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Thamm JR, Welzel J, Schuh S. Diagnosis and therapy of actinic keratosis. J Dtsch Dermatol Ges 2024. [PMID: 38456369 DOI: 10.1111/ddg.15288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/28/2023] [Indexed: 03/09/2024]
Abstract
Actinic keratosis (AK) is considered a chronic and recurring in situ skin neoplasia, with a possible transformation into invasive squamous cell carcinoma (SCC). Among others, predominant risk factors for development of AK are UV-light exposure and immunosuppression. Basal epidermal keratinocyte atypia (AK I) and proliferation (PRO score) seem to drive malignant transformation, rather than clinical appearance of AK (Olsen I-III). Due to the invasiveness of punch biopsy, those histological criteria are not regularly assessed. Non-invasive imaging techniques, such as optical coherence tomography (OCT), reflectance confocal microscopy (RCM) and line-field confocal OCT (LC-OCT) are helpful to distinguish complex cases of AK, Bowen's disease, and SCC. Moreover, LC-OCT can visualize the epidermis and the papillary dermis at cellular resolution, allowing real-time PRO score assessment. The decision-making for implementation of therapy is still based on clinical risk factors, ranging from lesion- to field-targeted and ablative to non-ablative regimens, but in approximately 85% of the cases a recurrence of AK can be observed after a 1-year follow-up. The possible beneficial use of imaging techniques for a non-invasive follow-up of AK to detect recurrence or invasive progression early on should be subject to critical evaluation in further studies.
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Affiliation(s)
- Janis Raphael Thamm
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Schuh
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
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Jacobsen K, Wenande E, Ortner VK, Schmidt G, Haedersdal M. Operationsplanung mit Line‐Field optischer konfokaler Kohärenztomographie bei rezidivierendem infiltrativem Basalzellkarzinom: Visualisierung des subklinischen Tumors zur Anpassung der Ränder. J Dtsch Dermatol Ges 2024; 22:462-465. [PMID: 38450967 DOI: 10.1111/ddg.15330_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/14/2023] [Indexed: 03/08/2024]
Affiliation(s)
- Kevin Jacobsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Emily Wenande
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Jacobsen K, Wenande E, Ortner VK, Schmidt G, Haedersdal M. Surgical planning with line-field confocal optical coherence tomography for recurrent infiltrative basal cell carcinoma: visualizing subclinical tumor for margin adjustment. J Dtsch Dermatol Ges 2024; 22:462-465. [PMID: 38396266 DOI: 10.1111/ddg.15330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/14/2023] [Indexed: 02/25/2024]
Affiliation(s)
- Kevin Jacobsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Emily Wenande
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Grethe Schmidt
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Palmisano G, Cappilli S, Lugli AP, Di Stefani A, Peris K. Solitary cutaneous focal mucinosis: In-vivo line-field confocal optical coherence tomography (LC-OCT) features correlate to histopathology. Int J Dermatol 2024. [PMID: 38419358 DOI: 10.1111/ijd.17118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Gerardo Palmisano
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simone Cappilli
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna P Lugli
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Di Stefani
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A, Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Verzì AE, Russo A, Castellino N, Caltabiano R, Fallico M, Cappellani F, Micali G, Lacarrubba F. Line-field confocal optical coherence tomography of eyelid margin growths: A case series. Skin Res Technol 2024; 30:e13559. [PMID: 38174775 PMCID: PMC10765353 DOI: 10.1111/srt.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The clinical differential diagnosis of lesions arising on the eyelid margin may be challenging and an unneeded surgical approach may have serious functional and aesthetic consequences. Nonetheless, early recognition and treatment of malignant tumors of the eyelid margin is mandatory. Line-field confocal optical coherence tomography (LC-OCT) is a novel tool for the in vivo, real-time skin imaging. OBJECTIVES The aim of the study was to identify and analyze the LC-OCT features of a series of eyelid margin growths and to correlate these features with the histopathological findings. METHODS Patients with eyelid margin growths who were scheduled for lesion excision underwent LC-OCT examination. Inclusion criteria were a challenging clinical aspect of the lesions and a clinical history of recent onset (up to 12 months). In all cases, the histopathological examination of the excised lesions was performed for the final diagnosis. RESULTS A total of 31 lesions located on the upper (13 cases) or lower (18 cases) eyelid margin from 28 consecutive patients (male = 15, female = 13; mean age: 64.7 years, range: 44-87 years) were evaluated and excised. The histopathologic diagnoses were nodular basal cell carcinoma (BCC) (nine cases), squamous cell carcinoma (SCC) (three cases), compound nevus (four cases), dermal nevus (two cases), seborrheic keratosis (four cases), pyogenic granuloma (one case), trichilemmal cyst (three cases), and hidrocystoma (five cases). LC-OCT allowed the in vivo recognition of the main microscopic features of the examined lesions. CONCLUSIONS LC-OCT represents a promising tool for the evaluation of eyelid margin lesions. Advantages of non-invasive diagnosis particularly relevant in such a sensitive region include a more correct planning of the treatment and, in case of surgery, the most appropriate surgical approach and, importantly, a correct timing of intervention.
