Optical Coherence Tomography of Peri-Ocular Skin Cancers: An Optical Biopsy

Introduction: Optical coherence tomography (OCT) imaging has been used as a diagnostic tool for retinal disease for several years, and OCT apparatuses are becoming increasingly powerful. However, OCT has yet to reach its full potential in ophthalmology clinics. Alike retinal layers, it has been shown that OCT is able to generate cross-sectional images of the skin and allows visualization of skin lesions in a histopathology-like manner. Objective: We aim to validate OCT as an imaging modality for peri-ocular skin cancer. Through a series of cases, we highlight findings for 3 common eyelid malignancies: basal cell carcinoma, squamous cell carcinoma and sebaceous carcinoma. We propose an OCT image-based signature for basal cell carcinoma. Methods: This is a prospective study. Fifty-eight lesions suspicious of malignancy from 57 patients were subjected to OCT imaging prior to the surgical excision of the lesion. OCT images were analysed and scored according to previously identified OCT features. Eight representative examples are presented, highlighting the OCT patterns for each malignancy side by side to its corresponding histopathological sections. Results: Out of the 58 lesions analysed, 53 were malignant. A loss of the dermal-epidermal junction is observed in all malignant lesions. A strong link is observed between the presence of subepithelial hyporeflective nests on OCT and the diagnosis of basal cell carcinoma (present in 83% of cases). Conversely, lesions of epithelial origin such as squamous cell carcinoma are most often represented on OCT by acanthosis. Two supplementary cases, one basal cell carcinoma and one sebaceous carcinoma, are provided to illustrate how OCT imaging is a valuable tool in cases where clinical observations may be unusual. Conclusions: We provide evidence supporting the use of OCT for the evaluation of peri-ocular cancers. OCT enables visualization of the skin layers in vivo, before biopsy. Our results show that certain OCT features can contribute to include or exclude a diagnosis of basal cell carcinoma. By integrating this non-invasive imaging methodology into the routine assessment of peri-ocular skin lesions, especially in health care centres where access to specialists is limited, OCT imaging can increase clinical precision, reduce delays in patient referral and enhance patient care.

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The Safety and Effectiveness of Elastic Scattering Spectroscopy and Machine Learning in the Evaluation of Skin Lesions for Cancer

Iproceedings ◽

10.2196/35441 ◽

2021 ◽

Vol 6 (1) ◽

pp. e35441

Author(s):

Cristiane Benvenuto-Andrade ◽

A Cognetta ◽

D Manolakos

Keyword(s):

