Line‐field confocal optical coherence tomography of basal cell carcinoma: a descriptive study

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.

Line‐field confocal optical coherence tomography of benign dermal melanocytic proliferations: a case series

“…This wave-like pattern, described here for the first time, could be a useful asset to differentiate intradermal nevi from nodular BCC, which is characterized on LC-OCT by the presence of well-delimited dermal lobules featuring the peculiar millefeuille pattern, previously described. 15 Dermal and compound nevi are among the many lesions that dermatologists are confronted to in their daily practice. Their recognition is of high importance when problems of differential diagnosis with other benign and malignant lesions occur.…”

Line field confocal optical coherence tomography: An adjunctive tool in the diagnosis of autoimmune bullous diseases

“…This new modality opens the possibility for a tridimensional visualization of a given skin condition: for examples, the exact vascular architecture of the examined lesion can be visualized and rotated trough 360 [18,23]. Fourth, the software segmentation allows to measure the diameter and the localization depth of each examined structure, and to acquire additional morphological details by using post-processing imaging tools for melanin/ water/hemoglobin enhancement [18,24,25]. Finally, from a practical point of view, the training and learning time needed to use the device is very fast, as previously reported [17].…”

“…We previously demonstrated the ability of LC-OCT to show the in vivo skin structure of healthy skin, with a clear definition of the epidermal layers and a depth of imaging reaching the deeper/papillary dermis [17][18][19][20][21][22][23]. Then, LC-OCT was successfully used to investigate the morphology of skin cancers [16,18,24,25] and rare skin diseases including inflammatory, [19,20] vascular structures [16][17][18] and morpho-functional alteration of stratum corneum and adnexa [21][22][23].…”

Line‐field confocal optical coherence tomography of sebaceous hyperplasia: a case series

“…1 Moreover, with its ability to produce images in both vertical and horizontal planes, it enables a tridimensional (3D) analysis of the skin, which can prove very useful for assessing physiological 2 and pathological skin. [3][4][5] Sebaceous hyperplasia (SH) is one of the most common lesions that dermatologists can encounter especially on the face of middle-aged to elderly patients. However, because its clinical and dermatoscopic aspect may sometimes show equivocal features, 6 it can be mistaken for a nodular basal cell carcinoma (BCC).…”

“…2). 5,8 Nodular BCC is characterized by well-delimited dermal lobules, which are separated from hair follicles and feature the so-called millefeuille pattern (the grey core of the lobule features a laminated structure prevalently parallel to the epidermis, resembling the arrangement seen in the eponymous French delicacy; it corresponds to dense cellularity prevalently orientated along the same axis) 5 (Fig. 2c).…”