and (iii) ovoid structures. Further, the participants ranked the ten most relevant image features for nodular, superficial, infiltrative and morpheaform BCC. The target group and the key components for a curriculum for OCT imaging of BCC have been defined. CONCLUSION We have established a set of OCT image features for BCC and preferred terminology. A comprehensive curriculum based on the expert suggestions will help implement OCT imaging of BCC in clinical and research settings.
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Affiliation(s)
- C S K Fuchs
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - V K Ortner
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - M Mogensen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - A M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - J Welzel
- Department of Dermatology, General Hospital Augsburg, Augsburg, Germany
| | - K Mosterd
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - P Guitera
- Melanoma Institute Australia, Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - L J Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - V L Johnsson
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - M Haedersdal
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - M G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
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Niculet E, Craescu M, Rebegea L, Bobeica C, Nastase F, Lupasteanu G, Stan DJ, Chioncel V, Anghel L, Lungu M, Tatu AL. Basal cell carcinoma: Comprehensive clinical and histopathological aspects, novel imaging tools and therapeutic approaches (Review). Exp Ther Med 2021; 23:60. [PMID: 34917186 PMCID: PMC8630439 DOI: 10.3892/etm.2021.10982] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022] Open
Abstract
Basal cell carcinoma (BCC) is one of the most common malignant tumors worldwide, involving the skin. It is also part of keratinocyte carcinomas, alongside its squamous counterpart. It has low mortality and extremely low metastatic rates (although when present, it indicates a poor patient prognosis); it also has a high morbidity rate through local destruction and recurrence, particularly when perineural invasion is observed, clinically or histopathologically. BCC development is the result of environmental and patient factors, with genetics and ultraviolet radiation playing major roles. The clinical and histopathological aspects vary according to tumor subtype, being classified as high-risk tumors (nodular, superficial, pigmented and infundibulocystic BCC with adnexal differentiation) and fibroepithelial subtypes, or as high-risk tumors (micronodular, infiltrating, sclerosing/morphoeic and basosquamous subtype or the type with sarcomatoid differentiation). Dermoscopy is now complimented by novel in vivo diagnostic tools (optical coherence tomography, reflectance confocal microscopy, high-resolution ultrasonography, Raman spectroscopy or terahertz pulse imaging), improving the diagnostic accuracy and providing tumor depth and lateral margins without the use of invasive techniques. Novel treatment approaches for the treatment of BCC have recently been investigated with the use of hedgehog pathway inhibitors, such as Vismodegib. These approaches aim for complete resolution, minimal side-effects, high patient satisfaction with the optimal cosmetic results, particularly in key areas, such as the face. The present review article summarizes and discusses the comprehensive clinical and histopathological aspects of BCC, and presents novel imaging tools and therapeutic approaches that have been identified.
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Affiliation(s)
- Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania.,Department of Pathology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania.,Department of Clinical Radiotherapy, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania
| | - Laura Rebegea
- Department of Clinical Radiotherapy, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania.,Department of Neuropsychomotor Rehabilitation, 'Sf. Ioan' Clinical Hospital for Children, 800487 Galați, Romania
| | - Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania
| | - Florentina Nastase
- Department of Neuropsychomotor Rehabilitation, 'Sf. Ioan' Clinical Hospital for Children, 800487 Galați, Romania
| | - Gabriela Lupasteanu
- Department of Infectious Diseases, 'Sf. Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galați, Romania.,Medical Doctoral School, 'Ovidius' University, 900573 Constanta, Romania
| | - Daniela Jicman Stan
- Department of Otorhinolaryngology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galați, Romania.,Biomedical Doctoral School, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galați, 800010 Galați, Romania
| | - Valentin Chioncel
- Department of Cardio-Thoracic Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Clinical Cardiology, 'Bagdasar Arseni' Emergency Hospital, 041915 Bucharest, Romania
| | - Lucretia Anghel
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania
| | - Mihaela Lungu
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania
| | - Alin Laurentiu Tatu
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galați, Romania.,Department of Dermatology, 'Sfanta Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galați, Romania.,Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, 'Dunărea de Jos' University, 800010 Galați, Romania.,Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), 'Dunărea de Jos' University, 800010 Galați, Romania
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11
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Abstract
Optical coherence tomography (OCT) and confocal laser microscopy (CLSM) are established non-invasive methods in clinical dermatological routine diagnosis. Whereas CLSM is especially useful to distinguish between nevi and melanoma, OCT is suitable for the diagnosis and differentiation of non-melanoma skin cancer. Line-field confocal optical coherence tomography (LC-OCT) is a new innovative device, which has better cellular resolution than OCT and a higher penetration depth than CLSM. Similar to CLSM, LC-OCT also allows 3D images in real time to be taken. Therefore LC-OCT is very useful for the examination of skin lesions of all kinds, since it unites the features of CLSM and OCT.
