Basal Cell Carcinoma (BCC)

VivoSight is a valuable research tool in the visualization of BCC and monitoring of treatment effects

Structural, cross-sectional OCT image (image size: 6 mm x 2 mm; imaging depth: 800 μm) of the nBCC lesion. The white asterisks mark hyporeflective ovoid structures corresponding to tumour nests; thin arrows mark dark peripheral borders at the margin of a hyporeflective ovoid structure; the thick white arrows mark the dermoepidermal junction; the black asterisk marks focal thinning of epidermis; the thick black arrow marks a hair casting a shadow. Image courtesy of Themstrup [4]

Dermatoscope and VivoSight Dx images of nodular BCC

  • Nodular BCC on the back shows sharply outlined ovoid hyporeflective structure (thin white arrows) with a bright surrounding stroma and a thinner epidermis above the lesion (thick white arrow).
  • Serpiginous vessels in branching shape forming an outlined figure can be seen in D-OCT en-face view. Images courtesy of Welzel, Schuh [1]

VivoSight can aid in the identification of suspicious lesions:

Sensitivity, specificity, positive predictive value and negative predictive value for three examination techniques [3] Note: OCT is not a substitute for biopsy. Individual results vary and depend on user experience

VivoSight Monitoring and Measurement of BCC Treatment Effect

Topical Treatment

OCT image of patient with BCC. Images courtesy of Banzhaf [9]

Before imiquimod therapy (visit 1)
Same patient at 1 week with imiquimod therapy (visit 2)
Patient treated 1 month with imiquimod (visit 3)
Patient 4 weeks after ended imiquimod therapy (visit 4). Epidermoid cysts (confirmed histopathologically), represented by the hyperreflective ovoid structures with hyporeflective cores have replaced the BCCislands

Laser Treatment

VivoSight scans of BCC before and after laser treatment, showing a marked reduction in vascular supply to the tumor.

  • Top: structural views of BCC before (left) and immediately after (right) laser treatment
  • Bottom: en-face views at 150 micrometers depth of BCC before (left) and immediately after (right) Nd:YAG laser treatment

VivoSight quantifies changes in the superficial vascular plexus and VivoTools calculates vessel density by depth. Images courtesy of Ahluwalia, Ortiz [5].

Photodynamic Therapy

Monitoring of PhotoDynamic Therapy (PDT) treatment of Basal Cell Carcinoma

  • Measure the effects of treatment on number, appearance, depth, thickness and lateral extent of lesions
  • Final outcome three month after second treatment

References:

1. Schuh S., Welzel J. (2020) OCT-Guided Laser Treatment and Surgery. In: Bard R. (eds) Image Guided Dermatologic Treatments. Springer, Cham

2. Ulrich M, Braunmuehl T, Kurzen H, Dirschka T, Kellner C, Sattler EC, Berking C, Welzel J, Reinhold U. The sensitivity and specificity of optical coherence tomography for the assisted diagnosis of nonpigmented basal cell carcinoma: an observational study. Br J Dermatol. 2015;173(2):428–35.

3. Markowitz O, Schwartz M, Feldman E, Bienenfeld A, Bieber AK, Ellis J, Alapati U, Lebwohl MG, Siegel DM. Evaluation of optical coherence tomography as a means of identifying earlier stage basal cell carcinomas while reducing the use of diagnostic biopsy. J Clin Aesthet Dermatol. 2015;8(10):14–20.

4. Themstrup L, De Carvalho N, Nielsen SM, Olsen J, Ciardo S, Schuh S, Nørnberg BM, Welzel J, Ulrich M, Pellacani G, Jemec GBE. In vivo differentiation of common basal cell carcinoma subtypes by microvascular and structural imaging using dynamic optical coherence tomography. Exp Dermatol. 2018;27(2):156–65.

5. Ahluwalia J, Avram MM, Ortiz AE. Outcomes of Long-Pulsed 1064 nm Nd:YAG Laser Treatment of Basal Cell Carcinoma: A Retrospective Review. Lasers Surg Med. 2019 Jan;51(1):34-39

6. Ahluwalia J, Avram MM, Ortiz AE. The Evolving Story of Laser Therapeutics for Basal Cell Carcinoma. Dermatol Surg. 2020 Feb 11

7. Markowitz O, Psomadakis CE. Patient-driven management using same-day noninvasive diagnosis and complete laser treatment of basal cell carcinomas: a pilot study. Cutis. 2019 Dec;104(6):345-348;350;351

8. Markowitz O, Tongdee E, Levine A. Optimal cosmetic outcomes for basal cell carcinoma: a retrospective study of nonablative laser management. Cutis. 2019 May;103(5):292-297;E1;E2;E3.

9. C. A. Banzhaf, L. Themstrup, H. C. Ring, M. Mogensen and G. B. E. Jemec. Optical coherence tomography imaging of non-melanoma skin cancer undergoing imiquimod therapy. Skin Research and Technology 2013; 0: 1–7