Squamous Cell Carcinoma ◽

Elastic Scattering ◽

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Basal Cell ◽

Predictive Value ◽

Prevalence Rate ◽

Skin Lesions ◽

Elastic Scattering Spectroscopy

Background Elastic scattering spectroscopy (ESS) is an optical biopsy technique that can distinguish between a normal and abnormal tissue in vivo without the need to remove it. The handheld device measures ESS spectra of skin lesions and classifies lesions as either malignant or benign with an output of “Investigate Further” or “Monitor,” respectively, with positive results accompanied by a spectral score output from 1 to 10, indicating how similar the lesion is to the malignant lesions the device was trained on. The algorithm was trained and validated with over 11,000 spectral scans from over 3500 skin lesions. Objective The purpose of this study was to evaluate the safety and effectiveness of the handheld ESS device in detecting the most common types of skin cancer. Methods A prospective, single-arm, investigator-blinded, multicenter study conducted at 4 investigational sites in the United States was performed. Patients who presented with skin lesions suggestive of melanoma, basal cell carcinoma, squamous cell carcinoma, and other highly atypical lesions were evaluated with the handheld ESS device. A validation performance analysis was performed with 553 lesions from 350 subjects with algorithm version 2.0. An independent test set of 281 lesions was selected and used to evaluate device performance in the detection of melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). Statistical analyses included overall effectiveness analyses for sensitivity and specificity as well as subgroup analyses for lesion diagnoses. Results The overall sensitivity of the device was 92.3% (95% CI: 87.1 to 95.5%). The sensitivity for subgroups of lesions was 95% (95% CI 75.1% to 99.9%) for melanomas, 94.4% (95% CI 86.3% to 98.4%) for BCCs, and 92.5% (95% CI 83.4% to 97.5%) for SCCs. The overall device specificity was 36.6% (95% CI 29.3% to 44.6%). There was no statistically significant difference between the dermatologist performance and the ESS device (P=.2520). The specificity of the device was highest for benign melanocytic nevi (62.5%) and seborrheic keratoses (78.2%). The overall positive predictive value (PPV) was 59.8%, and the negative predictive value (NPV) was 81.9% with the study’s malignancy prevalence rate of 51%. For a prevalence rate of 5%, the PPV was estimated to be 7.1%, and the NPV was estimated to be 98.9%. For a prevalence rate of 7%, the PPV was estimated to be 9.8%, and the NPV was estimated to be 98.4%. For a prevalence rate of 15%, the PPV was estimated to be 20.3%, and the NPV was 96.4%. Conclusions The handheld ESS device has a high sensitivity for the detection of melanoma, BCC, and SCC. Coupled with clinical exam findings, this device can aid physicians in detecting a variety of skin malignancies. The device output can aid teledermatology evaluations by helping frontline providers determine which lesions to share for teledermatologist evaluation as well as potentially benefitting teledermatologists’ virtual evaluation, especially in instances of suboptimal photo quality. Acknowledgments This study was sponsored by Dermasensor Inc. Conflicts of Interest None declared.

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LIGHT-INDUCED FLUORESCENCE SPECTROSCOPY AND OPTICAL COHERENCE TOMOGRAPHY OF BASAL CELL CARCINOMA

Journal of Innovative Optical Health Sciences ◽

10.1142/s1793545809000607 ◽

2009 ◽

Vol 02 (03) ◽

pp. 261-268 ◽

Cited By ~ 3

Author(s):

EKATERINA BORISOVA ◽

ELFRIDA CARSTEA ◽

LUMINITA CRISTESCU ◽

ELMIRA PAVLOVA ◽

NIKOLAY HADJIOLOV ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Skin Cancer ◽

Basal Cell Carcinoma ◽

Fluorescence Spectroscopy ◽

Cell Carcinoma ◽

Basal Cell ◽

Normal Skin ◽

Biological Tissues ◽

Skin Lesions ◽

Optical Coherence

Many up-to-date optical techniques have been developed and applied recently in clinical practice for obtaining qualitatively and quantitatively new data from the investigated lesions. Due to their high sensitivity in detection of small changes, these techniques are widely used for detection of early changes in biological tissues. Light-induced fluorescence spectroscopy (LIFS) is one of the most promising techniques for early detection of cutaneous neoplasia. Increasing number of recent publications have suggested that optical coherence tomography (OCT) also has potential for non-invasive diagnosis of skin cancer. This recent work is a part of clinical trial procedure for introduction of LIFS technique into the common medical practice in National Oncological Medical Center in Bulgaria for diagnosis of non-melanoma skin cancer. We focus our attention here on basal cell carcinoma lesions and their specific features revealed by LIFS and OCT analysis. In this paper we prove the efficiency of using the combined LIFS-OCT method in skin lesions studies by integrating the complimentary qualities of each particular technique. For LIFS measurements several excitation sources, each emitting at 365, 385 and 405 nm maxima are applied. An associated microspectrometer detects in vivo the fluorescence signals from human skin. The main spectral features of the lesions and normal skin are discussed and their possible origins are indicated. OCT images are used to evaluate the lesion thickness, structure and severity stage, when possible. The obtained results could be used to develop a more complete picture of optical properties of these widely spread skin disorders. At the same time, our studies show that the combined LIFS-OCT method could be introduced in clinical algorithms for early tumor detection and differentiation between normal/benign/malignant skin lesions.

