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Stephens R. Histologic depth measurement of basal cell carcinoma should not be considered as a standard to judge the accuracy of depth measurement made using optical coherence tomography. Australas J Dermatol 2023; 64:303-304. [PMID: 36716201 DOI: 10.1111/ajd.13989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/30/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Robert Stephens
- North West Sydney Dermatology and Laser, Rouse Hill, New South Wales, Australia
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2
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Ho G, Schwartz RJ, Melhoranse‐Gouveia B, Guitera P, O'Sullivan NA, Cheung VKY, Ch'ng S, Martin LK. Utility of optical coherence tomography in basal cell naevus syndrome: A case report. Australas J Dermatol 2022; 63:e331-e335. [PMID: 36125195 PMCID: PMC9826408 DOI: 10.1111/ajd.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
Optical Coherence Tomography (OCT) is a useful non-invasive diagnostic tool for diagnosing and monitoring treatment of basal cell carcinomas. We describe the use of OCT in a patient with Basal Cell Naevus Syndrome. Through measuring tumour depth on OCT, management of individual tumours was triaged accordingly using 0.4 mm tumour depth as a cut-off for surgical and non-surgical management. OCT has potential to reduce unnecessary excisions and associated morbidity in this population of patients.
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Affiliation(s)
- Genevieve Ho
- Melanoma Institute AustraliaSydneyNew South WalesAustralia,Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Rodrigo J. Schwartz
- Melanoma Institute AustraliaSydneyNew South WalesAustralia,Department of Dermatology, Faculty of MedicineUniversity of ChileSantiagoChile
| | - Bruna Melhoranse‐Gouveia
- Melanoma Institute AustraliaSydneyNew South WalesAustralia,Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Pascale Guitera
- Melanoma Institute AustraliaSydneyNew South WalesAustralia,Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,Sydney Melanoma Diagnostic CentreRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | | | - Veronica K. Y. Cheung
- Department of Tissue Pathology and Diagnostic OncologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Sydney Ch'ng
- Melanoma Institute AustraliaSydneyNew South WalesAustralia,Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,Royal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Linda K. Martin
- Melanoma Institute AustraliaSydneyNew South WalesAustralia,Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
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3
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Chai K, Zhu R, Luo F, Shi Y, Liu M, Xiao Y, Xiao R. Updated Role of High-frequency Ultrasound in Assessing Dermatological Manifestations in Autoimmune Skin Diseases. Acta Derm Venereol 2022; 102:adv00765. [PMID: 36000997 PMCID: PMC9558316 DOI: 10.2340/actadv.v102.1969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Autoimmune skin diseases are a group of disorders that arise due to the dysregulated immune system attacking self-antigens, causing multiple tissue and organ lesions. With disease progression, the physical and psychological health of patients may be seriously damaged. High-frequency ultrasound is non-invasive, reproducible, and suitable for visualizing the fine structure of external organs. The usage of high-frequency ultrasound has increased in recent years in the auxiliary diagnosis and monitoring of various skin diseases; it serves as a promising tool for dermatological disease assessment. This review summarizes the characteristics of high-frequency ultrasound imaging in common autoimmune skin diseases, including systemic lupus erythematosus, scleroderma, psoriasis, dermatomyositis, and pemphigus/pemphigoid. The objective of this review is to provide new ideas and strategies for dermatologists to diagnose and track the prognosis of autoimmune skin diseases.
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Affiliation(s)
| | | | | | | | | | - Yangfan Xiao
- Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha, China.
| | - Rong Xiao
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, China.
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4
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Adan F, Nelemans PJ, Essers BAB, Brinkhuizen T, Dodemont SRP, Kessels JPHM, Quaedvlieg PJF, Dermont GJ, Winnepenninckx VJL, Abdul Hamid M, Kelleners-Smeets NWJ, Mosterd K. Optical coherence tomography versus punch biopsy for diagnosis of basal cell carcinoma: a multicentre, randomised, non-inferiority trial. Lancet Oncol 2022; 23:1087-1096. [DOI: 10.1016/s1470-2045(22)00347-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
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5
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Real-time high-resolution millimeter-wave imaging for in-vivo skin cancer diagnosis. Sci Rep 2022; 12:4971. [PMID: 35322133 PMCID: PMC8943071 DOI: 10.1038/s41598-022-09047-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/16/2022] [Indexed: 12/26/2022] Open
Abstract
High-resolution millimeter-wave imaging (HR-MMWI), with its high discrimination contrast and sufficient penetration depth, can potentially provide affordable tissue diagnostic information noninvasively. In this study, we evaluate the application of a real-time system of HR-MMWI for in-vivo skin cancer diagnosis. 136 benign and malignant skin lesions from 71 patients, including melanoma, basal cell carcinoma, squamous cell carcinoma, actinic keratosis, melanocytic nevi, angiokeratoma, dermatofibroma, solar lentigo, and seborrheic keratosis were measured. Lesions were classified using a 3-D principal component analysis followed by five classifiers including linear discriminant analysis (LDA), K-nearest neighbor (KNN) with different K-values, linear and Gaussian support vector machine (LSVM and GSVM) with different margin factors, and multilayer perception (MLP). Our results suggested that the best classification was achieved by using five PCA components followed by MLP with 97% sensitivity and 98% specificity. Our findings establish that real-time millimeter-wave imaging can be used to distinguish malignant tissues from benign skin lesions with high diagnostic accuracy comparable with clinical examination and other methods.
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6
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Adan F, Mosterd K, Kelleners-Smeets NWJ, Nelemans PJ. Diagnostic Value of Optical Coherence Tomography Image Features for Diagnosis of Basal Cell Carcinoma. Acta Derm Venereol 2021; 101:adv00607. [PMID: 34724068 PMCID: PMC9455320 DOI: 10.2340/actadv.v101.421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Optical coherence tomography (OCT) is a non-invasive diagnostic method. Numerous morphological OCT features have been described for diagnosis of basal cell carcinoma (BCC). The aim of this study is to evaluate the diagnostic value of established OCT features and to explore whether the use of a small set of OCT features enables accurate discrimination between BCC and non-BCC lesions and between BCC subtypes. For each lesion, the presence or absence of specific OCT features was recorded. Histopathology was used as a gold standard. Diagnostic parameters were calculated for each OCT feature, and multivariate logistic regression analyses were performed to evaluate the loss in discriminative ability when using a small subset of OCT features instead of all features that are characteristic for BCC according to the literature. The results show that the use of a limited number of OCT features allows for good discrimination of superficial BCC from nonsuperficial BCC and non-BCC lesions. The prevalence of BCC was 75.3% (225/299) and the proposed diagnostic algorithm enabled detection of 97.8% of BCC lesions (220/225). Subtyping without the need for biopsy was possible in 132 of 299 patients (44%), with a predictive value for presence of superficial BCC of 84.3% vs 98.8% for presence of non-superficial BCC.