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12
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Seidl-Philipp M, Frischhut N, Höllweger N, Schmuth M, Nguyen VA. Known and new facts on basal cell carcinoma. J Dtsch Dermatol Ges 2021; 19:1021-1041. [PMID: 34288482 PMCID: PMC8361778 DOI: 10.1111/ddg.14580] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/02/2021] [Indexed: 12/18/2022]
Abstract
Basal cell carcinoma (BCC) is the most common malignant tumor in light‐skinned people and amounts to about 75 % of all cases of skin cancer. Increasing incidence rates have been reported for decades all over the world. The main risk factors include UV radiation, male sex, light skin type, advanced age, long‐term immunosuppression, a positive individual or family history, and certain genodermatoses. BCC metastasizes only rarely, and its mortality is low, but it is associated with significant morbidity. Genetic mutations especially in the hedgehog pathway play an important role in BCC pathogenesis. Non‐invasive procedures such as optical coherence tomography or confocal laser scan microscopy are increasingly utilized for diagnostics in addition to visual inspection and dermatoscopy, but only in exceptional cases can histological confirmation of the diagnosis be dispensed with. Various clinical and histological subtypes have been defined. Differentiating between BCC with high and low risk of recurrence has a significant influence on the choice of treatment. Most BCC can be treated effectively and safely with standard surgery, or in selected cases with topical treatment. Locally advanced and metastasized BCC must be treated with radiation or systemic therapy. Radiation is also an option for older patients with contraindications for surgery. The hedgehog inhibitors vismodegib and sonidegib are currently approved for systemic therapy of BCC in Europe. Approval for the PD1 inhibitor cemiplimab as second‐line therapy is expected in the near future.
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Affiliation(s)
- Magdalena Seidl-Philipp
- University Hospital for Dermatology, Venereology, and Allergology, Medical University Innsbruck, Austria
| | - Nina Frischhut
- University Hospital for Dermatology, Venereology, and Allergology, Medical University Innsbruck, Austria
| | - Nicole Höllweger
- University Hospital for Dermatology, Venereology, and Allergology, Medical University Innsbruck, Austria
| | - Matthias Schmuth
- University Hospital for Dermatology, Venereology, and Allergology, Medical University Innsbruck, Austria
| | - Van Anh Nguyen
- University Hospital for Dermatology, Venereology, and Allergology, Medical University Innsbruck, Austria
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13
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Seidl-Philipp M, Frischhut N, Höllweger N, Schmuth M, Nguyen VA. Bekanntes und Neues zum Basalzellkarzinom. J Dtsch Dermatol Ges 2021; 19:1021-1043. [PMID: 34288462 DOI: 10.1111/ddg.14580_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Magdalena Seidl-Philipp
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Österreich
| | - Nina Frischhut
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Österreich
| | - Nicole Höllweger
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Österreich
| | - Matthias Schmuth
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Österreich
| | - Van Anh Nguyen
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Österreich
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14
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Ruini C, Schuh S, Gust C, Kendziora B, Frommherz L, French LE, Hartmann D, Welzel J, Sattler E. Line-field optical coherence tomography: In vivo diagnosis of basal cell carcinoma subtypes compared to histopathology. Clin Exp Dermatol 2021; 46:1471-1481. [PMID: 34047380 DOI: 10.1111/ced.14762] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common skin cancer in the general population. Treatments vary from Mohs surgery to topical therapy, depending on the subtype. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) have gained a foothold in daily clinical practice to optimize diagnosis and subtype-oriented treatment. The new device Line-field confocal OCT (LC-OCT) allows imaging at high resolution and depth but its use is not yet been investigated in larger studies. OBJECTIVES To evaluate the main LC-OCT criteria for the diagnosis and subtyping of BCC in comparison to histopathology, OCT and RCM. METHODS Fifty-two histopathologically confirmed BCCs were evaluated for imaging criteria. Their frequency, predictive values and ROC curves were calculated. A multinominal regression with stepwise variables selection to distinguish BCC subtypes was performed. RESULTS Nodular BCCs were mainly characterized by atypical keratinocytes, altered DEJ, tumour nests in the dermis, dark clefting, prominent vascularisation and white hyperreflective stroma. Superficial BCCs showed a thickening of the epidermis due to a series of tumour lobules with clear connection to the DEJ (string of pearls pattern). Infiltrative BCCs were characterized by elongated hyporeflective tumour strands, surrounded by bright collagen (shoal of fish). The overall BCC subtype agreement between LC-OCT and conventional histology was 90.4 % (95% CI: 79.0, 96.8). CONCLUSION LC-OCT allows the non-invasive, real time identification of BCCs and their subtypes in vertical, horizontal and 3D mode compared to histology, RCM and OCT. Further larger studies are needed to better explore the clinical applications of this promising device.