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What should a cosmetologist know about dermatological lesions on the face?

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0012.6197 ◽

2018 ◽

Vol 12 (3) ◽

pp. 47-52

Author(s):

Klaudia Rubas ◽

Joanna Maj

Keyword(s):

Squamous Cell Carcinoma ◽

Malignant Melanoma ◽

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Basal Cell ◽

Actinic Keratosis ◽

Skin Lesions ◽

The Face ◽

Seborrheic Keratoses

In everyday practice, cosmetologists often observe abnormalities on the facial skin of his or her clients. Facial lesions have a diverse clinical picture, although most are benign. However, some lesions may be malignant and demand fast diagnosis and treatment. Among benign lesions are xanthomas, epidermal cysts, milia and seborrheic keratoses. Xanthomas are usually localized on the eyelids and often coexist with dyslipidemia. They appear clinically as yellowish papules that vary in size. Epidermal cysts are the most common type of skin cyst. They typically occur on the head and neck, and usually affect young adults in their 20s. Milia are common skin lesions that are typically numerous in presence and appear as small-sized sebaceous papules. Seborrheic keratoses are another important type of lesion that are localized on the face and may be disturbing for clients. These are benign tumors that usually appear in individuals over 50 years of age and have an incidence that rises with age. Typically, they are brown in color but they can also be other colors including black, yellow, grey or bluish. Other skin changes include basal cell carcinoma, actinic keratosis, squamous cell carcinoma and lentiginous malignant melanoma. Basal cell carcinoma is a slow-growing, locally malignant epithelial cancer of the skin. This cancer presents mainly in areas exposed to ultraviolet (UV) radiation. Actinic keratosis is a pre-cancerous lesion that is associated with UV radiation. It predisposes to squamous cell carcinoma and other skin cancers rarely. In contrast to basal cell carcinoma, squamous cell carcinoma may cause metastases with high mortality. Melanoma on the head and face usually takes the form of a lentiginous malignant melanoma. This manifests clinically as a brown spot that slowly grows centrifugally. Melanomas vary in size and color. Dermoscopy is an important tool that may help during diagnosis of facial lesions. Given the severe consequences of some skin lesions, it is very important for cosmetologists to have knowledge of the conditions described above. This is because he or she is often the first person who can persuade the client to undergo further diagnosis.

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Study of histomorphological spectrum of eyelid lesions

Journal of Pathology of Nepal ◽

10.3126/jpn.v11i1.31244 ◽

2021 ◽

Vol 11 (1) ◽

pp. 1790-1802

Author(s):

Reshmi Shrestha ◽

Gita Sayami

Keyword(s):

Squamous Cell Carcinoma ◽

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Basal Cell ◽

Sebaceous Carcinoma ◽

Epidermal Cyst ◽

Wide Range ◽

Malignant Lesions ◽

Eyelid Lesions

Background: Eyelid pathologies are the most common surgical specimens encountered among all of the ophthalmic lesions and constitute a wide range of diseases by their unique histologic features. This study aims to find out the histopathological spectrum of eyelid lesions, their demographic distribution, and preferential location prevalent in our community.Materials and Methods: This is an observational study in which we retrospectively evaluated the data of 692 patients retrieved from the histopathology department of National Reference Laboratory, Kathmandu, from May 2016 to April 2019.Results: A total of 701 histologic diagnoses comprised of benign, precursor, and malignant lesions and accounted for 86.6%, 2.6%, and 10.8% respectively with preponderance in females. The common benign lesions included melanocytic nevus (17.7%), epidermal cyst (11%), hemangioma (8.9%), dermoid cyst (8.2%), chalazion (6.7%), and squamous papilloma (6.4%). Tumour of epidermal origin was the most common neoplastic lesion accounting for 31.2%. Basal cell carcinoma (50%) followed by sebaceous carcinoma (27.6%) and squamous cell carcinoma (14.5%) constituted the majority of malignant lesions prevalent above the age of 60 years with the preferential site of the upper eyelid for basal cell carcinoma and squamous cell carcinoma; and lower eyelid for sebaceous carcinoma.Conclusions: Benign eyelid lesions are more prevalent than malignant ones with overall female preponderance. Epidermal tumours are common among neoplasms. A malignant tumour, a disease of an elderly individual, is predominated by basal cell carcinoma followed by sebaceous carcinoma, an aggressive tumour with a high recurrence rate in our population.

