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Presurgical evaluation of basal cell carcinoma using combined reflectance confocal microscopy–optical coherence tomography: A prospective study - 13/03/20

Doi : 10.1016/j.jaad.2019.10.028 
Saud Aleissa, MD a, Cristian Navarrete-Dechent, MD a, b, Miguel Cordova, MD a, Aditi Sahu, PhD a, Stephen W. Dusza, DrPH a, William Phillips, BS a, Anthony Rossi, MD a, Erica Lee, MD a, Kishwer S. Nehal, MD a,
a Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York 
b Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile 

Correspondence to: Kishwer S. Nehal, MD, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th St, New York, NY 10022.Dermatology ServiceDepartment of MedicineMemorial Sloan Kettering Cancer Center16 E 60th StNew YorkNY10022

Abstract

Background

Initial biopsy of basal cell carcinoma (BCC) may fail to show aggressive histologic subtypes. Additionality, the clinical evaluation of BCC before surgery can miss subclinical extension. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) are emerging tools that can help in the presurgical evaluation of BCCs.

Objective

To assess the feasibility of a combined RCM-OCT imaging modality for presurgical evaluation of biopsy-proven BCCs for residual tumor, margin status, and depth.

Methods

Thirty-eight BCCs in 35 patients referred to a tertiary cancer center for Mohs micrographic surgery (MMS) were imaged with combined RCM-OCT. Images were correlated to MMS frozen sections.

Results

Thirty-eight BCCs were analyzed. The mean age of patients was 67.34 years (range, 36-84 years), and 20 patients were female (57.14%). Twenty four BCCs were located on the head (63.16%) , and the mean size was 8.58 mm (range, 3-30 mm). RCM-OCT showed an overall agreement of 91.1% with MMS frozen sections. A sensitivity of 82.6% (95% confidence interval [CI], 69%-92%), specificity of 93.8% (95% CI, 88%-97%), and receiver operating characteristic curve of 0.88 (95% CI, 0.82-0.94) was found. OCT depth was highly correlated with MMS depth (r2 = 0.9).

Limitations

Small sample size and difficulty evaluating certain challenging anatomic sites.

Conclusions

Combined RCM-OCT may emerge as a useful tool for presurgical evaluation of BCCs.

Le texte complet de cet article est disponible en PDF.

Key words : basal cell carcinoma, biopsy, margins, Mohs, optical coherence tomography, reflectance confocal microscopy, residual, surgery

Abbreviations used : BCC, CI, MMS, OCT, RCM


Plan


 Drs Aleissa and Navarrete-Dechent are cofirst authors.
 Funding sources: Supported in part by a grant from the National Cancer Institute/National Institutes of Health (P30-CA008748) made to the Memorial Sloan Kettering Cancer Center.
 Disclosures: Dr Rossi has no relevant conflicts of interest related to this manuscript but has received grant funding from The Skin Cancer Foundation and the Award Ford Memorial Grant for research related to this work; he has also served on the advisory board of, served as a consultant for, or given educational presentations for Allergan, Galderma, Evolus, Elekta, Biofrontera, Quantia, Merz, DynaMed, Skinuvia, Perf-Action, and LAM Therapeutics. Dr Nehal received royalties from publishing companies for books and book chapters. Drs Aleissa, Navarrete-Dechent, Cordova, Sahu, Dusza, and Lee and Mr Phillips have no conflicts of interest to declare.
 Preliminary data were presented at the American College of Mohs Surgery Annual Meeting, Baltimore, Maryland, May 3, 2019.
 IRB approval status: Approved by the Memorial Sloan Kettering Cancer Center IRB (99-099).
 Reprints not available from the authors.


© 2019  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 82 - N° 4

P. 962-968 - avril 2020 Retour au numéro
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