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Affiliation(s)
- C Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - S Schuh
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - C Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - B Kendziora
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L Frommherz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine
| | - D Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - J Welzel
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - E Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
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15
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Monnier J, De Carvalho N, Harris U, Garfinkel J, Saud A, Navarrete-Dechent C, Liopyris K, Reiter O, Rubinstien G, Iftimia N, Nehal KS, Markova A, Deng L, Rossi AM, Marghoob AA, Marchetti MA, Rotemberg V, Pellacani G, Jain M. Combined reflectance confocal microscopy and optical coherence tomography to improve the diagnosis of equivocal lesions for basal cell carcinoma. J Am Acad Dermatol 2021; 86:934-936. [PMID: 33965274 DOI: 10.1016/j.jaad.2021.03.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/25/2021] [Accepted: 03/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Jilliana Monnier
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Dermatology and Skin cancer department, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France; Centre de Recherche en Cancerologie de Marseille, Inserm UMR1068, CNRS UMR7258, Aix-Marseille University, Marseille, France; Aix-Marseille Univ, Université de Marseille, CNRS UMR 7020, LIS, Marseille, France
| | - Nathalie De Carvalho
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ucalene Harris
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jason Garfinkel
- Dermatology and Laser Centre of Studio City, Los Angeles, California
| | - Aleissa Saud
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Cristian Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Konstantinos Liopyris
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Dermatology Department, University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Ofer Reiter
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Dermatology Department, Rabin Medical Center and Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Liang Deng
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Veronica Rotemberg
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Manu Jain
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
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16
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Suppa M, Fontaine M, Dejonckheere G, Cinotti E, Yélamos O, Diet G, Tognetti L, Miyamoto M, Orte Cano C, Perez-Anker J, Panagiotou V, Trepant AL, Monnier J, Berot V, Puig S, Rubegni P, Malvehy J, Perrot JL, Del Marmol V. Line-field confocal optical coherence tomography of basal cell carcinoma: a descriptive study. J Eur Acad Dermatol Venereol 2020; 35:1099-1110. [PMID: 33398911 DOI: 10.1111/jdv.17078] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/01/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early diagnosis and subtype classification of basal cell carcinoma (BCC) are crucial to reduce morbidity and optimize treatment. Good accuracy in differentiating BCC from clinical imitators has been achieved with existing diagnostic strategies but lower performance in discriminating BCC subtypes. Line-field confocal optical coherence tomography (LC-OCT) is a new technology able to combine the technical advantages of reflectance confocal microscopy and OCT. OBJECTIVES To identify and describe LC-OCT criteria associated with BCC and explore their association with BCC subtypes. METHODS Basal cell carcinoma were imaged with a handheld LC-OCT device before surgical excision. LC-OCT images were retrospectively evaluated by three observers for presence/absence of criteria for BCC. Multivariate logistic regression models were used to find independent predictors of BCC subtypes. RESULTS Eighty-nine histopathologically proven BCCs were included, of which 66 (74.2%) were pure subtypes [superficial BCC (sBCC): 19/66 (28.8%); nodular BCC (nBCC): 31/66 (47.0%); infiltrative BCC (iBCC): 16/66 (24.2%)]. Lobules, blood vessels and small bright cells within epidermis/lobules were the most frequent criteria for BCC. LC-OCT criteria independently associated with sBCC were presence of hemispheric lobules, absence of lobule separation from the epidermis, absence of stretching of the stroma; with nBCC were presence of macrolobules, absence of lobule connection to the epidermis; and with iBCC were presence of branched lobules. CONCLUSIONS This was the first study describing the characteristics of BCC under LC-OCT examination. We proposed morphologic criteria, which could be potentially useful for diagnosis and subtype classification of BCC, as well as for its therapeutic management. Future studies are needed to assess these hypotheses.
