This study explores the advanced imaging of skin vasculature using Line-Field Confocal Optical Coherence Tomography (LC-OCT), which offers high-resolution, three-dimensional (3D) visualization of vascular structures, especially within skin tumors. The research aims to improve the understanding of tumor angiogenesis and the complex vascular morphology associated with malignancies. The methodology involves converting original image stacks into negative images, manually tracing vessels using the Simple Neurite Tracer (SNT) plugin, and creating smoothed binary masks to reconstruct 3D models. The study’s results highlight the ability to visualize serpiginous, corkscrew-like, and irregular vessels across various skin cancers, including melanoma, squamous cell carcinoma, and basal cell carcinoma. These visualizations provide insights into vessel morphology, spatial arrangements, and blood flow patterns, which are crucial for assessing tumor growth and potential therapeutic responses. The findings indicate that 3D reconstructions from LC-OCT can uncover vascular details previously undetectable by two-dimensional imaging techniques, making it a valuable tool in dermatology for both clinical diagnostics and research. This method allows for better monitoring of skin cancer treatment and understanding of the role of vascular polymorphism in tumor development.

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.

To date, therapeutic responses in plaque psoriasis are evaluated with clinical scores. No objective examination has been established. A recently developed non-invasive imaging tool, line-field confocal optical coherence tomography (LC-OCT), enables the in vivo live imaging of skin changes in psoriasis under therapy. The aim of this study was to measure therapeutic response clinically and with LC-OCT, comparing the subjectively scored epidermal changes with an AI-supported analysis. This prospective, observational study included 12 patients with psoriasis starting a systemic treatment with IL-17 inhibitors (secukinumab, ixekizumab, and bimekizumab). LC-OCT and clinical assessment with a local psoriasis and severity index of the study plaque and a control area were performed before the initiation of therapy as well as after 4 and 12 weeks of treatment. A manual and AI-supported measurement of the thickness of epidermis, stratum corneum, and undulation of the dermo-epidermal junction was carried out. Acanthosis and hyperkeratosis showed a significant reduction under treatment. AI-supported calculations were compared to subjective measurements showing good reliability with high correlation. AI-supported analysis of vascular changes may serve as a prognostic and therapeutic response marker in the future.

Background/Objectives: Topical imiquimod is an established non-invasive treatment for superficial basal cell carcinoma (sBCC). However, data on treatment-associated changes in tumor microvascularization remain limited. This study investigated vascular changes before and after imiquimod therapy using multimodal non-invasive imaging. Methods: In this single-center, prospective observational study, 31 basal cell carcinomas in 20 patients were examined before and 12–16 weeks after topical imiquimod therapy (5%, five times weekly for six weeks) using dermoscopy, dynamic optical coherence tomography (D-OCT), and line-field confocal optical coherence tomography (LC-OCT). Analyses were performed as paired before-and-after comparisons. While approved for sBCC, a small number of thin nodular and infiltrative BCCs were included exploratorily; subgroup analyses were not powered. Results: Dermoscopy showed a nominally significant shift toward smaller vessel diameter categories after therapy (ATS = 8.183, df = 1, p = 0.004). D-OCT-derived parameters (vessel density, vessel diameter, and depth of the vascular plexus) did not show nominally significant changes. LC-OCT showed nominally lower apparent intratumoral flow scores (ATS = 13.285, df = 1, p < 0.001), reduced occurrence of vessel-wall-associated intraluminal structures showing a rolling-like motion pattern (86.7% before treatment versus 33.3% after treatment; ATS = 13.357; df = 1, p < 0.001), and a reduction in maximum vessel diameter (ATS = 6.110, df = 1, p = 0.013). The primary LC-OCT inferential analyses were performed at the lesion level without adjustment for within-patient clustering and should therefore be interpreted as exploratory. An additional patient-cluster-adjusted paired change-score sensitivity analysis for LC-OCT maximum vessel diameter yielded a directionally consistent estimate (−17.81 µm; 95% CI: −34.40 to −1.23; p = 0.037). The primary exploratory endpoints were LC-OCT–based apparent intratumoral flow and maximum vessel diameter; secondary endpoints included dermoscopic and D-OCT–based vascular parameters. In the exploratory response-stratified analysis, the change in LC-OCT-based maximum vessel diameter did not differ significantly among the assigned response groups (Kruskal–Wallis H = 3.870, df = 2, raw p = 0.144; BH-adjusted p = 0.753). Conclusions: LC-OCT detected several exploratory vascular changes between the pre-treatment examination and follow-up and may provide complementary information for the non-invasive assessment of BCC after imiquimod therapy. Given the exploratory design, limited sample size, and lack of systematic histological confirmation, these findings are hypothesis-generating and require validation in larger prospective studies.

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.