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Affiliation(s)
- Fieke Adan
- Department of Dermatology, Maastricht University Medical Centre, P. Debyelaan 25, NL-6229 HX Maastricht, The Netherlands.
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7
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Abstract
During the past decade, noninvasive imaging has emerged as a valuable tool in clinical dermatology and dermatologic research. Optical coherence tomography (OCT) is one such type of noninvasive imaging. OCT uses the principle of interferometry to produce real-time images. A low-power diode laser shines infrared light onto tissues, which reflects back to an optical fiber interferometer. Using time delay and the backscattered light intensity, a two-dimensional image akin to an ultrasound is rendered. We review the history, types, and modalities of OCT, plus the many applications of frequency domain, high definition, and dynamic OCT in practice, including its utility in diagnosis, monitoring, and grading disease severity in a variety of cutaneous conditions.
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Affiliation(s)
- Corinna E Psomadakis
- Department of Medicine, Mount Sinai West and Morningside, New York, New York, USA
| | - Nadeem Marghoob
- University of Vermont Medical Center, Department of Dermatology, Burlington, VT
| | - Brady Bleicher
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Orit Markowitz
- Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York, USA.
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8
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Jung JM, Cho JY, Lee WJ, Chang SE, Lee MW, Won CH. Emerging Minimally Invasive Technologies for the Detection of Skin Cancer. J Pers Med 2021; 11:951. [PMID: 34683091 PMCID: PMC8538732 DOI: 10.3390/jpm11100951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/23/2022] Open
Abstract
With the increasing incidence of skin cancer, many noninvasive technologies to detect its presence have been developed. This review focuses on reflectance confocal microscopy (RCM), optical coherence tomography (OCT), high-frequency ultrasound (HFUS), electrical impedance spectroscopy (EIS), pigmented lesion assay (PLA), and Raman spectroscopy (RS) and discusses the basic principle, clinical applications, advantages, and disadvantages of each technology. RCM provides high cellular resolution and has high sensitivity and specificity for the diagnosis of skin cancer. OCT provides lower resolution than RCM, although its evaluable depth is deeper than that of RCM. RCM and OCT may be useful in reducing the number of unnecessary biopsies, evaluating the tumor margin, and monitoring treatment response. HFUS can be mainly used to delineate tumor depths or margins and monitor the treatment response. EIS provides high sensitivity but low specificity for the diagnosis of skin malignancies. PLA, which is based on the genetic information of lesions, is applicable for the detection of melanoma with high sensitivity and moderate-to-high specificity. RS showed high accuracy for the diagnosis of skin cancer, although more clinical studies are required. Advances in these technologies for the diagnosis of skin cancer can lead to the realization of optimized and individualized treatments.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Ji Young Cho
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea;
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
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9
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Jerjes W, Hamdoon Z, Rashed D, Sattar AA, Hopper C. In vivo optical coherence tomography in assessment of suspicious facial lesions: A prospective study. Photodiagnosis Photodyn Ther 2021; 36:102493. [PMID: 34419675 DOI: 10.1016/j.pdpdt.2021.102493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/31/2021] [Accepted: 08/17/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Skin cancer continues to be the most common cancer in the Caucasian population. Over the past two decades, researchers around the world started assessing the possibility of diagnosing tissue pathologies by using optical systems. In this study, we aimed to use in vivo optical coherence tomography (OCT) technology to describe the morphologic features of normal and pathologic skin conditions. MATERIALS AND METHODS In this study, 72 patients with suspected skin pre-cancer/cancer were recruited. The lesions were subjected to in vivo OCT scanning using compact size probe. The main scanned areas were the centre of the lesion, periphery of the lesion and control reading at least 2cm from the lesion periphery but within the same dermatomal distribution. Following assessment, each lesion was surgically excised. All acquired OCT images were correlated with the corresponding histopathology images to ensure an accurate diagnosis and appropriate co-localisation of abnormal lesion on both OCT image and pathology slide. This was achieved in every resected lesion. RESULTS Histopathological analysis revealed that of the 96 macroscopically suspicious scanned lesions 26 were actinic keratosis (AK), 51 were basal cell carcinoma (BCC) and 19 were cutaneous squamous cell carcinoma (SCC). Different layers of healthy skin can be distinguished with clear demarcation between the epidermis and papillary dermis. An increase in epidermal thickness was observed in OCT images in AK that appeared relatively hyperintense. Cutaneous SCC was characterized by hypoechoic signal free spaces within the dermis and damaged of dermal-epidermal junction. BCCs were visualized as hypoechoic structures but showed a mixed echogenicity. Solid nodular BCC appeared as single or multiple areas with no clear arrangement surrounding low-reflectivity lobular structures surrounded. Cystic structures were identifiable by signal-free areas adjacent to healthy skin. Sensitivity and specificity for in vivo OCT in diagnosing these lesions were impressive, based on this small sample size. CONCLUSIONS OCT have shown that there are qualitative differences in OCT image features of skin with varying degrees of pathology, and between normal and pathological skin. This study indicates that in vivo OCT shows a good promise as a useful optical diagnostic technique in diagnosing skin pathologies.
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Affiliation(s)
- Waseem Jerjes
- North End Medical Centre, London, UK; UCL Medical School, London, UK.
| | - Zaid Hamdoon
- College of Dental Medicine, University of Sharjah, UAE; Unit of OMFS, UCL Eastman Dental Institute, London, UK.
