Line-Field Confocal Optical Coherence Tomography May Enhance Monitoring of Superficial Basal Cell Carcinoma Treated with Imiquimod 5% Cream: A Pilot Study

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.

Line‐field confocal optical coherence tomography of psoriasis, eczema and lichen planus: a case series with histopathological correlation

“…During the examination, the operator can quickly switch between horizontal or vertical vision. Also, the dermoscopic integrated camera allows a precise positioning over the area to examine, so to reduce the risks connected to relocation or probe slipping 3 . Once a representative field has been identified, a skin volume of 1200x500x500μm may be recorded in about 60 s and then the integrated software allows a 3D ‘navigation’ within the acquired images and post‐processing procedures such as measurements and contrast enhancement.…”

“…The user may switch in real time from a histology‐like vertical mode to a confocal‐like horizontal mode, and the integrated software also provides three‐dimensional (3D) skin reconstructions. Thus, LC‐OCT combines the advantages of reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) in terms of resolution, penetration and orientation 1–3 …”

“…It is based on an interferometric technique using a supercontinuum laser source (600-900 nm) and a line scan camera with an imaging speed of 8 frames per second. [1][2][3] It measures the echo time delay and amplitude of light backscattered from cutaneous microstructures, providing high-resolution images (axial: 1.1 lm; lateral: 1.3 lm) with a penetration depth of up to 500 lm. [1][2][3] The user may switch in real time from a histologylike vertical mode to a confocal-like horizontal mode, and the integrated software also provides three-dimensional (3D) skin reconstructions.…”

“…[1][2][3] It measures the echo time delay and amplitude of light backscattered from cutaneous microstructures, providing high-resolution images (axial: 1.1 lm; lateral: 1.3 lm) with a penetration depth of up to 500 lm. [1][2][3] The user may switch in real time from a histologylike vertical mode to a confocal-like horizontal mode, and the integrated software also provides three-dimensional (3D) skin reconstructions. Thus, LC-OCT combines the advantages of reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) in terms of resolution, penetration and orientation.…”

The Immunohistochemical Expression of the Serine and Arginine-Rich Splicing Factor 1 (SRSF1) Is a Predictive Factor of the Recurrence of Basal Cell Carcinoma: A Preliminary Study on a Series of 52 Cases

“…As its pathogenesis has been mainly related to sun exposure, the incidence rates of BCCs vary in relation to geographical latitude and are higher in patients with Fitzpatrick skin phototypes I and II [1]. BCC is usually diagnosed by clinical examination and dermoscopy [2]; in recent years, further diagnostic techniques, such as in vivo reflectance confocal microscopy (RCM) and line-field optical computed tomography (OCT) have contributed to the improvement of the sensibility and specificity of the clinical diagnosis of both inflammatory and neoplastic skin diseases, including BCC [3][4][5][6][7]. Histologically, BCCs are composed of islands/nests of basaloid cells with scant cytoplasm, hyperchromatic nuclei, and peripheral nuclear palisading; neoplastic cells are often surrounded by a fibro-myxoid stroma that induces Medicina 2022, 58, 139 2 of 8 tumor retraction [8].…”