Non‐invasive diagnostics like line‐field confocal optical coherence tomography (LC‐OCT) are being implemented in dermato‐oncology. However, unification of terminology in LC‐OCT is lacking. By reviewing the LC‐OCT literature in the field of dermato‐oncology, this study aimed to develop a unified terminological glossary integrated with traditional histopathology. A PRISMA‐guided literature‐search was conducted for English‐language publications on LC‐OCT of actinic keratosis (AK), keratinocyte carcinoma (KC), and malignant melanoma (MM). Study characteristics and terminology were compiled. To harmonize LC‐OCT terminology and integrate with histopathology, synonymous terms for image features of AK, KC, and MM were merged by two authors, organized by skin layer and lesion‐type. A subset of key LC‐OCT image‐markers with histopathological correlates that in combination were typical of AK, squamous cell carcinoma in situ (SCCis), invasive squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and MM in traditional histopathology, were selected from the glossary by an experienced dermatopathologist. Seventeen observational studies of AK (7 studies), KC (13 studies), MM (7 studies) utilizing LC‐OCT were included, with 117 terms describing either AK, KC, or MM. These were merged to produce 45 merged‐terms (61.5% reduction); 5 assigned to the stratum corneum (SC), 23 to the viable epidermis, 2 to dermo‐epidermal junction (DEJ) and 15 to the dermis. For each lesion, mandatory key image‐markers were a well‐defined DEJ and presence of mild/moderate but not severe epidermal dysplasia for AK, severe epidermal dysplasia and well‐defined DEJ for SCCis, interrupted DEJ and/or dermal broad infiltrative strands for invasive SCC, dermal lobules connected and/or unconnected to the epidermis for BCC, as well as single atypical melanocytes and/or nest of atypical melanocytes in the epidermis or dermis for MM. This review compiles evidence on LC‐OCT in dermato‐oncology, providing a harmonized histopathology‐integrated terminology and key image‐markers for each lesion. Further evaluation is required to determine the clinical value of these findings.

Background and Objectives: Electronic pneumatic injection (EPI) is a technique for dermal drug delivery, which is increasingly being used in clinical practice. However, only few studies have been reported on cutaneous drug distribution and related clinical endpoints. We aimed to visualize the immediate cutaneous drug distribution, changes in skin architecture, and related clinical endpoint of EPI.Study Design/Materials and Methods: Acridine orange (AO) solution was administered to ex vivo porcine skin by EPI at pressure levels from 4 to 6 bar with a fixed injection volume of 50 µl and nozzle size of 200 µm. Immediate cutaneous distribution was visualized using ex vivo confocal microscopy (EVCM). Changes in skin architecture were visualized using both EVCM and hematoxylin and eosin‐stained cryosections.Results: The defined immediate endpoint was a clinically visible papule formation on the skin. The pressure threshold to consistently induce a papule was 4 bar, achieving delivery of AO to the deep dermis (2319 µm axial and 5944 µm lateral distribution). Increasing the pressure level to 6 bar did not lead to significant differences in axial and lateral dispersion (P = 0.842, P = 0.905; respectively). A distinctively hemispherical distribution pattern was identified. Disruption of skin architecture occurred independently of pressure level, and consisted of subepidermal clefts, dermal vacuoles, and fragmented collagen.Conclusions: This is the first study to relate a reproducible clinical endpoint to EPI‐assisted immediate drug delivery using EVCM. An EPI‐induced skin papule indicates dermal drug delivery throughout all layers of the dermis, independent of pressure level settings. Lasers Surg. Med. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC

Background: The potential applications of artificial intelligence (AI) in dermatology are evolving rapidly. Chatbots are an emerging trend in healthcare that rely on large language models (LLMs) to generate answers to prompts from users. However, the factuality and user experience (UX) of such chatbots remain to be evaluated in the context of dermato‐oncology.Objectives: To examine the potential of Chat Generative Pretrained Transformer (ChatGPT) as a reliable source of information in the context of actinic keratosis (AK) and to evaluate clinicians' attitudes and UX with regard to the chatbot.Methods: A set of 38 clinical questions were compiled and entered as natural language queries in separate, individual conversation threads in ChatGPT (OpenAI, default GPT 3.5). Questions pertain to patient education, diagnosis, and treatment. ChatGPT's responses were presented to a panel of 7 dermatologists for rating of factual accuracy, currency of information, and completeness of the response. Attitudes towards ChatGTP were explored qualitatively and quantitatively using a validated user experience questionnaire (UEQ).Results: ChatGPT answered 12 questions (31.6%) with an accurate, current, and complete response. ChatGPT performed best for questions on patient education, including pathogenesis of AK and potential risk factors, but struggled with diagnosis and treatment. Major deficits were seen in grading AK, providing up‐to‐date treatment guidance, and asserting incorrect information with unwarranted confidence. Further, responses were considered verbose with an average word count of 198 (SD 55) and overly alarming of the risk of malignant transformation. Based on UEQ responses, the expert panel considered ChatGPT an attractive and efficient tool, scoring highest for speed of information retrieval, but deemed the chatbot inaccurate and verbose, scoring lowest for clarity.Conclusions: While dermatologists rated ChatGPT high in UX, the underlying LLMs that enable such chatbots require further development to guarantee accuracy and concision required in a clinical setting.

Background: The growing interest in the visualization of psoriatic nail unit changes has led to the discovery of an abundance of image characteristics across various modalities.Objective: To identify techniques for non‐invasive imaging of nail unit structures in psoriatic patients and review extracted image features to unify the diverse terminology.Methods: For this systematic scoping review, we included studies available on PubMed and Embase, independently extracted image characteristics, and semantically grouped the identified features to suggest a preferred terminology for each technique.Results: After screening 753 studies, 67 articles on the visualization of clinical and subclinical psoriatic changes in the nail plate, matrix, bed, folds and hyponychium were included. We identified 4 optical and 3 radiological imaging techniques for the assessment of surface (dermoscopy [n = 16], capillaroscopy [n = 12]), sub‐surface (ultrasound imaging [n = 36], optical coherence tomography [n = 4], fluorescence optical imaging [n = 3]), and deep‐seated psoriatic changes (magnetic resonance imaging [n = 2], positron emission tomography‐computed tomography [n = 1]). By condensing 244 image feature descriptions into a glossary of 82 terms, overall redundancy was cut by 66.4% (37.5%–77.1%). More than 75% of these image features provide additional disease‐relevant information that is not captured using conventional clinical assessment scales.Conclusions: This review has identified, unified, and contextualized image features and related terminology for non‐invasive imaging of the nail unit in patients with psoriatic conditions. The suggested glossary could facilitate the integrative use of non‐invasive imaging techniques for the detailed examination of psoriatic nail unit structures in research and clinical practice.