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Affiliation(s)
| | - Andrea Russo
- Department of OphthalmologyUniversity of CataniaCataniaItaly
| | | | - Rosario Caltabiano
- Department of MedicalSurgical Sciences and Advanced Technologies “G.F. Ingrassia”, Anatomic PathologyUniversity of CataniaCataniaItaly
| | - Matteo Fallico
- Department of OphthalmologyUniversity of CataniaCataniaItaly
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Orte Cano C, Suppa M, del Marmol V. Where Artificial Intelligence Can Take Us in the Management and Understanding of Cancerization Fields. Cancers (Basel) 2023; 15:5264. [PMID: 37958437 PMCID: PMC10649750 DOI: 10.3390/cancers15215264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/15/2023] Open
Abstract
Squamous cell carcinoma and its precursor lesion actinic keratosis are often found together in areas of skin chronically exposed to sun, otherwise called cancerisation fields. The clinical assessment of cancerisation fields and the correct diagnosis of lesions within these fields is usually challenging for dermatologists. The recent adoption of skin cancer diagnostic imaging techniques, particularly LC-OCT, helps clinicians in guiding treatment decisions of cancerization fields in a non-invasive way. The combination of artificial intelligence and non-invasive skin imaging opens up many possibilities as AI can perform tasks impossible for humans in a reasonable amount of time. In this text we review past examples of the application of AI to dermatological images for actinic keratosis/squamous cell carcinoma diagnosis, and we discuss about the prospects of the application of AI for the characterization and management of cancerization fields.
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Affiliation(s)
- Carmen Orte Cano
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Groupe d’Imagerie Cutanée Non Invasive (GICNI), Société Française de Dermatologie (SFD), 75008 Paris, France
| | - Véronique del Marmol
- Department of Dermatology, Hôpital Erasme, HUB, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium
- Department of Dermato-Oncology, Institut Jules Bordet, HUB, Université Libre de Bruxelles, 1070 Brussels, Belgium
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Affiliation(s)
- Thu M. Truong
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Gaurav N. Pathak
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Babar K. Rao
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Dermatology, Weill Cornell Medicine, New York, New York
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Affiliation(s)
- Gaurav N. Pathak
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Thu M. Truong
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Babar K. Rao
- Rao Dermatology, Atlantic Highlands, New Jersey
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
- Department of Dermatology, Weill Cornell Medicine, New York, New York
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Zaytsev SM, Amouroux M, Tuchin VV, Genina EA, Blondel W. In vivo skin optical clearing efficacy quantification of clinically compatible agents using line-field confocal optical coherence tomography. J Biomed Opt 2023; 28:055002. [PMID: 37250859 PMCID: PMC10224698 DOI: 10.1117/1.jbo.28.5.055002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/27/2023] [Indexed: 05/31/2023]
Abstract
Significance The clinical use of optical methods for in vivo skin imaging is limited by skin strong scattering properties, which reduce image contrast and probing depth. The efficiency of optical methods can be improved by optical clearing (OC). However, for the use of OC agents (OCAs) in a clinical setting, compliance with acceptable non-toxic concentrations is required. Aim OC of in vivo human skin, combined with physical and chemical methods to enhance skin permeability to OCAs, was performed to determine the clearing-effectiveness of biocompatible OCAs using line-field confocal optical coherence tomography (LC-OCT) imaging. Approach Nine types of OCAs mixtures were used in association with dermabrasion and sonophoresis for OC protocol on three volunteers hand skin. From 3D images obtained every 5 min for 40 min, the intensity and contrast parameters were extracted to assess their changes during the clearing process and evaluate each OCAs mixture's clearing efficacy. Results The LC-OCT images average intensity and contrast increased over the entire skin depth with all OCAs. The best image contrast and intensity improvement was observed using the polyethylene glycol, oleic acid, and propylene glycol mixture. Conclusions Complex OCAs featuring reduced component concentrations that meet drug regulation-established biocompatibility requirements were developed and proved to induce significant skin tissues clearing. By allowing deeper observations and higher contrast, such OCAs in combination with physical and chemical permeation enhancers may improve LC-OCT diagnostic efficacy.