| | - Dara Rashed
- Unit of OMFS, UCL Eastman Dental Institute, London, UK
| | | | - Colin Hopper
- UCL Medical School, London, UK; Unit of OMFS, UCL Eastman Dental Institute, London, UK
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10
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Adan F, Nelemans PJ, Kelleners-Smeets NWJ, Kessels JPHM, Brinkhuizen T, Mosterd K. The additional diagnostic value of optical coherence tomography in clinically diagnosed basal cell carcinomas undergoing direct surgical excision. Br J Dermatol 2021; 185:1065-1066. [PMID: 34128223 PMCID: PMC9291034 DOI: 10.1111/bjd.20579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- F Adan
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, the Netherlands.,GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - P J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - N W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, the Netherlands.,GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - J P H M Kessels
- Department of Dermatology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - T Brinkhuizen
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Dermatology, Catharina Hospital, Eindhoven, the Netherlands
| | - K Mosterd
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, the Netherlands.,GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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11
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Gill M, Sahu A, Alessi-Fox C, Cordova M, Gonzalez S, Iftimia N, Aleissa S, Navarrete-Dechent C, Dusza S, Rossi A, Marghoob AA, Rajadhyaksha M, Chen CSJ. Angulated small nests and cords: Key diagnostic histopathologic features of infiltrative basal cell carcinoma can be identified using integrated reflectance confocal microscopy-optical coherence tomography. J Cutan Pathol 2021; 48:53-65. [PMID: 32989842 PMCID: PMC7755835 DOI: 10.1111/cup.13871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/27/2020] [Accepted: 08/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurate basal cell carcinoma (BCC) subtyping is requisite for appropriate management, but non-representative sampling occurs in 18% to 25% of biopsies. By enabling non-invasive diagnosis and more comprehensive sampling, integrated reflectance confocal microscopy-optical coherence tomography (RCM-OCT) may improve the accuracy of BCC subtyping and subsequent management. We evaluated RCM-OCT images and histopathology slides for the presence of two key features, angulation and small nests and cords, and calculated (a) sensitivity and specificity of these features, combined and individually, for identifying an infiltrative BCC subtype and (b) agreement across modalities. METHODS Thirty-three RCM-OCT-imaged, histopathologically-proven BCCs (17 superficial and/or nodular; 16 containing an infiltrative component) were evaluated. RESULTS The presence of angulation or small nests and cords was sufficient to identify infiltrative BCC on RCM-OCT with 100% sensitivity and 82% specificity, similar to histopathology (100% sensitivity, 88% specificity, kappa = 0.82). When both features were present, the sensitivity for identifying infiltrative BCC was 100% using either modality and specificity was 88% on RCM-OCT vs 94% on histopathology, indicating near-perfect agreement between non-invasive and invasive diagnostic modalities (kappa = 0.94). CONCLUSIONS RCM-OCT can non-invasively identify key histopathologic features of infiltrative BCC offering a possible alternative to traditional invasive biopsy.
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Affiliation(s)
- Melissa Gill
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
- SkinMedical Research and Diagnostics, P.L.L.C., Dobbs Ferry, NY, USA
- Faculty of Medicine and Health Sciences, University of Alcala de Henares, Madrid, Spain
| | - Aditi Sahu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; USA
| | - Christi Alessi-Fox
- Caliber Imaging and Diagnostics Inc., 50 Methodist Hill Drive Suite 1000, Rochester, NY
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; USA
| | - Salvador Gonzalez
- Faculty of Medicine and Health Sciences, University of Alcala de Henares, Madrid, Spain
| | - Nicusor Iftimia
- Physical Sciences, Inc., 20 New England Business Ctr. Drive, Andover, MA
| | - Saud Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; USA
| | | | - Stephen Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; USA
| | - Anthony Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; USA
| | - Ashfaq A. Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; USA
| | - Milind Rajadhyaksha
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; USA
| | - Chih-Shan J. Chen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; USA
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12
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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] [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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13
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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] [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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14
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Fania L, Didona D, Morese R, Campana I, Coco V, Di Pietro FR, Ricci F, Pallotta S, Candi E, Abeni D, Dellambra E. Basal Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines 2020; 8:biomedicines8110449. [PMID: 33113965 PMCID: PMC7690754 DOI: 10.3390/biomedicines8110449] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/13/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common human cancer worldwide, and is a subtype of nonmelanoma skin cancer, characterized by a constantly increasing incidence due to an aging population and widespread sun exposure. Although the mortality from BCC is negligible, this tumor can be associated with significant morbidity and cost. This review presents a literature overview of BCC from pathophysiology to novel therapeutic approaches. Several histopathological BCC subtypes with different prognostic values have been described. Dermoscopy and, more recently, reflectance confocal microscopy have largely improved BCC diagnosis. Although surgery is the first-line treatment for localized BCC, other nonsurgical local treatment options are available. BCC pathogenesis depends on the interaction between environmental and genetic characteristics of the patient. Specifically, an aberrant activation of Hedgehog signaling pathway is implicated in its pathogenesis. Notably, Hedgehog signaling inhibitors, such as vismodegib and sonidegib, are successfully used as targeted treatment for advanced or metastatic BCC. Furthermore, the implementation of prevention measures has demonstrated to be useful in the patient management.
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Affiliation(s)
- Luca Fania
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
- Correspondence:
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps University, 35043 Marburg, Germany;
| | - Roberto Morese
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Irene Campana
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Valeria Coco
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Francesca Romana Di Pietro
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Francesca Ricci
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Sabatino Pallotta
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Eleonora Candi
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
- Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Damiano Abeni
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
| | - Elena Dellambra
- Istituto Dermopatico dell’Immacolata-IRCCS, via dei Monti di Creta 104, 00167 Rome, Italy; (R.M.); (I.C.); (V.C.); (F.R.D.P.); (F.R.); (S.P.); (E.C.); (D.A.); (E.D.)
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15
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Schneider H, Ahrens M, Strumpski M, Rüger C, Häfer M, Hüttmann G, Theisen-Kunde D, Schulz-Hildebrandt H, Haak R. An Intraoral OCT Probe to Enhanced Detection of Approximal Carious Lesions and Assessment of Restorations. J Clin Med 2020; 9:jcm9103257. [PMID: 33053724 PMCID: PMC7600310 DOI: 10.3390/jcm9103257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022] Open
Abstract
Caries, the world's most common chronic disease, remains a major cause of invasive restorative dental treatment. To take advantage of the diagnostic potential of optical coherence tomography (OCT) in contemporary dental prevention and treatment, an intraorally applicable spectral-domain OCT probe has been developed based on an OCT hand-held scanner equipped with a rigid 90°-optics endoscope. The probe was verified in vitro. In vivo, all tooth surfaces could be imaged with the OCT probe, except the vestibular surfaces of third molars and the proximal surface sections of molars within a "blind spot" at a distance greater than 2.5 mm from the tooth surface. Proximal surfaces of 64 posterior teeth of four volunteers were assessed by intraoral OCT, visual-tactile inspection, bitewing radiography and fiber-optic transillumination. The agreement in detecting healthy and carious surfaces varied greatly between OCT and established methods (18.2-94.7%), whereby the established methods could always be supplemented by OCT. Direct and indirect composite and ceramic restorations with inherent imperfections and failures of the tooth-restoration bond were imaged and qualitatively evaluated. The intraoral OCT probe proved to be a powerful technological approach for the non-invasive imaging of healthy and carious hard tooth tissues and gingiva as well as tooth-colored restorations.