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The Safety and Effectiveness of Elastic Scattering Spectroscopy and Machine Learning in the Evaluation of Skin Lesions for Cancer (Preprint)

10.2196/preprints.35441 ◽

2021 ◽

Author(s):

Cristiane Benvenuto-Andrade ◽

A Cognetta ◽

D Manolakos

Keyword(s):

Squamous Cell Carcinoma ◽

Elastic Scattering ◽

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Basal Cell ◽

Predictive Value ◽

Prevalence Rate ◽

Skin Lesions ◽

Elastic Scattering Spectroscopy

BACKGROUND Elastic scattering spectroscopy (ESS) is an optical biopsy technique that can distinguish between a normal and abnormal tissue in vivo without the need to remove it. The handheld device measures ESS spectra of skin lesions and classifies lesions as either malignant or benign with an output of “Investigate Further” or “Monitor,” respectively, with positive results accompanied by a spectral score output from 1 to 10, indicating how similar the lesion is to the malignant lesions the device was trained on. The algorithm was trained and validated with over 11,000 spectral scans from over 3500 skin lesions. OBJECTIVE The purpose of this study was to evaluate the safety and effectiveness of the handheld ESS device in detecting the most common types of skin cancer. METHODS A prospective, single-arm, investigator-blinded, multicenter study conducted at 4 investigational sites in the United States was performed. Patients who presented with skin lesions suggestive of melanoma, basal cell carcinoma, squamous cell carcinoma, and other highly atypical lesions were evaluated with the handheld ESS device. A validation performance analysis was performed with 553 lesions from 350 subjects with algorithm version 2.0. An independent test set of 281 lesions was selected and used to evaluate device performance in the detection of melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). Statistical analyses included overall effectiveness analyses for sensitivity and specificity as well as subgroup analyses for lesion diagnoses. RESULTS The overall sensitivity of the device was 92.3% (95% CI: 87.1 to 95.5%). The sensitivity for subgroups of lesions was 95% (95% CI 75.1% to 99.9%) for melanomas, 94.4% (95% CI 86.3% to 98.4%) for BCCs, and 92.5% (95% CI 83.4% to 97.5%) for SCCs. The overall device specificity was 36.6% (95% CI 29.3% to 44.6%). There was no statistically significant difference between the dermatologist performance and the ESS device (P=.2520). The specificity of the device was highest for benign melanocytic nevi (62.5%) and seborrheic keratoses (78.2%). The overall positive predictive value (PPV) was 59.8%, and the negative predictive value (NPV) was 81.9% with the study’s malignancy prevalence rate of 51%. For a prevalence rate of 5%, the PPV was estimated to be 7.1%, and the NPV was estimated to be 98.9%. For a prevalence rate of 7%, the PPV was estimated to be 9.8%, and the NPV was estimated to be 98.4%. For a prevalence rate of 15%, the PPV was estimated to be 20.3%, and the NPV was 96.4%. CONCLUSIONS The handheld ESS device has a high sensitivity for the detection of melanoma, BCC, and SCC. Coupled with clinical exam findings, this device can aid physicians in detecting a variety of skin malignancies. The device output can aid teledermatology evaluations by helping frontline providers determine which lesions to share for teledermatologist evaluation as well as potentially benefitting teledermatologists’ virtual evaluation, especially in instances of suboptimal photo quality.

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