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Affiliation(s)
- Sergey M. Zaytsev
- Université de Lorraine, CNRS, CRAN UMR 7039, Vandoeuvre-lès-Nancy, France
- Saratov State University, Science Medical Center and Institute of Physics, Saratov, Russia
| | - Marine Amouroux
- Université de Lorraine, CNRS, CRAN UMR 7039, Vandoeuvre-lès-Nancy, France
| | - Valery V. Tuchin
- Saratov State University, Science Medical Center and Institute of Physics, Saratov, Russia
- Tomsk State University, Laboratory of Laser Molecular Imaging and Machine Learning, Tomsk, Russia
- Institute of Precision Mechanics and Control, FRC “Saratov Scientific Centre of the Russian Academy of Sciences,” Saratov, Russia
| | - Elina A. Genina
- Saratov State University, Science Medical Center and Institute of Physics, Saratov, Russia
- Tomsk State University, Laboratory of Laser Molecular Imaging and Machine Learning, Tomsk, Russia
| | - Walter Blondel
- Université de Lorraine, CNRS, CRAN UMR 7039, Vandoeuvre-lès-Nancy, France
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Verzì AE, Broggi G, Caltabiano R, Micali G, Lacarrubba F. Line-field confocal optical coherence tomography of lentigo maligna with horizontal and vertical histopathologic correlations. J Cutan Pathol 2023; 50:118-122. [PMID: 36056910 PMCID: PMC10087826 DOI: 10.1111/cup.14321] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/26/2022] [Accepted: 08/28/2022] [Indexed: 01/24/2023]
Abstract
Lentigo maligna (LM) is a subtype of in situ melanoma that classically presents in elderly patients as a slowly growing lesion on sun-exposed areas that may evolve to invasive melanoma. Line-field confocal optical coherence tomography (LC-OCT) is a new non-invasive technique for a real-time, vertical, and horizontal skin imaging with high resolution close to conventional histopathology. We present the LC-OCT features of an LM of the nose in a 49-year-old white man along with their horizontal and vertical histopathological correlations. LC-OCT was able to detect in vivo, in both horizontal and vertical imaging, the main microscopic features typical of LM by showing, in the epidermis and around the hair follicles, the presence of large, bright roundish, or dendritic atypical cells, with evident nuclei, corresponding to atypical melanocytes with a tendency toward folliculotropism. A strong correspondence between LC-OCT images and vertical and horizontal histopathological sections was observed. Our study, although limited to a single case, is indicative of the great potential of LC-OCT to improve the non-invasive diagnosis of LM.