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Affiliation(s)
- Hartmut Schneider
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (M.S.); (C.R.); (M.H.); (R.H.)
- Correspondence: ; Tel.: +49-341-97-212-63; Fax: +49-341-97-212-19
| | - Martin Ahrens
- Institut für Biomedizinische Optik, Universität zu Lübeck, 23562 Lübeck, Germany; (M.A.); (G.H.); (H.S.-H.)
- Medizinisches Laserzentrum Lübeck GmbH, 23562 Lübeck, Germany;
| | - Michaela Strumpski
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (M.S.); (C.R.); (M.H.); (R.H.)
| | - Claudia Rüger
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (M.S.); (C.R.); (M.H.); (R.H.)
| | - Matthias Häfer
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (M.S.); (C.R.); (M.H.); (R.H.)
| | - Gereon Hüttmann
- Institut für Biomedizinische Optik, Universität zu Lübeck, 23562 Lübeck, Germany; (M.A.); (G.H.); (H.S.-H.)
- Medizinisches Laserzentrum Lübeck GmbH, 23562 Lübeck, Germany;
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 23562 Lübeck, Germany
| | | | - Hinnerk Schulz-Hildebrandt
- Institut für Biomedizinische Optik, Universität zu Lübeck, 23562 Lübeck, Germany; (M.A.); (G.H.); (H.S.-H.)
- Medizinisches Laserzentrum Lübeck GmbH, 23562 Lübeck, Germany;
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 23562 Lübeck, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany; (M.S.); (C.R.); (M.H.); (R.H.)
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16
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Abstract
As a result of increasing melanoma incidence and challenges with clinical and histopathologic evaluation of pigmented lesions, noninvasive techniques to assist in the assessment of skin lesions are highly sought after. This review discusses the methods, benefits, and limitations of adhesive patch biopsy, electrical impedance spectroscopy (EIS), multispectral imaging, high-frequency ultrasonography (HFUS), optical coherence tomography (OCT), and reflectance confocal microscopy (RCM) in the detection of skin cancer. Adhesive patch biopsy provides improved sensitivity and specificity for the detection of melanoma without a trade-off of higher sensitivity for lower specificity seen in other diagnostic tools to aid in skin cancer detection, including EIS and multispectral imaging. EIS and multispectral imaging provide objective information based on computer-assisted diagnosis to assist in the decision to biopsy and/or excise an atypical melanocytic lesion. HFUS may be useful for the determination of skin tumor depth and identification of surgical borders, although further studies are necessary to determine its accuracy in the detection of skin cancer. OCT and RCM provide enhanced resolution of skin tissue and have been applied for improved accuracy in skin cancer diagnosis, as well as monitoring the response of nonsurgical treatments of skin cancers and the determination of tumor margins and recurrences. These novel approaches to skin cancer assessment offer opportunities to dermatologists, but are dependent on the individual dermatologist's comfort, knowledge, and desire to invest in training and implementation of noninvasive techniques. These noninvasive modalities may have a role in the complementary assessment of skin cancers, although histopathologic diagnosis remains the gold standard for the evaluation of skin cancer.
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17
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Sinx KAE, van Loo E, Tonk EHJ, Kelleners-Smeets NWJ, Winnepenninckx VJL, Nelemans PJ, Mosterd K. Optical Coherence Tomography for Noninvasive Diagnosis and Subtyping of Basal Cell Carcinoma: A Prospective Cohort Study. J Invest Dermatol 2020; 140:1962-1967. [PMID: 32147505 DOI: 10.1016/j.jid.2020.01.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023]
Abstract
Noninvasive diagnostic strategies such as optical coherence tomography (OCT) enable detailed examination of skin tissue architecture and have potential for identification and subtyping of basal cell carcinoma (BCC). To evaluate the additional diagnostic value of OCT, a prospective cohort study was performed in 182 patients with 250 lesions suspected for non-melanoma skin premalignancies requiring a biopsy. Accuracy of BCC diagnosis and subtype on the basis of clinical examination (CE) of patients was compared with that on the basis of OCT scans in conjunction with clinical images of lesions (cOCT). Confidence levels were recorded on a 5-point scale, where score 0 indicated absence of BCC and scores 1-4 indicated increasing suspicion of BCC. Diagnostic performance parameters were compared using histopathologic diagnosis as gold standard. The patient-based area under the receiver operating characteristic curve (AUC) increased from 85.6% for CE to 91.2% for cOCT (P = 0.061) and the lesion-based AUC from 82.7% to 91.3% (P < 0.001). When confidence scores 1-4 were defined as positive, patient-based specificity increased from 47.5% (CE alone) to 76.8% (cOCT) at similar sensitivity (97.6% and 95.2%, respectively). cOCT slightly improved the ability to discriminate between superficial and nonsuperficial BCC subtypes and seemed to be a valuable addition to CE alone in the diagnosis and subtyping of BCC.
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Affiliation(s)
- Kelly A E Sinx
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Eva van Loo
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Erwin H J Tonk
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | | | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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18
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Presurgical evaluation of basal cell carcinoma using combined reflectance confocal microscopy-optical coherence tomography: A prospective study. J Am Acad Dermatol 2019; 82:962-968. [PMID: 31634517 DOI: 10.1016/j.jaad.2019.10.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/11/2019] [Accepted: 10/02/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Initial biopsy of basal cell carcinoma (BCC) may fail to show aggressive histologic subtypes. Additionality, the clinical evaluation of BCC before surgery can miss subclinical extension. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) are emerging tools that can help in the presurgical evaluation of BCCs. OBJECTIVE To assess the feasibility of a combined RCM-OCT imaging modality for presurgical evaluation of biopsy-proven BCCs for residual tumor, margin status, and depth. METHODS Thirty-eight BCCs in 35 patients referred to a tertiary cancer center for Mohs micrographic surgery (MMS) were imaged with combined RCM-OCT. Images were correlated to MMS frozen sections. RESULTS Thirty-eight BCCs were analyzed. The mean age of patients was 67.34 years (range, 36-84 years), and 20 patients were female (57.14%). Twenty four BCCs were located on the head (63.16%) , and the mean size was 8.58 mm (range, 3-30 mm). RCM-OCT showed an overall agreement of 91.1% with MMS frozen sections. A sensitivity of 82.6% (95% confidence interval [CI], 69%-92%), specificity of 93.8% (95% CI, 88%-97%), and receiver operating characteristic curve of 0.88 (95% CI, 0.82-0.94) was found. OCT depth was highly correlated with MMS depth (r2 = 0.9). LIMITATIONS Small sample size and difficulty evaluating certain challenging anatomic sites. CONCLUSIONS Combined RCM-OCT may emerge as a useful tool for presurgical evaluation of BCCs.
