OCT of healthy skin, actinic skin and NMSC lesions

Methods of Melanoma Detection

Detection and removal of melanoma, before it has metastasized, dramatically improves prognosis and survival. The purpose of this chapter is to (1) summarize current methods of melanoma detection and (2) review state-of-the-art detection methods and technologies that have the potential to reduce melanoma mortality. Current strategies for the detection of melanoma range from population-based educational campaigns and screening to the use of algorithm-driven imaging technologies and performance of assays that identify markers of transformation. This chapter will begin by describing state-of-the-art methods for educating and increasing awareness of at-risk individuals and for performing comprehensive screening examinations. Standard and advanced photographic methods designed to improve reliability and reproducibility of the clinical examination will also be reviewed. Devices that magnify and/or enhance malignant features of individual melanocytic lesions (and algorithms that are available to interpret the results obtained from these devices) will be compared and contrasted. In vivo confocal microscopy and other cellular-level in vivo technologies will be compared to traditional tissue biopsy, and the role of a noninvasive "optical biopsy" in the clinical setting will be discussed. Finally, cellular and molecular methods that have been applied to the diagnosis of melanoma, such as comparative genomic hybridization (CGH), fluorescent in situ hybridization (FISH), and quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), will be discussed.

Optical coherence tomography and polarimetry of superficial skin biopsies

The goal. Of this study was to develop and assess the efficacy of polarization probing of biotissues in vitro. The method is based on the determination of polarization parameters of scattered radiation. Materials and methods. The well-known superficial epidermis stripping method was applied using the Sulfacrylate self-sterile medical adhesive. Small portions of thin layers of the adhesive were applied to slide plates and then to different skin sites. The corneous layer in the normal condition and in case of skin diseases (psoriasis, lichen acuminatus, discoid lupus erythematosus, alopecia, itching and demodectic mange) was examined based on the optical coherence tomography (OCT) method using the 0CS1300SS device (Thorlabs Inc, USA). Results. The authors obtained pictures visualizing the structural organization of different layers of the epidermis using the superficial epidermis biopsy method in case of lichen acuminatus, hyperkeratosis, itching and other skin diseases. Conclusion. This method ensures non-invasive high-precision measurement of the structure of different layers of the epidermis, which may be useful both for research purposes and practical dermatology.

Optical coherence tomography in the diagnosis of basal cell carcinoma

Since its introduction in dermatology in the late 1990s optical coherence tomography (OCT) has been used to study many skin diseases, in particular non-melanoma skin cancer and it s precursors. Special attention has been paid to superficial basal cell carcinoma (BCC), and a number of smaller observational studies have been published. The diagnostic criteria for BCC of these studies are systematically reviewed. A systemic review of English language studies was performed using PubMed, Google Scholar and Royal Danish Library, to search for primary papers on OCT and BCC. The references of retrieved papers were searched by hand for further relevant papers. A total of 39 papers were identified (search date: 2014-01-15). 22 were excluded because they did not meet the inclusion criteria, leaving 17 papers for analysis. In 100% of the studies, rounded dark structures in the upper dermis surrounded by a hyperreflective halo possibly surrounded by a hyporeflective border and disruption of epidermal layering were described. In 53% of the reports a hyporeflective lateral tumour border was described. A range of other features were mentioned in a minority of the studies. It is suggested that these diagnostic criteria could be characteristic for identifying BCC lesions using OCT.

Three-dimensional multiphoton/optical coherence tomography for diagnostic applications in dermatology

A preliminary clinical trial using state-of-the-art multiphoton tomography (MPT) and optical coherence tomography (OCT) for three-dimensional (3D) multimodal in vivo imaging of normal skin, nevi, scars and pathologic skin lesions has been conducted. MPT enabled visualization of sub-cellular details with axial and transverse resolutions of <2 μm and <0.5 μm, respectively, from a volume of 0.35 × 0.35 × 0.2 mm(3) at a frame rate of 0.14 Hz (512 × 512 pixels). State-of-the-art OCT, operating at a center wavelength of 1300 nm, was capable of acquiring 3D images depicting the layered architecture of skin with axial and transverse resolutions ~8 μm and ~20 μm, respectively, from a volume of 7 × 3.5 × 1.5 mm(3) at a frame rate of 46 Hz (1024 × 1024 pixels). This study demonstrates the clinical diagnostic potential of MPT/OCT for pre-screening relatively large areas of skin using 3D OCT to identify suspicious regions at microscopic level and subsequently using high resolution MPT to obtain zoomed in, sub-cellular level information of the respective regions.

Imaging of skin microvessels with optical coherence tomography: potential uses in port wine stains

The knowledge of vascular structures of port wine stains (PWSs) may be useful to select treatment doses and improve therapeutic efficacy. Biopsies are impractical to implement, therefore, it is necessary to develop non-invasive techniques for morphological evaluation. This study aimed to evaluate the application of a novel optical coherence tomography (OCT) system to characterize the vascular structures of PWSs. First, OCT images were obtained from the skin of healthy rabbit ears and compared with the histopathological images. Second, OCT was used to document the differences between PWS lesions and contralateral normal skin; the size and depth of the vascular structures of two clinical types of PWSs were measured and statistically analyzed. The dermal blood vessels of healthy rabbit ears were clearly distinguished from other tissue. There was no statistical difference between the vascular diameter or depth measured by OCT images and histopathological sections (P>0.05). The OCT images of the PWSs could be distinguished from normal skin. There was no statistical difference in the depth of vessels between the purple-type and the proliferative-type PWSs (P>0.05), while there was statistical difference in the diameter of vessels between them (P<0.01). Therefore, OCT is a promising, real-time, in vivo and non-invasive tool with which to characterize the vascular structures of PWSs.

Swept-source optical coherence tomography of lower limb wound healing with histopathological correlation

Direct noninvasive visualization of wound bed with depth information is important to understand the tissue repair. We correlate skin swept-source-optical coherence tomography (OCT) with histopathological and immunohistochemical evaluation on traumatic lower limb wounds under honey dressing to compare and assess the tissue repair features acquired noninvasively and invasively. Analysis of optical biopsy identifies an uppermost brighter band for stratum corneum with region specific thickness (p < 0.0001) and gray-level intensity (p < 0.0001) variation. Below the stratum corneum, variation in optical intensities is remarkable in different regions of the wound bed. Correlation between OCT and microscopic observations are explored especially in respect to progressive growth and maturation of the epithelial and subepithelial components. Characteristic transition of uniform hypolucid band in OCT image for depigmented zone to wavy highly lucid band in the pigmented zone could be directly correlated with the microscopic findings. The transformation of prematured epithelium of depigmented area, with low expression of E-cadherin, to matured epithelium with higher E-cadherin expression in pigmented zone, implicated plausible change in their optical properties as depicted in OCT. This correlated evaluation of multimodal images demonstrates applicability of swept-source-OCT in wound research and importance of integrated approach in validation of new technology.

Elastographic contrast generation in optical coherence tomography from a localized shear stress

A technique for generating contrast in two-dimensional shear strain elastograms from a localized stress is presented. The technique involves generating a non-uniform, localized stress via a magnetically actuated implant. Its effectiveness is demonstrated using finite-element simulations and a phantom study provides experimental verification of this. The method is applied to a superficial cancerous lesion model represented as a stiff inclusion in normal tissue. The lesion was best distinguished from its surroundings using total shear strain elastograms, rather than individual strain components. In experimental phantom studies, the lesion was imaged using optical coherence tomography (OCT) and could still be distinguished in elastograms when not readily identifiable in standard OCT images.