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Affiliation(s)
| | - Giuseppe Broggi
- Department "G.F. Ingrassia," Section of Anatomic Pathology, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department "G.F. Ingrassia," Section of Anatomic Pathology, University of Catania, Catania, Italy
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Olesen UH, Jacobsen K, Lerche CM, Haedersdal M. Repeated exposure to fractional CO 2 laser delays squamous cell carcinoma formation and prevents clinical and subclinical photodamage visualized by line-field confocal optical coherence tomography and histology. Lasers Surg Med 2023; 55:73-81. [PMID: 36229986 PMCID: PMC10092156 DOI: 10.1002/lsm.23613] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Ablative fractional laser (AFL) is a well-established modality for treating ultraviolet radiation (UVR)-induced skin photodamage. We aimed to investigate the potential of AFL to delay squamous cell carcinoma (SCC) formation and prevent photodamage in a preclinical UVR-induced SCC model. MATERIALS AND METHODS Hairless C3.Cg-Hrhr /TifBomTac mice (n = 50) were exposed to UVR three times weekly throughout the study. UV-exposed mice were randomized to two groups that received dorsal CO2 AFL (10 mJ/mb, 10% density) or no treatment. AFL was performed every other week for a total of 16 weeks (nine treatments in total). The primary outcome was time to tumor occurrence. In a subset of mice on Day 150, prevention of clinical photodamage was assessed by examination of skin tightness and dyspigmentation. Concomitantly, assessment of subclinical photoprevention based on normalization of keratinocyte dysplasia, dermo-fiber morphology (collagen and elastin fibers), and skin thickness, was performed using line-field confocal optical coherence tomography (LC-OCT) and histology. RESULTS Repeated AFL treatments delayed SCC tumor development compared to UVR control mice by 12, 19, and 30 days for first, second, and third tumors, respectively (p ≤ 0.0017). Compared to UVR controls, AFL prevented photodamage both clinically and subclinically, based on LC-OCT and histology. In the epidermal layer, AFL imparted photopreventative effects including reduced dyspigmentation and keratinocyte dysplasia (1 vs. 2.5, p = 0.0079) and partial normalization of the epidermal thickness (p < 0.0001). In the dermis, AFL led to twofold greater skin tightness (p = 0.0079), improved dermo-fiber structure, and dermal thickness (p = 0.0011). CONCLUSION In conclusion, repeated AFL treatments of UVR-exposed skin significantly delayed SCC tumor formation and prevented clinical and imaging-assessed subclinical signs of photodamage, indicating a potential for AFL in prevention strategies for SCC and photodamage in high-risk populations.
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Affiliation(s)
- Uffe H. Olesen
- Department of DermatologyCopenhagen University Hospital—BispebjergCopenhagenDenmark
| | - Kevin Jacobsen
- Department of DermatologyCopenhagen University Hospital—BispebjergCopenhagenDenmark
| | - Catharina M. Lerche
- Department of DermatologyCopenhagen University Hospital—BispebjergCopenhagenDenmark
- Department of PharmacyUniversity of CopenhagenCopenhagenDenmark
| | - Merete Haedersdal
- Department of DermatologyCopenhagen University Hospital—BispebjergCopenhagenDenmark
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Breugnot J, Rouaud-Tinguely P, Gilardeau S, Rondeau D, Bordes S, Aymard E, Closs B. Utilizing deep learning for dermal matrix quality assessment on in vivo line-field confocal optical coherence tomography images. Skin Res Technol 2023; 29:e13221. [PMID: 36366860 PMCID: PMC9838780 DOI: 10.1111/srt.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Line-field confocal optical coherence tomography (LC-OCT) is an imaging technique providing non-invasive "optical biopsies" with an isotropic spatial resolution of ∼1 μm and deep penetration until the dermis. Analysis of obtained images is classically performed by experts, thus requiring long and fastidious training and giving operator-dependent results. In this study, the objective was to develop a new automated method to score the quality of the dermal matrix precisely, quickly, and directly from in vivo LC-OCT images. Once validated, this new automated method was applied to assess photo-aging-related changes in the quality of the dermal matrix. MATERIALS AND METHODS LC-OCT measurements were conducted on the face of 57 healthy Caucasian volunteers. The quality of the dermal matrix was scored by experts trained to evaluate the fibers' state according to four grades. In parallel, these images were used to develop the deep learning model by adapting a MobileNetv3-Small architecture. Once validated, this model was applied to the study of dermal matrix changes on a panel of 36 healthy Caucasian females, divided into three groups according to their age and photo-exposition. RESULTS The deep learning model was trained and tested on a set of 15 993 images. Calculated on the test data set, the accuracy score was 0.83. As expected, when applied to different volunteer groups, the model shows greater and deeper alteration of the dermal matrix for old and photoexposed subjects. CONCLUSIONS In conclusion, we have developed a new method that automatically scores the quality of the dermal matrix on in vivo LC-OCT images. This accurate model could be used for further investigations, both in the dermatological and cosmetic fields.