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19
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20
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Sahu A, Yélamos O, Iftimia N, Cordova M, Alessi-Fox C, Gill M, Maguluri G, Dusza SW, Navarrete-Dechent C, González S, Rossi AM, Marghoob AA, Rajadhyaksha M, Chen CSJ. Evaluation of a Combined Reflectance Confocal Microscopy-Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma. JAMA Dermatol 2019; 154:1175-1183. [PMID: 30140851 DOI: 10.1001/jamadermatol.2018.2446] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Importance The limited tissue sampling of a biopsy can lead to an incomplete assessment of basal cell carcinoma (BCC) subtypes and depth. Reflectance confocal microscopy (RCM) combined with optical coherence tomography (OCT) imaging may enable real-time, noninvasive, comprehensive three-dimensional sampling in vivo, which may improve the diagnostic accuracy and margin assessment of BCCs. Objective To determine the accuracy of a combined RCM-OCT device for BCC detection and deep margin assessment. Design, Setting, and Participants This pilot study was carried out on 85 lesions from 55 patients referred for physician consultation or Mohs surgery at Memorial Sloan Kettering Skin Cancer Center in Hauppauge, New York. These patients were prospectively and consecutively enrolled in the study between January 1, 2017, and December 31, 2017. Patients underwent imaging, with the combined RCM-OCT probe, for previously biopsied, histopathologically confirmed BCCs and lesions clinically or dermoscopically suggestive of BCC. Only patients with available histopathologic examination after imaging were included. Main Outcomes and Measures Improvements in sensitivity, specificity, and diagnostic accuracy for BCC using the combined RCM-OCT probe as well as the correlation between OCT-estimated depth and histopathologically measured depth were investigated. Results In total, 85 lesions from 55 patients (27 [49%] were female and 28 [51%] were male with a median [range] age of 59 [21-90] years) were imaged. Imaging was performed on 25 previously biopsied and histopathologically confirmed BCCs and 60 previously nonbiopsied but clinically or dermoscopically suspicious lesions. Normal skin and BCC features were correlated and validated with histopathologic examination. In previously biopsied lesions, residual tumors were detected in 12 of 25 (48%) lesions with 100% sensitivity (95% CI, 73.5%-100%) and 23.1% specificity (95% CI, 5.0%-53.8%) for combined RCM-OCT probe. In previously nonbiopsied and suspicious lesions, BCCs were diagnosed in 48 of 60 (80%) lesions with 100% sensitivity (95% CI, 92.6%-100%) and 75% specificity (95% CI, 42.8%-94.5%). Correlation was observed between depth estimated with OCT and depth measured with histopathologic examination: the coefficient of determination (R2) was 0.75 (R = 0.86; P < .001) for all lesions, 0.73 (R = 0.85; P < .001) for lesions less than 500 μm deep, and 0.65 (R = 0.43; P < .001) for lesions greater than 500 μm deep. Conclusions and Relevance Combined RCM-OCT imaging may be prospectively used to comprehensively diagnose lesions suggestive of BCC and triage for treatment. Further validation of this device must be performed on a larger cohort.
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Affiliation(s)
- Aditi Sahu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oriol Yélamos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Nicusor Iftimia
- Biomedical Optics Technologies Group, Physical Sciences Inc, Andover, Massachusetts
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christi Alessi-Fox
- Clinical Development, Caliber Imaging and Diagnostics Inc, Rochester, New York
| | - Melissa Gill
- SkinMedical Research and Diagnostics, PLLC, Dobbs Ferry, New York.,Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Gopi Maguluri
- Biomedical Optics Technologies Group, Physical Sciences Inc, Andover, Massachusetts
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cristián Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Salvador González
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Medicine and Medical Specialties Department, Instituto Ramon y Cajal de Investigacion Sanitaria, Alcalá University, Madrid, Spain.,Department of Dermatology, Alcalá University, Madrid, Spain
| | - 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
| | - Milind Rajadhyaksha
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chih-Shan J Chen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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21
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Marghoob N, Psomadakis CE, Markowitz O. Noninvasive imaging to improve diagnostic accuracy: A case report. JAAD Case Rep 2019; 5:508-510. [PMID: 31205991 PMCID: PMC6558235 DOI: 10.1016/j.jdcr.2019.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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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22
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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] [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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23
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Cameron MC, Lee E, Hibler BP, Giordano CN, Barker CA, Mori S, Cordova M, Nehal KS, Rossi AM. Basal cell carcinoma: Contemporary approaches to diagnosis, treatment, and prevention. J Am Acad Dermatol 2019; 80:321-339. [PMID: 29782901 DOI: 10.1016/j.jaad.2018.02.083] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/12/2018] [Accepted: 02/17/2018] [Indexed: 12/21/2022]
Abstract
As the most common human cancer worldwide and continuing to increase in incidence, basal cell carcinoma is associated with significant morbidity and cost. Continued advances in research have refined both our insight and approach to this seemingly ubiquitous disease. This 2-part continuing medical education series provides a comprehensive and contemporary review of basal cell carcinoma. The second article in this series will present both the current standard of care and newly developed approaches to diagnosis, treatment, and prevention of this disease.
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Affiliation(s)
- Michael C Cameron
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian P Hibler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cerrene N Giordano
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shoko Mori
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- 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.
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24
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Evaluation of calculus imaging on root surfaces by spectral-domain optical coherence tomography. Photodiagnosis Photodyn Ther 2019; 25:275-279. [PMID: 30648636 DOI: 10.1016/j.pdpdt.2019.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/30/2018] [Accepted: 01/11/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this in vitro study was to evaluate the ability of optical coherence tomography (OCT) to display calculus on root surfaces. MATERIAL AND METHODS Ten teeth with calculus on the root surface were embedded in resin, omitting the root surface. A region of interest (ROI) was marked by small drill holes coronally and apically of the calculus and imaged by spectral-domain optical coherence tomography ([SD OCT], Telesto SP5, centre wavelength 1310 nm) and light microscopy (LM). To evaluate the impact of different fluids on calculus visualisation, using OCT, root surfaces were covered by a layer of NaCl and blood and displayed by OCT. Subsequently, teeth were completely covered with resin and sectioned for histological evaluation. Within the ROI, lengths of root surface and calculus were measured by LM and OCT, and the ratio [%] was calculated. In addition, at three sites of each ROI, agreement of presence and length of calculus was evaluated. Both methods were compared using Pearson's correlation. RESULTS Regarding the presence of calculus, agreement between LM and OCT was strong (κi = 0.783, p = 0.033), and measurements regarding the length of the calculus were strongly correlated (ri >0.906; pi <0.001). However, the values differed for dry (p = 0.023) and NaCl-covered root surfaces (p = 0.035). CONCLUSION Calculus on the root surface can be displayed by SD-OCT, which therefore may be suited as imaging technology for subgingival calculus in periodontal pockets.