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Affiliation(s)
- M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Fontaine
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - G Dejonckheere
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - E Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - O Yélamos
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.,Dermatology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Diet
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - L Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - M Miyamoto
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - C Orte Cano
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - J Perez-Anker
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.,CIBER de enfermedades raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - V Panagiotou
- Department of Pathology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A L Trepant
- Department of Pathology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - J Monnier
- Department of Dermatology, AP-HM, Aix-Marseille University, Marseille, France
| | - V Berot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - S Puig
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.,CIBER de enfermedades raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - P Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - J Malvehy
- Melanoma Unit, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.,CIBER de enfermedades raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - J L Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Bergeron S, Arthurs B, Sanft DM, Mastromonaco C, Burnier MN. Optical Coherence Tomography of Peri-Ocular Skin Cancers: An Optical Biopsy. Ocul Oncol Pathol 2020; 7:149-158. [PMID: 33981698 DOI: 10.1159/000511188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/24/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Optical coherence tomography (OCT) imaging has been used as a diagnostic tool for retinal disease for several years, and OCT apparatuses are becoming increasingly powerful. However, OCT has yet to reach its full potential in ophthalmology clinics. Alike retinal layers, it has been shown that OCT is able to generate cross-sectional images of the skin and allows visualization of skin lesions in a histopathology-like manner. Objective We aim to validate OCT as an imaging modality for peri-ocular skin cancer. Through a series of cases, we highlight findings for 3 common eyelid malignancies: basal cell carcinoma, squamous cell carcinoma and sebaceous carcinoma. We propose an OCT image-based signature for basal cell carcinoma. Methods This is a prospective study. Fifty-eight lesions suspicious of malignancy from 57 patients were subjected to OCT imaging prior to the surgical excision of the lesion. OCT images were analysed and scored according to previously identified OCT features. Eight representative examples are presented, highlighting the OCT patterns for each malignancy side by side to its corresponding histopathological sections. Results Out of the 58 lesions analysed, 53 were malignant. A loss of the dermal-epidermal junction is observed in all malignant lesions. A strong link is observed between the presence of subepithelial hyporeflective nests on OCT and the diagnosis of basal cell carcinoma (present in 83% of cases). Conversely, lesions of epithelial origin such as squamous cell carcinoma are most often represented on OCT by acanthosis. Two supplementary cases, one basal cell carcinoma and one sebaceous carcinoma, are provided to illustrate how OCT imaging is a valuable tool in cases where clinical observations may be unusual. Conclusions We provide evidence supporting the use of OCT for the evaluation of peri-ocular cancers. OCT enables visualization of the skin layers in vivo, before biopsy. Our results show that certain OCT features can contribute to include or exclude a diagnosis of basal cell carcinoma. By integrating this non-invasive imaging methodology into the routine assessment of peri-ocular skin lesions, especially in health care centres where access to specialists is limited, OCT imaging can increase clinical precision, reduce delays in patient referral and enhance patient care.