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Schuh S, Ruini C, Perwein MKE, Daxenberger F, Gust C, Sattler EC, Welzel J. Line-Field Confocal Optical Coherence Tomography: A New Tool for the Differentiation between Nevi and Melanomas? Cancers (Basel) 2022; 14:1140. [PMID: 35267448 DOI: 10.3390/cancers14051140] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023] Open
Abstract
Until now, the clinical differentiation between a nevus and a melanoma is still challenging in some cases. Line-field confocal optical coherence tomography (LC-OCT) is a new tool with the aim to change that. The aim of the study was to evaluate LC-OCT for the discrimination between nevi and melanomas. A total of 84 melanocytic lesions were examined with LC-OCT and 36 were also imaged with RCM. The observers recorded the diagnoses, and the presence or absence of the 18 most common imaging parameters for melanocytic lesions, nevi, and melanomas in the LC-OCT images. Their confidence in diagnosis and the image quality of LC-OCT and RCM were evaluated. The most useful criteria, the sensitivity and specificity of LC-OCT vs. RCM vs. histology, to differentiate a (dysplastic) nevus from a melanoma were analyzed. Good image quality correlated with better diagnostic performance (Spearman correlation: 0.4). LC-OCT had a 93% sensitivity and 100% specificity compared to RCM (93% sensitivity, 95% specificity) for diagnosing a melanoma (vs. all types of nevi). No difference in performance between RCM and LC-OCT was observed (McNemar's p value = 1). Both devices falsely diagnosed dysplastic nevi as non-dysplastic (43% sensitivity for dysplastic nevus diagnosis). The most significant criteria for diagnosing a melanoma with LC-OCT were irregular honeycombed patterns (92% occurrence rate; 31.7 odds ratio (OR)), the presence of pagetoid spread (89% occurrence rate; 23.6 OR) and the absence of dermal nests (23% occurrence rate, 0.02 OR). In conclusion LC-OCT is useful for the discrimination between melanomas and nevi.
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Gust C, Schuh S, Welzel J, Daxenberger F, Hartmann D, French LE, Ruini C, Sattler EC. Line-Field Confocal Optical Coherence Tomography Increases the Diagnostic Accuracy and Confidence for Basal Cell Carcinoma in Equivocal Lesions: A Prospective Study. Cancers (Basel) 2022; 14:cancers14041082. [PMID: 35205830 PMCID: PMC8870684 DOI: 10.3390/cancers14041082] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 12/05/2022] Open
Abstract
Simple Summary Basal cell carcinoma is the most frequently occurring type of skin cancer. Its treatment can be either local or surgical depending on its subtype and extension, with early recognized and superficial cases being easier to treat. Some of them, however, display unspecific features, making diagnosis difficult. Non-invasive devices such as line-field confocal optical coherence tomography (LC-OCT) are able to recognize morphological features of different BCC subtypes with a good correlation to histopathology. We decided to study their application to clinically doubtful BCC cases. Abstract Diagnosing clinically unclear basal cell carcinomas (BCCs) can be challenging. Line-field confocal optical coherence tomography (LC-OCT) is able to display morphological features of BCC subtypes with good histological correlation. The aim of this study was to investigate the accuracy of LC-OCT in diagnosing clinically unsure cases of BCC compared to dermoscopy alone and in distinguishing between superficial BCCs and other BCC subtypes. Moreover, we addressed pitfalls in false positive cases. We prospectively enrolled 182 lesions of 154 patients, referred to our department to confirm or to rule out the diagnosis of BCC. Dermoscopy and LC-OCT images were evaluated by two experts independently. Image quality, LC-OCT patterns and criteria, diagnosis, BCC subtype, and diagnostic confidence were assessed. Sensitivity and specificity of additional LC-OCT were compared to dermoscopy alone for identifying BCC in clinically unclear lesions. In addition, key LC-OCT features to distinguish between BCCs and non-BCCs and to differentiate superficial BCCs from other BCC subtypes were determined by linear regressions. Diagnostic confidence was rated as “high” in only 48% of the lesions with dermoscopy alone compared to 70% with LC-OCT. LC-OCT showed a high sensitivity (98%) and specificity (80%) compared to histology, and these were even higher (100% sensitivity and 97% specificity) in the subgroup of lesions with high diagnostic confidence. Interobserver agreement was nearly perfect (95%). The combination of dermoscopy and LC-OCT reached a sensitivity of 100% and specificity of 81.2% in all cases and increased to sensitivity of 100% and specificity of 94.9% in cases with a high diagnostic confidence. The performance of LC-OCT was influenced by the image quality but not by the anatomical location of the lesion. The most specific morphological LC-OCT criteria in BCCs compared to non-BCCs were: less defined dermoepidermal junction (DEJ), hyporeflective tumor lobules, and dark rim. The most relevant features of the subgroup of superficial BCCs (sBCCs) were: string of pearls pattern and absence of epidermal thinning. Our diagnostic confidence, sensitivity, and specificity in detecting BCCs in the context of clinically equivocal lesions significantly improved using LC-OCT in comparison to dermoscopy only. Operator training for image acquisition is fundamental to achieve the best results. Not only the differential diagnosis of BCC, but also BCC subtyping can be performed at bedside with LC-OCT.
