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High-Definition Optical Coherence Tomography in the Diagnosis of Basal Cell Carcinoma Evaluated by an Experienced Versus Inexperienced Investigator
摘要： Background: Histopathology is the gold standard in the diagnosis of basal cell carcinoma (BCC) but biopsies are invasive and often not the preferred diagnostic method for patients. In this context, non-invasive diagnostic imaging tools such as high definition optical coherence tomography (HD-OCT) have shown promising results in diagnosing BCC in real time, atraumatically and repeatedly. Objective: To evaluate the sensitivity and specificity of HD-OCT in the diagnosis of BCC by an experienced versus an inexperienced investigator and describe typical features in common differential diagnosis of BCC. Patients and methods: Forty three patients with clinical suspicion for BCC were included. The HD-OCT images were evaluated in a blinded manner by an experienced and inexperienced investigator. The results were compared to the histopathological diagnosis. Results: Histopathology revealed 22 BCC, 10 fibrous papules of the face, 5 actinic keratoses, 3 intradermal nevi, 2 squamous cell carcinomas and 1 sebaceous hyperplasia. The sensitivity and specificity in diagnosing BCCs correctly by HD-OCT in the experienced investigator was 86.4% and 90.5%, respectively. In the inexperienced investigator the sensitivity and the specificity was 77.3% and 81.0%, respectively. There was a good inter-observer agreement found between experienced and inexperienced investigators. Conclusion: HD-OCT can be used as auxiliary diagnostic tool in the evaluation and treatment of BCC even by inexperienced investigators.
关键词： Differential,Basal cell carcinoma,Optical coherence tomography,Diagnosis
更新于2025-09-23 15:23:52
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Apport de la microscopie confocale par réflectance et de l’OCT dans le diagnostic d’un carcinome basocellulaire nodulaire kystique
摘要： The role of reflectance confocal microscopy and OCT in the diagnosis of nodular kystic BCC
关键词： Basal cell carcinoma,Noninvasive imaging,Optical coherence tomography,In vivo confocal microscopy,Dermoscopy,In vivo reflectance confocal microscopy,Cystic basal cell carcinoma
更新于2025-09-19 17:15:36
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Reflectance confocal microscopy-guided carbon dioxide laser ablation of low-risk basal cell carcinomas: A prospective study
摘要： Background: Basal cell carcinoma (BCC) treatment modalities can be strati?ed by tumor subtype and recurrence risk. The main limitation of nonsurgical treatment modalities is the lack of histopathologic con?rmation. Re?ectance confocal microscopy (RCM) is a noninvasive imaging device that provides quasihistologic images. Objective: To evaluate the feasibility and ef?cacy of RCM-guided carbon dioxide (CO2) laser ablation of low-risk BCCs. Methods: Prospective study with biopsy specimeneproven low-risk BCCs imaged with RCM. RCM was performed on these sites before and after ablation. If residual tumor was found, a new series of laser passes were performed. The patients were then monitored for recurrence clinically and with RCM. Results: Twenty-two tumor sites in 9 patients (5 men, 4 women) were imaged and treated. Median age was 59 6 12.9 years (range, 30-74 years). Mean tumor size was 7.7 mm (range, 5-10 mm). Residual tumor was identi?ed in 5 of 22 cases (22.7%) under RCM on immediate ?rst-pass postablation sites, prompting additional laser passes. Median follow-up was 28.5 months (range, 22-32 months) with no recurrences found. Conclusions: Addition of RCM to laser ablation work?ow can detect subclinical persistent tumor after initial ablation and may serve as an aid to increase the ef?cacy of laser ablation.