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25
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Ferrante di Ruffano L, Dinnes J, Deeks JJ, Chuchu N, Bayliss SE, Davenport C, Takwoingi Y, Godfrey K, O'Sullivan C, Matin RN, Tehrani H, Williams HC. Optical coherence tomography for diagnosing skin cancer in adults. Cochrane Database Syst Rev 2018; 12:CD013189. [PMID: 30521690 PMCID: PMC6516952 DOI: 10.1002/14651858.cd013189] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers, which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Optical coherence tomography (OCT) is a microscopic imaging technique, which magnifies the surface of a skin lesion using near-infrared light. Used in conjunction with clinical or dermoscopic examination of suspected skin cancer, or both, OCT may offer additional diagnostic information compared to other technologies. OBJECTIVES To determine the diagnostic accuracy of OCT for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, basal cell carcinoma (BCC), or cutaneous squamous cell carcinoma (cSCC) in adults. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA We included studies of any design evaluating OCT in adults with lesions suspicious for invasive melanoma and atypical intraepidermal melanocytic variants, BCC or cSCC, compared with a reference standard of histological confirmation or clinical follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a standardised data extraction and quality assessment form (based on QUADAS-2). Our unit of analysis was lesions. Where possible, we estimated summary sensitivities and specificities using the bivariate hierarchical model. MAIN RESULTS We included five studies with 529 cutaneous lesions (282 malignant lesions) providing nine datasets for OCT, two for visual inspection alone, and two for visual inspection plus dermoscopy. Studies were of moderate to unclear quality, using data-driven thresholds for test positivity and giving poor accounts of reference standard interpretation and blinding. Studies may not have been representative of populations eligible for OCT in practice, for example due to high disease prevalence in study populations, and may not have reflected how OCT is used in practice, for example by using previously acquired OCT images.It was not possible to make summary statements regarding accuracy of detection of melanoma or of cSCC because of the paucity of studies, small sample sizes, and for melanoma differences in the OCT technologies used (high-definition versus conventional resolution OCT), and differences in the degree of testing performed prior to OCT (i.e. visual inspection alone or visual inspection plus dermoscopy).Pooled data from two studies using conventional swept-source OCT alongside visual inspection and dermoscopy for the detection of BCC estimated the sensitivity of OCT as 95% (95% confidence interval (CI) 91% to 97%) and specificity of 77% (95% CI 69% to 83%).When applied to a hypothetical population of 1000 lesions at the mean observed BCC prevalence of 60%, OCT would miss 31 BCCs (91 fewer than would be missed by visual inspection alone and 53 fewer than would be missed by visual inspection plus dermoscopy), and OCT would lead to 93 false-positive results for BCC (a reduction in unnecessary excisions of 159 compared to using visual inspection alone and of 87 compared to visual inspection plus dermoscopy). AUTHORS' CONCLUSIONS Insufficient data are available on the use of OCT for the detection of melanoma or cSCC. Initial data suggest conventional OCT may have a role for the diagnosis of BCC in clinically challenging lesions, with our meta-analysis showing a higher sensitivity and higher specificity when compared to visual inspection plus dermoscopy. However, the small number of studies and varying methodological quality means implications to guide practice cannot currently be drawn.Appropriately designed prospective comparative studies are required, given the paucity of data comparing OCT with dermoscopy and other similar diagnostic aids such as reflectance confocal microscopy.
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Affiliation(s)
| | - Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbaston CampusBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | | | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Hamid Tehrani
- Whiston HospitalDepartment of Plastic and Reconstructive SurgeryWarrington RoadLiverpoolUKL35 5DR
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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26
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Schneider SL, Kohli I, Hamzavi IH, Council ML, Rossi AM, Ozog DM. Emerging imaging technologies in dermatology: Part II: Applications and limitations. J Am Acad Dermatol 2018; 80:1121-1131. [PMID: 30528310 DOI: 10.1016/j.jaad.2018.11.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022]
Abstract
Clinical examination is critical for the diagnosis and identification of response to treatment. It is fortunate that technologies are continuing to evolve, enabling augmentation of classical clinical examination with noninvasive imaging modalities. This article discusses emerging technologies with a focus on digital photographic imaging, confocal microscopy, optical coherence tomography, and high-frequency ultrasound, as well as several additional developing modalities. The most readily adopted technologies to date include total-body digital photography and dermoscopy, with some practitioners beginning to use confocal microscopy. In this article, applications and limitations are addressed. For a detailed discussion of the principles involved in these technologies, please refer to the first part of this review article.
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Affiliation(s)
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - M Laurin Council
- Division of Dermatology, Washington University, St. Louis, Missouri
| | - Anthony M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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27
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Usefulness of dermoscopy to improve the clinical and histopathologic diagnosis of skin cancers. J Am Acad Dermatol 2018; 80:365-377. [PMID: 30321580 DOI: 10.1016/j.jaad.2018.07.072] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/01/2018] [Accepted: 07/04/2018] [Indexed: 01/03/2023]
Abstract
Multiple studies have shown that dermoscopy increases the sensitivity and specificity for the detection of skin cancers compared with examination by the naked eye. Dermoscopy can also lead to the detection of thinner and smaller cancers. In addition, dermoscopy leads to the more precise selection of lesions requiring excision. In essence, dermoscopy helps clinicians differentiate benign from malignant lesions through the presence or absence of specific dermoscopic structures. Therefore, because most dermoscopic structures have direct histopathologic correlates, dermoscopy can allow the prediction of certain histologic findings present in skin cancers, thus helping select management and treatment options for select types of skin cancers. Visualizing dermoscopic structures in the ex vivo specimens can also be beneficial. It can improve the histologic diagnostic accuracy by targeted step-sectioning in areas of concern, which can be marked by the clinician before sending the specimen to the pathologist, or by the pathologist on the excised specimen in the laboratory. In addition, ex vivo dermoscopy can also be used to select tumor areas with genetic importance because some dermoscopic structures have been related to mutations with theragnostic relevance. In the second article in this continuing medical education series, we review the impact of dermoscopy on the diagnostic accuracy of skin cancer, how dermoscopy can affect the histopathologic examination, and which dermoscopic features may be more relevant in terms of histologic and genetic prediction.
