Optical coherence tomography for presurgical margin assessment of non‐melanoma skin cancer – a practical approach

Abstract

In the clinical setting, optical coherence tomography (OCT) is applicable for the non-invasive diagnosis of skin cancer and may in particular be used for margin definition prior to excision. In this regard, OCT may improve the success rate of removing tumor lesions more effectively, preventing repetitive excision, which may subsequently result in smaller excisions. In this study, we have aimed to evaluate the applicability of OCT for in vivo presurgical margin assessment of non-melanocytic skin tumors (NMSC) and to describe the feasibility of different scanning techniques. A total number of 18 patients planned for excision of lesions suspicious of NMSC were included in this study. Based on OCT, we defined the specific tumor margins on 19 lesions preoperatively using different scanning modalities. Sixty-one margin points and five complete tumor margins were analysed on 18 patients with a total of 19 lesions including 63% basal cell carcinoma (BCC) (n = 12), 16% (n = 3) squamous cell carcinoma (SCC) and 21% of other types of skin tumors (n = 4) were classified. In 84% of the cases (n = 16), the OCT-defined lateral margins correctly indicated complete removal of the tumor. The surgical margins chosen by the surgeon never fell below the OCT-defined margin. Regarding the techniques of marginal definition, punctual tumor border scan in the perpendicular direction, with an extension of free-run scans for unsure cases can hardly be recommended. This study shows that suspected NMSC can effectively be confirmed, and furthermore, resection margin can be minimized under OCT control without reducing the rate of complete removal.

Intraoperative imaging during Mohs surgery with reflectance confocal microscopy: initial clinical experience

“…In the long term, our approach may be combined with preoperative detection of lateral margins, to provide a perioperative tool for guiding Mohs surgery. Microscopic approaches that are being investigated for preoperative imaging include RCM, optical coherence tomography, and ultrasound [31][32][33][34][35][36] Furthermore, microscopic imaging may be combined with macroscopic approaches [37][38][39][40] to enable detection over larger areas and/or increased speed. Finally, all of this work in skin and the Mohs surgery setting may serve as an excellent model for optical imaging of residual cancers in other tissues and for translation to other surgical settings.…”

Differentiation of Different Nonmelanoma Skin Cancer Types Using OCT

“…Another equally promising procedure that is increasingly gaining importance is optical coherence tomography (OCT). Like the above-mentioned procedures, OCT is an easily applied, noninvasive, real-time technique that is based on low-coherence interferometry [4]. OCT was first practically described by Huang et al [5] in 1991.…”

Molecular mobility and activity in an intravital imaging setting – implications for cancer progression and targeting

“…Assessing/identifying tumour margins (Alawi et al, 2013;Nguyen et al, 2009) Cancer diagnosis (Chen et al, 2007;Gora et al, 2013;Karl et al, 2010;Kim et al, 2009) Combined OCT and Raman spectroscopy to detect colon and breast cancers based on signature of lipids, collagen and DNA (Ashok et al, 2013;Patil et al, 2008) Coherent Multi-modal CARS imaging for pathological detection and live imaging of cancer (Evans and Xie, 2008;Evans et al, 2007;Heuke et al, 2013;Lee et al, 2015;Lee and Serrels, 2016;Meyer et al, 2011;Meyer et al, 2013;Xu et al, 2013b) Link metabolic changes to disease (Le et al, 2009(Le et al, , 2007 with ongoing advances in CARS endoscopy (Légaré et al, 2006) Fluorescence lifetime imaging microscopy (FLIM) of endogenous compounds…”