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Verzì AE, Micali G, Lacarrubba F. Line-Field Confocal Optical Coherence Tomography May Enhance Monitoring of Superficial Basal Cell Carcinoma Treated with Imiquimod 5% Cream: A Pilot Study. Cancers (Basel) 2021; 13:4913. [PMID: 34638396 DOI: 10.3390/cancers13194913] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 07/26/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 12/12/2022] Open
Abstract
Line-field confocal optical coherence tomography (LC-OCT) is a novel, non-invasive technique for real-time skin imaging. Imiquimod (IQ) 5% cream is an immune response modifier currently approved for the treatment of small, superficial basal cell carcinoma (BCC). The aim of this study was to investigate if LC-OCT may be useful to enhance the treatment monitoring of BCC. Twenty superficial BCCs from 12 patients were treated with IQ 5% cream once daily, five days a week, for six weeks. Clinical and LC-OCT evaluations were performed at baseline and 4 weeks after the end of treatment. At the end of the study, 13 lesions showed a complete clinical and LC-OCT response, 4 lesions a partial clinical and LC-OCT response, and 3 lesions a complete clinical response but residual tumoral signs at LC-OCT. Our pilot study suggests that LC-OCT may represent a promising tool able to enhance the evaluation of the treatment response of BCCs to non-invasive treatments. In our case series, its use highlighted, through a detailed, fast, and complete examination of the treated area, three cases of residual BCC that otherwise would have gone undetected at clinical examination. Future studies on larger series of patients treated with different modalities and with a longer follow-up are advisable.
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Abstract
Although surgical therapy continues to be the gold standard for the treatment of basal cell carcinoma given high cure rates and the ability to histologically confirm tumor clearance, there are a number of nonsurgical treatment options that may be considered based on individual tumor characteristics, functional and cosmetic considerations, patient comorbidities and patient preference. Topical 5-fluorouracil 5% cream and imiquimod 5% cream have been US FDA-approved for the treatment of superficial basal cell carcinoma. Additionally, a number of new and emerging topical agents and techniques have been described for the treatment of basal cell carcinoma and will be reviewed herein.
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Affiliation(s)
- Natalie Kash
- Department of Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology & Cosmetic Surgery Orlando Program, Maitland, FL 32751, USA
| | - Sirunya Silapunt
- Department of Dermatology, University of Texas McGovern Medical School at Houston, Houston, TX 77030, USA
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Yélamos O, Alejo B, Ertekin SS, Villa-Crespo L, Zamora-Barquero S, Martinez N, Domínguez M, Iglesias P, Herrero A, Malvehy J, Puig S. Non-invasive clinical and microscopic evaluation of the response to treatment with clobetasol cream vs. calcipotriol/betamethasone dipropionate foam in mild to moderate plaque psoriasis: an investigator-initiated, phase IV, unicentric, open, randomized clinical trial. J Eur Acad Dermatol Venereol 2020; 35:143-149. [PMID: 32365242 PMCID: PMC7818495 DOI: 10.1111/jdv.16559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/01/2020] [Accepted: 04/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Treatment response for psoriasis is typically evaluated using clinical scores. However, patients can relapse after clinical clearance, suggesting persistent inflammation. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) can non-invasively improve treatment response assessment. OBJECTIVES To compare the clinical and non-invasive microscopic features in a psoriatic target lesion treated with clobetasol cream or calcipotriol/betamethasone dipropionate foam (Cal/BD foam). METHODS Prospective, unicentric, open, randomized clinical trial comparing clinical data [total clinical score (TCS)] and microscopic data (dermoscopy, RCM and OCT) in psoriasis patients treated with clobetasol or Cal/BD foam. RESULTS We included 36 adult patients (22 men). At week 4, more patients treated with Cal/BD foam achieved TCS ≤1 than with clobetasol (63.2% vs. 18.8%, P = 0.016). Treatment satisfaction was higher with Cal/BD foam (P < 0.03). Microscopically, Cal/BD foam induced more reduction in epidermal thickness at week 4 (P < 0.049). Dilated horizontal blood vessels were more common with clobetasol than with Cal/BD foam at week 8 (69.2% vs. 31.2%, P = 0.159). If epidermal hyperplasia was noted at baseline, the response was poorer with clobetasol (P = 0.029). LIMITATIONS Small sample size, open study, imaging sampling bias. CONCLUSION Cal/BD foam is more effective than clobetasol, has better patient satisfaction and induces greater reduction in the hyperkeratosis/acanthosis, regardless of baseline epidermal hyperplasia.