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Affiliation(s)
- Sabrina Bergeron
- The MUHC, McGill University Ocular Pathology and Translational Research Laboratory, McGill University, Montreal, Québec, Canada
| | - Bryan Arthurs
- Department of Ophthalmology, McGill University, Montreal, Québec, Canada
| | - Debra-Meghan Sanft
- Department of Ophthalmology, McGill University, Montreal, Québec, Canada
| | - Christina Mastromonaco
- The MUHC, McGill University Ocular Pathology and Translational Research Laboratory, McGill University, Montreal, Québec, Canada
| | - Miguel N Burnier
- The MUHC, McGill University Ocular Pathology and Translational Research Laboratory, McGill University, Montreal, Québec, Canada.,Department of Ophthalmology, McGill University, Montreal, Québec, Canada
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18
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Ruini C, Rahimi F, Fiocco Z, French LE, Hartmann D, Oppel E, Sattler E. Optical coherence tomography for patch test grading: A prospective study on its use for noninvasive diagnosis of allergic contact dermatitis. Contact Dermatitis 2020; 84:183-191. [PMID: 33012002 DOI: 10.1111/cod.13714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The diagnosis of allergic contact dermatitis should be confirmed by skin patch tests. Distinguishing between irritant and allergic reactions is sometimes difficult. OBJECTIVES To analyse the in vivo morphological changes in patch test reactions compared to healthy skin, and to detect subclinical changes in doubtful reactions using optical coherence tomography (OCT). To develop an OCT-based algorithm to support patch-test grading. METHODS One hundred twenty-nine skin patch-test areas were scanned with OCT to evaluate the following features: architectural and vascular morphology, epidermal thickness, optical attenuation coefficient (AC), and blood flow at 0.1, 0.2, and 0.35 mm depth. RESULTS Most common OCT features of acute contact allergic reactions in patch tests were spongiosis with microvesicles (94.8%), macrovesicles (60.3%), and coalescing vesicles (46.6%), the latter useful in differentiating acute allergic from irritant dermatitis (P-value < .05). Objective quantitative parameters correlated well with the severity grade: epidermal thickness due to spongiosis, AC (P-value < .05) and blood flow at 0.2 and 0.35 mm (P-value < .01). CONCLUSIONS OCT as a noninvasive diagnostic tool, established for skin cancer diagnosis, is useful for evaluating contact allergic patch-test reactions. Not only morphological but also objective features such as blood flow and AC correlate with the reaction severity. Further studies are needed to explore the differences in irritant and allergic contact dermatitis.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany.,Department of Dermatology and PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Farnaz Rahimi
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Zeno Fiocco
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Eva Oppel
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Elke Sattler
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
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19
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Ruini C, Schuh S, Sattler E, Welzel J. Line-field confocal optical coherence tomography-Practical applications in dermatology and comparison with established imaging methods. Skin Res Technol 2020; 27:340-352. [PMID: 33085784 DOI: 10.1111/srt.12949] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/07/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Non-invasive diagnostic techniques in dermatology gained increasing popularity in the last decade. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) are meanwhile established in research and clinical routine. While OCT is mainly indicated for detecting non-melanoma skin cancer, RCM has proven its usefulness additionally in distinguishing melanocytic lesions. Line-field confocal optical coherence tomography (LC-OCT) is an emerging tool combining the principles of both above-mentioned methods. METHODS Healthy skin at different body sites and exemplary skin lesions (basal cell carcinoma, malignant melanoma, actinic keratosis) were examined using dermoscopy, RCM, OCT and LC-OCT. Standard features for RCM and OCT and comparable features for LC-OCT were analysed. RESULTS LC-OCT has a lower penetration depth but superior resolution compared to OCT. In comparison with RCM, which provides only horizontal sections, LC-OCT creates both vertical and horizontal images in real time and has nearly the same cellular resolution. DISCUSSION Our preliminary experiences suggest that LC-OCT combines the advantages of RCM and OCT, with optimal resolution and penetration depth to diagnose all types of skin cancer. Larger systematic studies are needed to further characterize the field of use of this device and its sensitivity and specificity compared to histology.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Sandra Schuh
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Elke Sattler
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
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20
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Conforti C, Pizzichetta MA, Vichi S, Toffolutti F, Serraino D, Di Meo N, Giuffrida R, Deinlein T, Giacomel J, Rosendahl C, Gourhant JY, Zalaudek I. Sclerodermiform basal cell carcinomas vs. other histotypes: analysis of specific demographic, clinical and dermatoscopic features. J Eur Acad Dermatol Venereol 2020; 35:79-87. [PMID: 32401364 DOI: 10.1111/jdv.16597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/21/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Among the various types of basal cell carcinoma, the sclerodermiform variant has a high risk of recurrence and local invasiveness. A systematic description of the dermatoscopic features associated with specific body localization is lacking. OBJECTIVES To describe the clinical and dermoscopic features of sclerodermiform basal cell carcinoma (BCC) according to localization in the body confronting with superficial and nodular types. METHODS Clinical and dermoscopic images of sclerodermiform, nodular and superficial BCCs were retrospectively evaluated to study the location in the various body districts, maximum diameter, clinical appearance of the lesion, features of edges and presence or absence of specific dermatoscopic criteria of BCCs. RESULTS We examined 291 histopathologically proven BCCs showing that in nodular BCCs, classical arborizing vessels were more frequently found in the body macro-area (trunk and limbs; n = 46, 97.9%) than in the head/neck area (n = 43, 82.7%); within sclerodermiform BCCs, short arborizing vessels were found more frequently in the head/neck district (n = 35, 49.3%) than in the body (n = 6, 23.1%; P-value 0.02); within nodular BCCs, multiple blue-grey dots and globules were more frequently found on the trunk (n = 23, 48.9%) than in the head/neck district (n = 12, 23.1%; P-value 0.01). In sclerodermiform BCCs, ulceration was found more frequently in the head/neck district (n = 38, 53.5%) than in the body (n = 4, 15.4%; P-value > 0.01), and in superficial BCCs, ulceration was found more frequently in the head/neck district (n = 5, 38.5%) than in the body (n = 8, 9.8%; P-value 0.02). CONCLUSION Our study shows that superficial BCC are found frequently in the head/neck district dermoscopically characterized by ulceration and arborizing vessels; nodular BCCs are more frequently found in the body than in the head/neck district, and the dermoscopic pattern is characterized by the combination of three features: (i) classical arborizing vessels, (ii) multiple blue-grey dots and (iii) globules. Instead, sclerodermiform BCC is preferentially located in areas at high-moderate risk of recurrence; if pink-white areas and/or fine arborizing vessels are seen, clinicians should consider this diagnosis. Furthermore, location-specific dermatoscopic criteria have been described.