关键词： laser,basal cell carcinoma,carbon dioxide laser,ablation,diagnosis,follow-up,re?ectance confocal microscopy,treatment
更新于2025-09-19 17:13:59
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Lesions Mimicking Melanoma at Dermoscopy Confirmed Basal Cell Carcinoma: Evaluation with Reflectance Confocal Microscopy
摘要： Background: Atypical basal cell carcinoma (BCC), characterized by equivocal dermoscopic features typical of malignant melanoma (MM), can be difficult to diagnose. Reflectance confocal microscopy (RCM) enables in vivo imaging at nearly histological resolution. Objectives: To evaluate with RCM atypical melanocytic lesions identified in dermoscopy, according to common RCM criteria for the differential diagnosis of BCC, and to identify representative RCM parameters for superficial (sBCCs) and nonsuperficial (nsBCCs) basal cell carcinomas (BCCs). Methods: A retrospective analysis of consecutive patients evaluated with RCM, selecting excised lesions classified at dermoscopy with ≥1 score from the revisited 7-point checklist, mimicking melanoma, registered between 2010 and 2016. Cluster analysis identified BCC subclassifications. Results: Of 178 atypical lesions, 34 lesions were diagnosed as BCCs with RCM. Lesions were confirmed BCCs with histopathology. Dermoscopic features included atypical network (55.9%) and regression structures (35.5%) associated with sBCCs, and an atypical vascular pattern (58.8%) and irregular blotches (58.8%) with nsBCCs. Hierarchical cluster analysis identified 2 clusters: cluster 1 (100% sBCCs) was characterized by the presence of cords connected to the epidermis (90%, p < 0.001), tumor islands located in the epidermis (100%, p < 0.001), smaller vascular diameter (100%, p < 0.001) and solar elastosis (90%, p = 0.017), and cluster 2 (nsBCCs 85%) was defined by the dermic location of tumor islands (87.5%, p < 0.001) with branch-like structures (70.8%, p = 0.007) and surrounding collagen (83.3%, p = 0.012), peripheral palisading (83.3%, p = 0.012) and coiled vascular morphology (79.2%, p < 0.001) with a larger vascular diameter (50%, p < 0.001). Conclusions: RCM is able to diagnose BCCs mimicking melanoma at dermoscopy and seems able to identify sBCCs and nsBCCs.
关键词： Melanoma,Basal cell carcinoma,Reflectance confocal microscopy,Dermoscopy,Noninvasive diagnosis
更新于2025-09-10 09:29:36
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Diagnostic accuracy of ex vivo fluorescence confocal microscopy for Mohs surgery of basal cell carcinomas: a prospective study on 753 margins
摘要： Background: Frozen histological sections are currently used for intra-operative margin assessment during Mohs surgery. Fluorescence confocal microscopy (FCM) is a new tool, which offers a promising and faster alternative to frozen histology. Objective: The aim of the present study is to prospectively evaluate in a clinical setting, the accuracy of FCM as compared to frozen sections in BCC’s margin assessment. Methods: Patients with BCC, scheduled for Mohs surgery were prospectively enrolled. Freshly-excised surgical specimens were first examined through FCM and then frozen sections were evaluated. Permanent sections were finally obtained, in order to validate our sample technique. A blind re-evaluation was also performed for discordant cases between FCM and frozen sections. Sensitivity and specificity levels, as well as positive and negative predicting values were calculated and ROC curves were generated. Results: We enrolled 127 BCCs in as many patients (40.2% females). A total number of 753 sections were examined. All BCCs were located on the head and neck area. When evaluating the performance of FCM as compared to frozen sections 79.8% sensitivity, 95.8% specificity, 80.5% positive predicting and 95.7% negative predicting values were found (Area Under the Curve: .88, 95%CI .84-.92; P<.001). A total of 49 discordant cases between FCM and frozen sections evaluations were blindly re-evaluated, of which 24 were false positive and 25 false negative. The performance of FCM and frozen sections was also evaluated according to the final histopathological assessment. Conclusions: We found high levels of accuracy for FCM as compared to frozen sections evaluation, in intra-operative BCC’s margin assessment during Mohs surgery. Some technical issues still prevent a wide use of this technique, but new upcoming devices promise to overcome these limitations.
关键词： basal cell carcinoma,fluorescence confocal microscopy,Mohs surgery,skin cancer,ex vivo confocal microscopy
更新于2025-09-09 09:28:46
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Shedding light on photodynamic therapy for basal cell carcinoma
摘要： The recognition of photodynamic therapy (PDT) as an effective treatment of cancers was due, in large part, to the studies of Thomas Dougherty and his colleagues at Roswell Park Cancer Institute in Buffalo, NY, started in the 1970s.1 In those studies, intravenous porphyrin derivatives and visible light were used. Topical PDT treatment, currently widely performed in dermatology, uses topically applied 5-aminolaevulinic acid (ALA) or ALA esters.2,3 ALA is converted to protoporphyrin IX in the epidermis. On exposure of protoporphyrin IX to its absorption spectrum in the visible light range, oxygen-dependent phototoxic reaction occurs resulting in cytotoxicity.