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Affiliation(s)
- O Yélamos
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.,Department of Dermatology, Centro Médico Teknon - Quirónsalud, Barcelona, Spain
| | - B Alejo
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - S S Ertekin
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - L Villa-Crespo
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - S Zamora-Barquero
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - N Martinez
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - M Domínguez
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - P Iglesias
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - A Herrero
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - J Malvehy
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - S Puig
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
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Banzhaf C, Phothong W, Suku M, Ulrich M, Philipsen P, Mogensen M, Haedersdal M. Basal cell carcinoma treated with combined ablative fractional laser and ingenol mebutate – an exploratory study monitored by optical coherence tomography and reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2019; 34:502-509. [DOI: 10.1111/jdv.15907] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023]
Affiliation(s)
- C.A. Banzhaf
- Department of Dermatology University of Copenhagen Bispebjerg Hospital Copenhagen Denmark
| | - W. Phothong
- Department of Dermatology University of Copenhagen Bispebjerg Hospital Copenhagen Denmark
| | - M.‐L.H. Suku
- Department of Pathology University of Copenhagen Rigshospitalet Copenhagen Denmark
| | - M. Ulrich
- CMB Collegium Medicum Berlin GmbH Berlin Germany
| | - P.A. Philipsen
- Department of Dermatology University of Copenhagen Bispebjerg Hospital Copenhagen Denmark
| | - M. Mogensen
- Department of Dermatology University of Copenhagen Bispebjerg Hospital Copenhagen Denmark
| | - M. Haedersdal
- Department of Dermatology University of Copenhagen Bispebjerg Hospital Copenhagen Denmark
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Lupu M, Popa IM, Voiculescu VM, Boda D, Caruntu C, Zurac S, Giurcaneanu C. A Retrospective Study of the Diagnostic Accuracy of In Vivo Reflectance Confocal Microscopy for Basal Cell Carcinoma Diagnosis and Subtyping. J Clin Med 2019; 8:E449. [PMID: 30987174 DOI: 10.3390/jcm8040449] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 03/11/2019] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 12/15/2022] Open
Abstract
Current national and European guidelines recommend distinct management approaches for basal cell carcinoma (BCC) based on tumor location, size, and histopathological subtype. In vivo reflectance confocal microscopy (RCM) is a non-invasive skin imaging technique which may change the diagnostic pathway for BCC patients. This study aimed to determine the sensitivity and specificity of RCM for BCC diagnosis, assess the predictive values of several confocal criteria in correctly classifying BCC subtypes, and evaluate the intraobserver reliability of RCM diagnosis for BCC. We conducted a retrospective study in two tertiary care centers in Bucharest, Romania. We included adults with clinically and dermoscopic suspect BCCs who underwent RCM and histopathological examination of excision specimens. For RCM examinations, we used the VivaScope 1500 and histopathology of the surgical excision specimen was the reference standard. Of the 123 cases included in the analysis, BCC was confirmed in 104 and excluded in 19 cases. RCM showed both high sensitivity (97.1%, 95% CI (91.80, 99.40)) and specificity (78.95%, 95% CI (54.43, 93.95)) for detecting BCC. Several RCM criteria were highly predictive for BCC subtypes: cords connected to the epidermis for superficial BCC, big tumor islands, peritumoral collagen bundles and increased vascularization for nodular BCC, and hyporefractile silhouettes for aggressive BCC. Excellent intraobserver agreement (κ = 0.909, p < 0.001) was observed. This data suggests that RCM could be used for preoperative diagnosis and BCC subtype classification in patients with suspected BCCs seen in tertiary care centers.
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Boitor R, Kong K, Shipp D, Varma S, Koloydenko A, Kulkarni K, Elsheikh S, Schut TB, Caspers P, Puppels G, van der Wolf M, Sokolova E, Nijsten TEC, Salence B, Williams H, Notingher I. Automated multimodal spectral histopathology for quantitative diagnosis of residual tumour during basal cell carcinoma surgery. Biomed Opt Express 2017; 8:5749-5766. [PMID: 29296502 PMCID: PMC5745117 DOI: 10.1364/boe.8.005749] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/10/2017] [Accepted: 11/12/2017] [Indexed: 05/11/2023]
Abstract
Multimodal spectral histopathology (MSH), an optical technique combining tissue auto-fluorescence (AF) imaging and Raman micro-spectroscopy (RMS), was previously proposed for detection of residual basal cell carcinoma (BCC) at the surface of surgically-resected skin tissue. Here we report the development of a fully-automated prototype instrument based on MSH designed to be used in the clinic and operated by a non-specialist spectroscopy user. The algorithms for the AF image processing and Raman spectroscopy classification had been first optimised on a manually-operated laboratory instrument and then validated on the automated prototype using skin samples from independent patients. We present results on a range of skin samples excised during Mohs micrographic surgery, and demonstrate consistent diagnosis obtained in repeat test measurement, in agreement with the reference histopathology diagnosis. We also show that the prototype instrument can be operated by clinical users (a skin surgeon and a core medical trainee, after only 1-8 hours of training) to obtain consistent results in agreement with histopathology. The development of the new automated prototype and demonstration of inter-instrument transferability of the diagnosis models are important steps on the clinical translation path: it allows the testing of the MSH technology in a relevant clinical environment in order to evaluate its performance on a sufficiently large number of patients.