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Affiliation(s)
- C Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - M A Pizzichetta
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy.,Department of Medical Oncology-Preventive Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - S Vichi
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - F Toffolutti
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - D Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - N Di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - R Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology Section, University of Messina, Messina, Italy
| | - T Deinlein
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - J Giacomel
- Skin Spectrum Medical Services, Como, WA, Australia
| | - C Rosendahl
- School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - I Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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21
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Arnold-Brüning FS, Blaschke T, Kramer K, Lademann J, Thiede G, Fluhr JW, Patzelt A, Meinke MC. Application of parelectric spectroscopy to detect skin cancer-A pilot study. Skin Res Technol 2020; 26:234-240. [PMID: 31549768 DOI: 10.1111/srt.12785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The early detection of skin cancer is still challenging and calls for objective, fast diagnostic, and ideally non-invasive methods in order to leave the potentially malignant tumor cells unaltered. In this paper, the parelectric spectroscopy was applied to evaluate the potential of a non-invasive detection of basal cell carcinoma (BCC) and malignant melanoma. MATERIALS AND METHODS A prototype of parelectric spectroscopy was used to investigate non-invasively dipole density and mobility of suspicious skin lesions. The differences in investigated tissue were analyzed compared to pathohistological findings in a clinical study on 51 patients with suspected BCC and malignant melanoma. RESULTS The non-invasive parelectric spectroscopy could differentiate between normal skin, BCC, and melanoma but failed to distinguish between different types of skin cancer. The data were normalized to unsuspected nearby skin because the different skin locations influence dipole density and mobility. CONCLUSION The results of the pilot study indicate that the parelectric spectroscopy might be an additional, useful non-invasive diagnostic procedure to distinguish between normal skin and skin cancer.
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Affiliation(s)
- Frederike S Arnold-Brüning
- Department of Dermatology, Venerology and Allergology, Center of Experimental and Applied Cutaneous Physiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | | | - Jürgen Lademann
- Department of Dermatology, Venerology and Allergology, Center of Experimental and Applied Cutaneous Physiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Gisela Thiede
- Department of Dermatology, Venerology and Allergology, Center of Experimental and Applied Cutaneous Physiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Joachim W Fluhr
- Department of Dermatology, Venerology and Allergology, Center of Experimental and Applied Cutaneous Physiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexa Patzelt
- Department of Dermatology, Venerology and Allergology, Center of Experimental and Applied Cutaneous Physiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martina C Meinke
- Department of Dermatology, Venerology and Allergology, Center of Experimental and Applied Cutaneous Physiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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22
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Abstract
Basal cell carcinoma (BCC) as a non-melanoma skin cancer type is the most common malignant tumor throughout the world. The incidence is higher in age over 60. The intense of exposure to ultraviolet radiation is one of the known risk factors. Over 50% of BCC of the periocular region initially occur on the lower lid and inner angle. Literature review of treatment options for basal cell carcinoma, which consist of surgery, or combined techniques plus vismodegib, radiotherapy and imiquimod. The first consideration for treatment of periocular BCC is radical surgical excision using Mohs micrographic technique. Functional and esthetic outcome in patients are important after clear excisions and reconstruction should be carefully considered. Radical exenteration is considered in the case of orbital invasion of high-risk aggressive BCC.