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28
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Corneli P, Zalaudek I, Magaton Rizzi G, di Meo N. Improving the early diagnosis of early nodular melanoma: can we do better? Expert Rev Anticancer Ther 2018; 18:1007-1012. [DOI: 10.1080/14737140.2018.1507822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Paola Corneli
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | | | - Nicola di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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29
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Halani S, Foster FS, Breslavets M, Shear NH. Ultrasound and Infrared-Based Imaging Modalities for Diagnosis and Management of Cutaneous Diseases. Front Med (Lausanne) 2018; 5:115. [PMID: 29922650 PMCID: PMC5996893 DOI: 10.3389/fmed.2018.00115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/06/2018] [Indexed: 12/16/2022] Open
Abstract
Non-invasive bedside imaging tools are becoming more prevalent for assessing cutaneous lesions. Ultrasound used at specific frequencies allows us to assess margins of lesions to minimize the extent of the biopsy that is performed and improve cosmetic outcomes. Vascularity, seen on Doppler ultrasound and contrast-enhanced ultrasound, and stiffness, assessed on tissue elastography, can help differentiate between benign and malignant lesions for clinicians to be more judicious in deciding whether to biopsy. Moreover, research has shown the efficacy in using ultrasound in monitoring flares of hidradenitis suppurativa, a disease affecting apocrine gland-rich areas of the body, for which the current gold standard involves examining and scoring inflammatory lesions with the naked eye. Infrared-based modalities have also been on the uptrend to aid in clinical decision-making regarding suspiciousness of lesions. Reflectance confocal microscopy has lateral resolution that is comparable to histopathology and it has been shown to be an appropriate adjunctive tool to dermoscopy, specifically when evaluating melanomas. Optical coherence tomography has utility in determining lesion thickness because of its depth penetration, and spectrophotometric intracutaneous analysis is becoming more popular as a tool that can be used by general practitioners to know when to refer to dermatology regarding worrisome pigmented lesions. Strides have been made to incorporate electrical impedance spectroscopy alongside dermoscopy in decision-making regarding excision, although the evidence for its use in the clincial setting remains inconclusive. This paper reviews the efficacy and drawbacks of these techniques in the field of dermatology and suggests future directions.
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Affiliation(s)
- Sheliza Halani
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - F Stuart Foster
- Medical Biophysics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Neil H Shear
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dermatology, University of Toronto, Toronto, ON, Canada
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30
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Holmes J, von Braunmühl T, Berking C, Sattler E, Ulrich M, Reinhold U, Kurzen H, Dirschka T, Kellner C, Schuh S, Welzel J. Optical coherence tomography of basal cell carcinoma: influence of location, subtype, observer variability and image quality on diagnostic performance. Br J Dermatol 2018; 178:1102-1110. [DOI: 10.1111/bjd.16154] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/27/2022]
Affiliation(s)
- J. Holmes
- Michelson Diagnostics Ltd; Maidstone Kent U.K
| | - T. von Braunmühl
- University Hospital Munich; Department of Dermatology; Munich Germany
| | - C. Berking
- University Hospital Munich; Department of Dermatology; Munich Germany
| | - E. Sattler
- University Hospital Munich; Department of Dermatology; Munich Germany
| | - M. Ulrich
- Private Dermatology Office/CMB Collegium Medicum Berlin GmbH; Berlin Germany
| | - U. Reinhold
- Dermatology Center Bonn Friedensplatz; Bonn Germany
| | - H. Kurzen
- Private Dermatology Office; Freising Germany
| | - T. Dirschka
- Private Dermatology Office; Wuppertal Germany
| | - C. Kellner
- St Bernard-Hospital; Kamp Lintfort Germany
| | - S. Schuh
- General Hospital Augsburg; Department of Dermatology and Allergology; Augsburg Germany
| | - J. Welzel
- General Hospital Augsburg; Department of Dermatology and Allergology; Augsburg Germany
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31
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Xiong YQ, Mo Y, Wen YQ, Cheng MJ, Huo ST, Chen XJ, Chen Q. Optical coherence tomography for the diagnosis of malignant skin tumors: a meta-analysis. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-10. [PMID: 29473350 DOI: 10.1117/1.jbo.23.2.020902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/29/2018] [Indexed: 05/18/2023]
Abstract
Optical coherence tomography (OCT) is an emergent imaging tool used for noninvasive diagnosis of skin diseases. The present meta-analysis was carried out to assess the accuracy of OCT for the diagnosis of skin cancer. We conducted a systematic literature search though EMBASE, Medline, PubMed, the Cochrane Library, and Web of Science database for relevant articles published up to June 6, 2017. The quality of the included studies was assessed using the QUADAS-2 tool and the Oxford Levels of Evidence Scale. Statistical analyses were conducted using the software Meta-Disc version 1.4 and STATA version 12.0. A total of 14 studies involving more than 813 patients with a total of 1958 lesions were included in our analyses. The pooled sensitivity and specificity of OCT for skin cancer diagnoses were 91.8% and 86.7%, respectively. Subgroup analysis showed that the pooled sensitivities of OCT for detecting basal cell carcinoma (BCC), squamous cell carcinoma (SCC), actinic keratosis, and malignant melanoma were 92.4%, 92.3%, 73.8%, and 81.0%, respectively. The pooled specificities were 86.9%, 99.5%, 91.5%, and 93.8%, respectively. OCT appears to be useful for the detection of BCC and SCC. It is a valuable diagnostic method when screening for early skin cancers.