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Affiliation(s)
- Radu Boitor
- School of Physics and Astronomy, University Park, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Kenny Kong
- School of Physics and Astronomy, University Park, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Dustin Shipp
- School of Physics and Astronomy, University Park, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Sandeep Varma
- Circle Nottingham Ltd NHS Treatment Centre, Lister Road, Nottingham NG7 2FT, UK
| | - Alexey Koloydenko
- Mathematics Department, Royal Holloway University of London, Egham, TW20 OEX, UK
| | - Kusum Kulkarni
- Department of Pathology, Nottingham University Hospitals NHS Trust, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK
| | - Somaia Elsheikh
- Department of Pathology, Nottingham University Hospitals NHS Trust, QMC Campus, Derby Road, Nottingham, NG7 2UH, UK
| | - Tom Bakker Schut
- Erasmus-University Medical Center Rotterdam, Department of Dermatology, The Netherlands
- RiverD International, Marconistraat 16, Rotterdam 3029 AK, The Netherlands
| | - Peter Caspers
- Erasmus-University Medical Center Rotterdam, Department of Dermatology, The Netherlands
- RiverD International, Marconistraat 16, Rotterdam 3029 AK, The Netherlands
| | - Gerwin Puppels
- Erasmus-University Medical Center Rotterdam, Department of Dermatology, The Netherlands
- RiverD International, Marconistraat 16, Rotterdam 3029 AK, The Netherlands
| | | | - Elena Sokolova
- RiverD International, Marconistraat 16, Rotterdam 3029 AK, The Netherlands
| | - T. E. C. Nijsten
- Erasmus-University Medical Center Rotterdam, Department of Dermatology, The Netherlands
| | | | - Hywel Williams
- Centre of Evidence-Based Dermatology, Nottingham University Hospital NHS Trust, QMC Campus, Derby Road, NG7 2UH, UK
| | - Ioan Notingher
- School of Physics and Astronomy, University Park, University of Nottingham, Nottingham, NG7 2RD, UK
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Kadouch DJ, Leeflang MM, Elshot YS, Longo C, Ulrich M, van der Wal AC, Wolkerstorfer A, Bekkenk MW, de Rie MA. Diagnostic accuracy of confocal microscopy imaging vs. punch biopsy for diagnosing and subtyping basal cell carcinoma. J Eur Acad Dermatol Venereol 2017; 31:1641-1648. [PMID: 28370434 PMCID: PMC5697654 DOI: 10.1111/jdv.14253] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 01/12/2017] [Accepted: 02/27/2017] [Indexed: 12/11/2022]
Abstract
Background In vivo reflectance confocal microscopy (RCM) is a promising non‐invasive skin imaging technique that could facilitate early diagnosis of basal cell carcinoma (BCC) instead of routine punch biopsies. However, the clinical value and utility of RCM vs. a punch biopsy in diagnosing and subtyping BCC is unknown. Objective To assess diagnostic accuracy of RCM vs. punch biopsy for diagnosing and subtyping clinically suspected primary BCC. Methods A prospective, consecutive cohort of 100 patients with clinically suspected BCC were included at two tertiary hospitals in Amsterdam, the Netherlands, between 3 February 2015 and 2 October 2015. Patients were randomized between two test‐treatment pathways: diagnosing and subtyping using RCM imaging followed by direct surgical excision (RCM one‐stop‐shop) or planned excision based upon the histological diagnosis and subtype of punch biopsy (standard care). The primary outcome was the agreement between the index tests (RCM vs. punch biopsy) and reference standard (excision specimen) in correctly diagnosing BCC. The secondary outcome was the agreement between the index tests and reference standard in correctly identifying the most aggressive BCC subtypes. Results Sensitivity to detect BCC was similar for RCM and punch biopsy (100% vs. 93.94%), but a punch biopsy was more specific than RCM (79% vs. 38%). RCM expert evaluation for diagnosing BCC had a sensitivity of 100% and a specificity of 75%. The agreement between RCM and excision specimen in identifying the most aggressive BCC subtype ranged from 50% to 85% vs. 77% by a punch biopsy. Conclusion Reflectance confocal microscopy and punch biopsy have comparable diagnostic accuracy to diagnose and subtype BCC depending on RCM experience. Although experienced RCM users could accurately diagnose BCC at a distance, we found an important difference in subtyping BCC. Future RCM studies need to focus on diagnostic accuracy, reliability and specific criteria to improve BCC subtype differentiation.
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Affiliation(s)
- D J Kadouch
- Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands
| | - M M Leeflang
- Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Y S Elshot
- Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands.,Department of Dermatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Longo
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova - IRCCS/University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - M Ulrich
- Private Dermatology Office/CMB Collegium Medicum Berlin, Berlin, Germany
| | - A C van der Wal
- Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands
| | - M W Bekkenk
- Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands.,Department of Dermatology, VU Medical Centre, Amsterdam, The Netherlands
| | - M A de Rie
- Department of Dermatology, Academic Medical Centre, Amsterdam, The Netherlands.,Department of Dermatology, VU Medical Centre, Amsterdam, The Netherlands
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