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Affiliation(s)
- Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
| | - Sandra Schuh
- Department of Dermatology and Allergy, University Hospital, 86179 Augsburg, Germany; (S.S.); (J.W.)
| | - Julia Welzel
- Department of Dermatology and Allergy, University Hospital, 86179 Augsburg, Germany; (S.S.); (J.W.)
| | - Fabia Daxenberger
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
| | - Lars E. French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence: (C.R.); (E.C.S.); Tel.: +49-(0)89-4400-56010 (C.R.)
| | - Elke C. Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; (C.G.); (F.D.); (D.H.); (L.E.F.)
- Correspondence: (C.R.); (E.C.S.); Tel.: +49-(0)89-4400-56010 (C.R.)
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15
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Verzì AE, Micali G, Lacarrubba F. Line-Field Confocal Optical Coherence Tomography May Enhance Monitoring of Superficial Basal Cell Carcinoma Treated with Imiquimod 5% Cream: A Pilot Study. Cancers (Basel) 2021; 13:4913. [PMID: 34638396 DOI: 10.3390/cancers13194913] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 12/12/2022] Open
Abstract
Line-field confocal optical coherence tomography (LC-OCT) is a novel, non-invasive technique for real-time skin imaging. Imiquimod (IQ) 5% cream is an immune response modifier currently approved for the treatment of small, superficial basal cell carcinoma (BCC). The aim of this study was to investigate if LC-OCT may be useful to enhance the treatment monitoring of BCC. Twenty superficial BCCs from 12 patients were treated with IQ 5% cream once daily, five days a week, for six weeks. Clinical and LC-OCT evaluations were performed at baseline and 4 weeks after the end of treatment. At the end of the study, 13 lesions showed a complete clinical and LC-OCT response, 4 lesions a partial clinical and LC-OCT response, and 3 lesions a complete clinical response but residual tumoral signs at LC-OCT. Our pilot study suggests that LC-OCT may represent a promising tool able to enhance the evaluation of the treatment response of BCCs to non-invasive treatments. In our case series, its use highlighted, through a detailed, fast, and complete examination of the treated area, three cases of residual BCC that otherwise would have gone undetected at clinical examination. Future studies on larger series of patients treated with different modalities and with a longer follow-up are advisable.
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Lacarrubba F, Verzì AE, Puglisi DF, Broggi G, Caltabiano R, Micali G. Line-field confocal optical coherence tomography of xanthogranuloma: Correlation with vertical and horizontal histopathology. J Cutan Pathol 2021; 48:1208-1211. [PMID: 34028070 PMCID: PMC8453847 DOI: 10.1111/cup.14067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
Line‐field confocal optical coherence tomography (LC‐OCT) is a new noninvasive technique for a real‐time, vertical, and horizontal imaging of the skin at cellular resolution. A 47‐year‐old female presented with a 6‐month history of an asymptomatic yellowish papule. LC‐OCT evaluation was able to show the diagnostic microscopic features of xanthogranuloma and showed an excellent correlation with vertical and horizontal histopathological sections by revealing enlarged dermal papillae containing multiple, bright roundish giant cells, corresponding to foamy histiocytes, and giant cells characterized by a dark center surrounded by a highly hyper‐refractile peripheral ring, corresponding to Touton cells. LC‐OCT may represent a valid, noninvasive alternative to histopathological examination in clinically atypical cases of xanthogranuloma.