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Affiliation(s)
- Alena Furdova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Karolina Kapitanova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Alexandra Kollarova
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Juraj Sekac
- Department of Ophthalmology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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23
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Garbarino F, Migliorati S, Farnetani F, De Pace B, Ciardo S, Manfredini M, Reggiani Bonetti L, Kaleci S, Chester J, Pellacani G. Nodular skin lesions: correlation of reflectance confocal microscopy and optical coherence tomography features. J Eur Acad Dermatol Venereol 2019; 34:101-111. [DOI: 10.1111/jdv.15953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/13/2019] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - F. Farnetani
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - B. De Pace
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - S. Ciardo
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - M. Manfredini
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | | | - S. Kaleci
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - J. Chester
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - G. Pellacani
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
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24
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Navarrete-Dechent C, Rajadhyaksha M, Nehal KS. Can optical coherence tomography improve the management of basal cell carcinoma? Br J Dermatol 2019; 180:448-449. [PMID: 30821394 DOI: 10.1111/bjd.17522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- C Navarrete-Dechent
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - M Rajadhyaksha
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | - K S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
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25
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Affiliation(s)
| | | | - Orit Markowitz
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York.,Department of Dermatology, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York.,Department of Dermatology, New York Harbor Healthcare System, Brooklyn, New York
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26
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Rossi AM, Navarrete-Dechent C, Nehal KS. Beyond skin deep: taking bedside dermatology to the next level with noninvasive technologies. Br J Dermatol 2019; 178:994-996. [PMID: 29785824 DOI: 10.1111/bjd.16503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- A M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, U.S.A
| | - C Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, U.S.A.,Melanoma and Skin Cancer Unit, Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - K S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, U.S.A
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27
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Feng H, Christman MP, Holmes J, Geronemus RG. Utilization of optical coherence tomography as a noninvasive, bedside imaging technique to identify residual nodular basal cell carcinoma at a well-healed and clinically unidentifiable biopsy site. J Am Acad Dermatol 2019; 81:e9-e10. [PMID: 30771419 DOI: 10.1016/j.jaad.2019.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/30/2019] [Accepted: 02/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Hao Feng
- Laser and Skin Surgery Center of New York, New York, New York; The Ronald O. Perelman Department of Dermatology, New York University, New York, New York.
| | - Mitalee P Christman
- Laser and Skin Surgery Center of New York, New York, New York; The Ronald O. Perelman Department of Dermatology, New York University, New York, New York
| | - Jon Holmes
- Michelson Diagnostics Ltd, Maidstone, United Kingdom
| | - Roy G Geronemus
- Laser and Skin Surgery Center of New York, New York, New York; The Ronald O. Perelman Department of Dermatology, New York University, New York, New York
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28
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Rao BK, John AM, Francisco G, Haroon A. Diagnostic Accuracy of Reflectance Confocal Microscopy for Diagnosis of Skin Lesions: An Update. Arch Pathol Lab Med 2018; 143:326-329. [DOI: 10.5858/arpa.2018-0124-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Histopathology is the current standard to diagnose skin disease. However, biopsy may not always be feasible, such as in patients with multiple nevi, a patient with a lesion on an aesthetically significant site, or in children. Recently, noninvasive techniques, including reflectance confocal microscopy (RCM), optical coherence tomography, and Raman spectroscopy, have enabled dermatologists to manage skin lesions in real time without the need for biopsy.
Objective.—
To report the updated diagnostic accuracy of RCM for equivocal skin lesions.
Design.—
In this study, we retrospectively reviewed our data of clinically suspicious lesions from 2010 to 2017 that were evaluated by RCM.
Results.—
Our results showed an overall sensitivity of 98.2% and specificity of 99.8%.
Conclusions.—
In conclusion, RCM is a noninvasive real-time tool with the potential to diagnose skin lesions with high accuracy and without biopsy.
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Affiliation(s)
- Babar K. Rao
- From the Department of Dermatology, Rutgers, Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Ann M John
- From the Department of Dermatology, Rutgers, Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Gina Francisco
- From the Department of Dermatology, Rutgers, Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Attiya Haroon
- From the Department of Dermatology, Rutgers, Robert Wood Johnson Medical School, Somerset, New Jersey
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