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Affiliation(s)
- Yi-Quan Xiong
- Southern Medical University, School of Public Health, Guangdong Provincial Key Laboratory of Tropica, China
| | - Yun Mo
- Southern Medical University, School of Public Health, Guangdong Provincial Key Laboratory of Tropica, China
| | - Yu-Qi Wen
- Southern Medical University, School of Public Health, Guangdong Provincial Key Laboratory of Tropica, China
| | - Ming-Ji Cheng
- Southern Medical University, School of Public Health, Guangdong Provincial Key Laboratory of Tropica, China
| | - Shu-Ting Huo
- Southern Medical University, School of Public Health, Guangdong Provincial Key Laboratory of Tropica, China
| | - Xue-Jiao Chen
- Southern Medical University, School of Public Health, Guangdong Provincial Key Laboratory of Tropica, China
| | - Qing Chen
- Southern Medical University, School of Public Health, Guangdong Provincial Key Laboratory of Tropica, China
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32
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Themstrup L, De Carvalho N, Nielsen SM, Olsen J, Ciardo S, Schuh S, Nørnberg BMH, Welzel J, Ulrich M, Pellacani G, Jemec GBE. In vivo differentiation of common basal cell carcinoma subtypes by microvascular and structural imaging using dynamic optical coherence tomography. Exp Dermatol 2018; 27:156-165. [DOI: 10.1111/exd.13479] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Lotte Themstrup
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | | | - Sabrina M. Nielsen
- Musculoskeletal Statistics Unit; The Parker Institute; Bispebjerg and Frederiksberg Hospital; Frederiksberg Copenhagen Denmark
| | - Jonas Olsen
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Silvana Ciardo
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - Sandra Schuh
- Department of Dermatology and Allergology; General Hospital Augsburg; Augsburg Germany
| | | | - Julia Welzel
- Department of Dermatology and Allergology; General Hospital Augsburg; Augsburg Germany
| | | | - Giovanni Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - Gregor B. E. Jemec
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
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33
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34
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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] [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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35
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Iftimia N, Yélamos O, Chen CSJ, Maguluri G, Cordova MA, Sahu A, Park J, Fox W, Alessi-Fox C, Rajadhyaksha M. Handheld optical coherence tomography-reflectance confocal microscopy probe for detection of basal cell carcinoma and delineation of margins. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:76006. [PMID: 28697233 PMCID: PMC5995139 DOI: 10.1117/1.jbo.22.7.076006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/20/2017] [Indexed: 05/22/2023]
Abstract
We present a hand-held implementation and preliminary evaluation of a combined optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) probe for detecting and delineating the margins of basal cell carcinomas (BCCs) in human skin <italic<in vivo</italic<. A standard OCT approach (spectrometer-based) with a central wavelength of 1310 nm and 0.11 numerical aperture (NA) was combined with a standard RCM approach (830-nm wavelength and 0.9 NA) into a common path hand-held probe. Cross-sectional OCT images and enface RCM images are simultaneously displayed, allowing for three-dimensional microscopic assessment of tumor morphology in real time. Depending on the subtype and depth of the BCC tumor and surrounding skin conditions, OCT and RCM imaging are able to complement each other, the strengths of each helping overcome the limitations of the other. Four representative cases are summarized, out of the 15 investigated in a preliminary pilot study, demonstrating how OCT and RCM imaging may be synergistically combined to more accurately detect BCCs and more completely delineate margins. Our preliminary results highlight the potential benefits of combining the two technologies within a single probe to potentially guide diagnosis as well as treatment of BCCs.
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Affiliation(s)
- Nicusor Iftimia
- Physical Sciences, Inc., Andover, Massachusetts, United States
- Address all correspondence to: Nicusor Iftimia, E-mail:
| | - Oriol Yélamos
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
- Universitat de Barcelona, Dermatology Department, Hospital Clínic, Barcelona, Spain
| | - Chih-Shan J. Chen
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
| | - Gopi Maguluri
- Physical Sciences, Inc., Andover, Massachusetts, United States
| | - Miguel A. Cordova
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
| | - Aditi Sahu
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
| | - Jesung Park
- Physical Sciences, Inc., Andover, Massachusetts, United States
| | - William Fox
- Caliber I.D., Rochester, New York, United States
| | | | - Milind Rajadhyaksha
- Memorial Sloan Kettering Cancer Center, Dermatology Service, Department of Medicine, New York, United States
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36
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Maher NG, Blumetti TP, Gomes EE, Cheng HM, Satgunaseelan L, Lo S, Rezze GG, Scolyer RA, Guitera P. Melanoma diagnosis may be a pitfall for optical coherence tomography assessment of equivocal amelanotic or hypomelanotic skin lesions. Br J Dermatol 2017; 177:574-577. [DOI: 10.1111/bjd.15187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- N G Maher
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - T P Blumetti
- AC Camargo Cancer Center, Cutaneous Oncology Department, São Paulo, Brazil
| | - E E Gomes
- AC Camargo Cancer Center, Cutaneous Oncology Department, São Paulo, Brazil
| | - H M Cheng
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - L Satgunaseelan
- Melanoma Institute Australia, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Sydney, Australia
| | - S Lo
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - G G Rezze
- AC Camargo Cancer Center, Cutaneous Oncology Department, São Paulo, Brazil
| | - R A Scolyer
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Sydney, Australia
| | - P Guitera
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
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37
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Dental Applications of Optical Coherence Tomography (OCT) in Cariology. APPLIED SCIENCES-BASEL 2017. [DOI: 10.3390/app7050472] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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38
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Ulrich M. Optical coherence tomography for diagnosis of basal cell carcinoma: essentials and perspectives. Br J Dermatol 2016; 175:1145-1146. [DOI: 10.1111/bjd.15137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M. Ulrich
- Dermatology Office/CMB Collegum Medicum Berlin GmbH; Luisenstrasse 54/55 10117 Berlin Germany
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39
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Diagnostic accuracy of optical coherence tomography in actinic keratosis and basal cell carcinoma. Photodiagnosis Photodyn Ther 2016; 16:44-49. [DOI: 10.1016/j.pdpdt.2016.08.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/13/2016] [Accepted: 08/08/2016] [Indexed: 12/16/2022]
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40
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Rajadhyaksha M, Marghoob A, Rossi A, Halpern AC, Nehal KS. Reflectance confocal microscopy of skin in vivo: From bench to bedside. Lasers Surg Med 2016; 49:7-19. [PMID: 27785781 DOI: 10.1002/lsm.22600] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 12/24/2022]
Abstract
Following more than two decades of effort, reflectance confocal microscopy (RCM) imaging of skin was granted codes for reimbursement by the US Centers for Medicare and Medicaid Services. Dermatologists in the USA have started billing and receiving reimbursement for the imaging procedure and for the reading and interpretation of images. RCM imaging combined with dermoscopic examination is guiding the triage of lesions into those that appear benign, which are being spared from biopsy, against those that appear suspicious, which are then biopsied. Thus far, a few thousand patients have been spared from biopsy of benign lesions. The journey of RCM imaging from bench to bedside is certainly a success story, but still much more work lies ahead toward wider dissemination, acceptance, and adoption. We present a brief review of RCM imaging and highlight key challenges and opportunities. The success of RCM imaging paves the way for other emerging optical technologies, as well-and our bet for the future is on multimodal approaches. Lasers Surg. Med. 49:7-19, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Milind Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allan C Halpern
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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