关键词： cosmesis,basal cell carcinoma,photodynamic therapy,treatment,dermatology
更新于2025-09-09 09:28:46
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Original paper Efficacy and safety of electronic brachytherapy for superficial and nodular basal cell carcinoma
摘要： Purpose: Surface electronic brachytherapy (EBT) is an alternative radiotherapy solution to external beam electron radiotherapy and high-dose-rate radionuclide-based brachytherapy. In fact, it is also an alternative solution to surgery for a subgroup of patients. The objective of this work is to confirm the clinical efficacy, toxicity and cosmesis of a new EBT system, namely Esteya? in the treatment of nodular and superficial basal cell carcinoma (BCC). Material and methods: This is a prospective single-center, non-randomized pilot study to assess the efficacy and safety of EBT in nodular and superficial BCC using the Esteya? system. The study was conducted from June 2014 to February 2015. The follow up time was 6 months for all cases. Results: Twenty patients with 23 lesions were included. A complete response was documented in all lesions (100%). A low level of toxicity was observed after the 4th fraction in all cases. Erythema was the most frequent adverse event. Cosmesis was excellent, with more than 60% of cases without skin alteration and with subtle changes in the rest. Conclusions: Electronic brachytherapy with Esteya? appears to be an effective, simple, safe, and comfortable treatment for nodular and superficial BCC associated with excellent cosmesis. It could be a good choice for elderly patients, patients with contraindications for surgery (due to comorbidities or anticoagulant drugs) or patients where surgery would result in a more disfiguring outcome. A longer follow-up and more studies are needed to confirm these preliminary results.
关键词： electronic brachytherapy,skin brachytherapy,basal cell carcinoma,skin cancer
更新于2025-09-04 15:30:14
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Ex Vivo Confocal Microscopy Of Basal Cell Carcinoma On A 3-Color Scale
摘要： Ex vivo confocal microscopy (CM) is capable of visualizing freshly excised tissue in real-time with cellular resolution without routine processing. Depending on the laser wavelength, either reflectance (RCM) or fluorescence (FCM) is utilized. Ex vivo CM is useful for the rapid evaluation of tumor margins during Mohs micrographic surgery (MMS). Initially, ex vivo RCM studies used acetic acid as contrast agent to enhance basal cell carcinoma (BCC) cell nuclei. However, thin strands of BCC were frequently missed. The use of fluorophores improves contrast, so that even small strands of BCC can be spotted in FCM mosaics. Acridine orange (AO) is the dye most widely used. AO binds specifically to DNA and emits fluorescence, so images of living cell nuclei can be enhanced and displayed as bright structures in FCM mosaics. Even though good resolution and morphological correlation are achieved with this standard technique, nowadays confocal mosaics are displayed in a grey scale format. However, dermato-pathologists are often neither familiar with nor comfortable assessing these black-and-white images. We herein report a new technique for obtaining 3-color scale confocal mosaics (3CS-FCM) with the simultaneous use of AO and ethidium bromide (EB) as fluorescent dyes. In this technique, the excised skin sample is first soaked with liquid nitrogen. The sample is then sectioned into 20-30 μm-thick slices using a cryostat and stained with the dye mixture (AO 0.1 mM + EB 0.25 mM) for about one minute. The sample is then placed in the confocal microscope plate for imaging (Nikon A1R+, NIKON CORPORATION?, Japan). The tissue is scanned simultaneously with two different wavelength lasers (405 and 488 nm) and the collected fluorescence displayed on the screen as a 3-color-scale mosaic. Around 10 to 15 minutes are required for completion of the tissue processing and for final mosaics to be developed. Unlike AO, EB binds specifically to the DNA of BCC cells that are damaged due to freezing. As a result, BCC nests are stained by EB and emit red fluorescence after laser stimulation; in contrast, the epidermis and dermis are stained by AO and emit green fluorescence. Blue color corresponds to the background tissue autofluorescence. All fluorescence is collected by the microscope displaying the final images in a 3-color scale format. AO and EB staining do not affect additional fixation or staining of the sample. Figure 1 shows completed BCC mosaics displayed with this new technique. Each color represents a different skin structure, making the mosaics easier to read. In this way, 3CS confocal mosaics are more user-friendly and can be interpreted by healthcare professionals without previous experience with FCM. Moreover, with frozen sample processing, the tissue is completely flattened and the entire sample can be displayed on the screen. These developments represent important advantages over previously described images obtained with CM. In conclusion, 3CS-FCM is an innovative technique that provides colored images, expanding significantly the applicability of FCM. Larger studies are nevertheless required to validate the technique for MMS and other applications.
关键词： fluorescence confocal microscopy,3-color scale mosaics,basal cell carcinoma,ethidium bromide,acridine orange,ex vivo confocal microscopy,Mohs micrographic surgery
更新于2025-09-04 15:30:14