Basal & Squamous Cell Carcinoma (BCC, SCC)

See the whole picture with Vivosight to inform and optimize treatment planning and monitoring

 

  • Obtain images of sub-surface, sub-clinical tumor tissue
  • Aid decision making with more information than can be obtained through clinical assessment or dermoscopy alone
  • More confidence in treatment decisions when histological evaluation is not available or appropriate
  • Tested and proven in multiple large studies

“We have found VivoSight to be a useful technology in our BCC practice. This allows us to investigate pre-Mohs surgical sites to a depth of 1 mm, and provides us with details to a depth of 1 mm which is well beyond the limitations of the naked eye and the dermatoscope. Visualization of tumor subtype size and depth helps us with pretreatment planning and also in monitoring subsequent outcomes”.

Chris Zachary, MD. Chair – Department of Dermatology, University of California, Irvine

VivoSight Impact on Treatment

VivoSight can aid in the identification of suspicious lesions

  • Understanding lesion features can better inform treatment methods
  • See beneath the surface and beyond what can be seen with dermoscopy
Training is key to gain solid user experience. Image courtesy of Welzel, MD

Superficial BCC

Infiltrative BCC: • Multiple small dark ovoids in dermis • "Shoal of fish" look • Epidermis thinned

Nodular BCC

Nodular BCC: • Dark ovoids with dark rims and sharp borders • Peritumoral bright stroma • Thin epidermis

Infiltrative BCC

Infiltrative BCC: • Multiple small dark ovoids in dermis • "Shoal of fish" look • Epidermis thinned

Supported by published data:

Clinical trial results for Sensitivity & Specificity for identification of Basal Cell Carcinoma using VivoSight OCT:

Note: OCT is not a substitute for biopsy. Individual results vary and depend on user experience

Monitor Immediate Treatment Effect and Lesion Site Changes at Follow-up

PDT Case:

Superficial basal cell carcinoma (BCC) located above the eyebrow.

A) Clinical photo of lesion (white arrow) B) OCT image of lesion displaying disruption of normal layering (white vertical line) and tumour lobules (white arrows) with reflective cores representing central necrosis (white circles) C) OCT image of lesion taken right after first MAL-PDT treatment. The image has a homogeneous texture, a blurred appearance and the lesion is not obvious D) OCT image at a 3-month follow-up. The dermoepidermal junction has been fully restored (white arrows), sign of complete remission. Images courtesy of Themstrup [7]

PDT Case:

  • Pretreatment image shows nodular BCC with cystic core.
  • Measure the effects of treatment on number, appearance, depth, thickness and lateral extent of lesions
  • OCT monitoring of PhotoDynamic Therapy (PDT): clearance three months after second treatment
Photodynamic therapy BCC OCT image. before and after

Laser Case:

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

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

VivoSight dynamic scan detects blood flow and images the vascular network highlighted in red. Both views show the treatments thermal effect with significantly less blood flow detected immediately after treatment. Images courtesy of Ahluwalia, Ortiz [8]

Squamous Cell Carcinoma (SCC)

VivoSight can aid in the identification of unique characteristics associated with SCC:

SCC in situ: Thickened epidermis. DEJ irregular/unclear
SCC: No or poorly defined DEJ. Very irregular epidermis. Bright horn-like cysts

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. Cheng HM, Lo S, Scolyer R, Meekings A, Carlos G, Guitera P. Accuracy of optical coherence tomography for the diagnosis of superficial basal cell carcinoma–a prospective, consecutive, cohort study of 168 cases. British Journal of Dermatology. 2016 May 1.

5. Sinx KA, Tonk EH, Kelleners-Smeets NW, Winnepenninckx VJ, Nelemans PJ, Mosterd K. Optical Coherence Tomography for non-invasive diagnosis and subtyping of Basal Cell Carcinoma, a prospective cohort study. Journal of Investigative Dermatology. 2020 Mar 6.

6. Feng H, Christman MP, Holmes J, Geronemus RG. Utilization of optical coherence tomography as a noninvasive, bedside imaging technique to identify residual nodular basal cell carcinoma at a well-healed and clinically unidentifiable biopsy site. J Am Acad Dermatol. 2019 Jul;81(1).

7. 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.

8. 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.

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

10. 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;E1;E2.

11. 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.

12. Stephens R, Holmes J, Eadie E. Lesion compression during light activation may improve efficacy of Photodynamic Treatment (PDT) of Basal Cell Carcinoma (BCC): Preliminary results and rationale. J Eur Acad Dermatol Venereol. 2020 Apr 20. doi: 10.1111/jdv.16503.

13. L. Schmitz L, Bierhoff E, Dirschka T. Optical Coherence Tomography Imaging of Erythroplasia of Queyrat and Treatment with Imiquimod 5% Cream: A Case Report. Dermatology DOI: 10.1159/000354652.

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