Monitoring the tumor margins of basal cell carcinomas is still a challenge in everyday clinical practice. Usually, the clinical margins of the tumor are marked by the naked eye or, even better, with dermoscopy before surgery and then examined in detail after the operation using histological examination. In order to achieve tumor freedom, several surgical steps are sometimes necessary, meaning that patients spend longer periods in hospital and the healthcare system is burdened more as a result. One way to improve this is the one-stop shop method, which requires precise diagnostics and margin marking before and during surgery so that tumor freedom can be achieved after just one surgery. For this reason, the current status of the diagnosis and treatment of basal cell carcinomas before and after surgery is to be examined following extensive literature research using devices and methods that have already been tested in order to determine how a simplified process of tumor margin control of basal cell carcinomas can be made possible both in vivo and ex vivo.

Background/Objectives: The surgical treatment of basal cell carcinoma (BCC) remains challenging due to the time-consuming, expensive and invasive nature of Mohs micrographic surgery. The objective is to develop a standardized protocol for managing diagnosis, surgery, and margin control within a single patient visit. Methods: Several protocols were tested to establish a “BCC-One-Stop-Shop”, combining in vivo and ex vivo margin mapping of BCC, pre- and postoperatively using Line-field confocal optical coherence tomography (LC-OCT). We introduce an algorithm enabling real-time localization of LC-OCT acquisitions on a previously acquired dermoscopy image. Additionally, an artificial intelligence model provides a BCC probability score based on LC-OCT images. Together, the co-localization algorithm and AI BCC model generate a color-coded visualization of the tumor within the dermoscopy image, allowing precise pre-operative in vivo margin assessment. Results: We found our protocol, the implementation of the co-localization tool and the AI model, to be quick to apply, easy to learn and helpful regarding the initial determination of BCC tumor margins. Patients responded positively to the recognizable visualization of the disease. Conclusions: Pre- and postoperative margin mapping using LC-OCT imaging appears to be effective and feasible and could reduce time, costs, resources, excision sizes and patient burden by sparing additional excision steps in micrographic surgery. The integration of real-time co-localization and the AI-calculated probability score represent meaningful and practical enhancements for routine clinical use. To further evaluate the efficacy and safety of the BCC-One-Stop-Shop-Method and the newly introduced device features, larger-scale studies are warranted and are currently being conducted.

Background/Objectives: Rapid optical assessment of freshly excised basal cell carcinoma (BCC) specimens may shorten the interval between excision and margin evaluation. This prospective pilot study estimated the diagnostic performance of ex vivo line-field confocal optical coherence tomography (LC-OCT) for detecting residual BCC at lateral surgical margins, using histopathology as the reference standard. Methods: Fifty-five clinically suspicious lesions from 48 patients were examined at two centers. Results were analyzed for the complete cohort and for a post-training inclusion phase comprising 32 lesions from 31 patients. Overall lesion-level consensus classifications were recorded separately from classifications of the four clock-face quadrants. Lesions with a negative overall LC-OCT assessment and at least one non-evaluable quadrant were classified as indeterminate and excluded from the primary lesion-level analysis. Thirteen lesions also underwent exploratory ex vivo fusion confocal microscopy (evFCM). Results: In the inclusion phase, 125 of 128 quadrants were evaluable. Thirteen true-positive, 106 true-negative, 2 false-negative, and 4 false-positive quadrant results yielded 86.7% sensitivity, 96.4% specificity, and 95.2% accuracy. At the lesion level, 2 of 32 results were indeterminate. Among the remaining 30 lesions, LC-OCT yielded 5 true-positive, 22 true-negative, 2 false-negative, and 1 false-positive results, corresponding to 71.4% sensitivity, 95.7% specificity, and 90.0% accuracy. The evFCM analysis was descriptive because the subset was small and nonconsecutive. Conclusions: Ex vivo LC-OCT showed promising specificity and overall accuracy for assessing lateral BCC margins after training. The limited number of margin-positive lesions, indeterminate results, clustered quadrant data, and absence of systematic deep-margin imaging require cautious interpretation. LC-OCT should not replace histopathological margin assessment on the basis of the present data.

Malignant eccrine differentiated sweat gland tumours, including porocarcinoma and eccrine spiradenocarcinoma, are rare and aggressive neoplasms that pose diagnostic and therapeutic challenges. This case report aims to describe the role of in‐vivo and ex‐vivo line‐field confocal optical coherence tomography (LC‐OCT), optical coherence tomography (OCT), and ex‐vivo fusion confocal microscopy (evFCM) in diagnosing and assessing the margins of a malignant eccrine differentiated sweat gland tumour with features of both porocarcinoma and eccrine spiradenocarcinoma. An 84‐year‐old man presented with a nodular scalp lesion. The lesion was evaluated using dermoscopy, OCT, in‐vivo and ex‐vivo LC‐OCT and evFCM. The findings were followed by Mohs micrographic surgery and histopathological examination to confirm the diagnosis. Dermoscopy revealed a vascular pattern with polymorphous vessels, while in vivo LC‐OCT and OCT demonstrated large nodules with necrotic areas and cuboidal cells. Ex‐vivo LC‐OCT and evFCM confirmed the complete tumour excision, corroborated by histology. Histopathologic evaluation identified a malignant epithelial tumour with two components: epithelioid clusters mimicking glandular lumina and polymorphic cells with pronounced pleomorphism. The diagnosis of a malignant eccrine differentiated sweat gland tumour with features of porocarcinoma and eccrine spiradenocarcinoma was made. This case highlights the utility of LC‐OCT, OCT, and evFCM in diagnosing and managing malignant eccrine differentiated sweat gland tumours. These noninvasive imaging techniques offer near‐histological resolution, enabling more precise diagnosis and margin assessment. Further studies are warranted to validate these findings and improve diagnostic protocols for such rare tumours.