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Affiliation(s)
| | | | | | - Giuseppe Broggi
- Department "G.F. Ingrassia", Section of Anatomic Pathology, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department "G.F. Ingrassia", Section of Anatomic Pathology, University of Catania, Catania, Italy
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17
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Ruini C, Schuh S, Gust C, Hartmann D, French LE, Sattler EC, Welzel J. In-Vivo LC-OCT Evaluation of the Downward Proliferation Pattern of Keratinocytes in Actinic Keratosis in Comparison with Histology: First Impressions from a Pilot Study. Cancers (Basel) 2021; 13:2856. [PMID: 34201052 PMCID: PMC8228287 DOI: 10.3390/cancers13122856] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Abstract
It is known that actinic keratoses (AKs) can progress to invasive squamous cell carcinoma (SCC). The histological PRO grading of AKs is based on the growth pattern of basal keratinocytes and relates to their progression risk. AKs can be non-invasively characterized by line-field confocal optical coherence tomography (LC-OCT). The aim of the study was to define criteria for an LC-OCT grading of AKs based on the PRO classification and to correlate it with its histological counterpart. To evaluate the interobserver agreement for the LC-OCT PRO classification, fifty AKs were imaged by LC-OCT and biopsied for histopathology. PRO histological grading was assessed by an expert consensus, while two evaluator groups separately performed LC-OCT grading on vertical sections. The agreement between LC-OCT and histological PRO grading was 75% for all lesions (weighted kappa 0.66, 95% CI 0.48-0.83, p ≤ 0.001) and 85.4% when comparing the subgroups PRO I vs. PRO II/III (weighted kappa 0.64, 95% CI 0.40-0.88, p ≤ 0.001). The interobserver agreement for LC-OCT was 90% (Cohen's kappa 0.84, 95% CI 0.71-0.91, p ≤ 0.001). In this pilot study, we demonstrated that LC-OCT is potentially able to classify AKs based on the basal growth pattern of keratinocytes, in-vivo reproducing the PRO classification, with strong interobserver agreement and a good correlation with histopathology.
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Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Sandra Schuh
- Department of Dermatology and Allergy, University Hospital, 86156 Augsburg, Germany;
| | - Charlotte Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Lars Einar French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Elke Christina Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
| | - Julia Welzel
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (C.G.); (D.H.); (L.E.F.); (E.C.S.)
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18
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Pedrazzani M, Breugnot J, Rouaud-Tinguely P, Cazalas M, Davis A, Bordes S, Dubois A, Closs B. Comparison of line-field confocal optical coherence tomography images with histological sections: Validation of a new method for in vivo and non-invasive quantification of superficial dermis thickness. Skin Res Technol 2019; 26:398-404. [PMID: 31799766 DOI: 10.1111/srt.12815] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/09/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Line-field confocal optical coherence tomography (LC-OCT) is an imaging technique providing "optical biopsies" of the skin in real time and non-invasively. At a center optical wavelength of 1.3 µm, this innovative technology can be applied to dermo-cosmetic product development due to both high image resolution (~2 µm) and sufficient penetration (~0.5 mm). Nevertheless, the precise dermal area analyzed with LC-OCT has never been identified. In this study, the objective was to compare LC-OCT images with histological sections of the same area, in order to validate a new method for in vivo and non-invasive quantification of superficial dermis thickness. Once validated, this standardized and quantitative method was used to assess age-related changes of the superficial dermis. MATERIALS AND METHODS Ex vivo LC-OCT acquisitions and hematoxylin-eosin-safran staining were performed on a panel of four healthy Caucasian female volunteers. In vivo LC-OCT study of skin aging was performed on a panel of 37 healthy Caucasian female divided into five different age-groups. RESULTS Comparison with histological sections revealed that LC-OCT images allow the visualization and the quantification of the superficial portion of papillary dermis. Applied to different age-group of volunteers, LC-OCT images show a constant decrease in this superficial dermis thickness with age. CONCLUSIONS In conclusion, we have introduced LC-OCT as a novel technique for in vivo and non-invasive evaluation of superficial dermis thickness. This approach could be used in the future to demonstrate visually and quantitatively the capacity of a dermo-cosmetic active ingredient to renormalize the structural properties of the dermis.
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Affiliation(s)
| | | | | | | | - Arthur Davis
- DAMAE Medical, Paris, France.,Laboratoire Charles Fabry, Institut d'Optique Graduate School, Université Paris-Saclay, Palaiseau, France
| | | | - Arnaud Dubois
- DAMAE Medical, Paris, France.,Laboratoire Charles Fabry, Institut d'Optique Graduate School, Université Paris-Saclay, Palaiseau, France
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