Adjunct use of optical coherence tomography increases the detection of recurrent basal cell carcinoma over clinical and dermoscopic examination alone.

BACKGROUND: Basal cell carcinoma (BCC) is a locally destructive form of skin cancer, mainly affecting Caucasians. In the last few years non-surgical treatments of BCC have become widely used and non-invasive methods for treatment monitoring and follow-up are therefore becoming increasingly warranted. The objective of this study was to investigate the utility of adjunct use of non-invasive optical coherence tomography (OCT) imaging for the detection of recurrent BCC over clinical and dermoscopic examination alone, in a real-world setting. METHODS: A total of 58 patients, previously treated with curettage and/or MAL-PDT for BCC, were included in the study. The patients were examined clinically and dermoscopically for recurrence by a dermatologist before joining the study. The included patients were then OCT scanned and if the OCT images raised suspicion of recurrent BCC the area was biopsied. RESULTS: In 6 cases the clinical examination revealed suspicions recurrent lesions and OCT correctly identified all of these (6/6). In 49 cases the follow-up examinations showed no clinical or dermoscopic signs of recurrence, but in 12.2% (6/49) of these cases the subsequent OCT examination revealed a subclinical recurrent BCC lesion. These were all confirmed by histology. In 3 cases both the clinical and the OCT diagnosis was unclear and recurrent BCC could not be ruled out, but histology showed no sign of malignancy. CONCLUSIONS: These results suggest that the adjunct use of OCT increases the detection rate of recurrent BCC over clinical/dermoscopy examination alone.

In vivo thickness measurement of basal cell carcinoma and actinic keratosis with optical coherence tomography and 20-MHz ultrasound.

BACKGROUND: Accurate assessment of tumour size is important when planning treatment of nonmelanoma skin cancer (NMSC). Imaging with optical coherence tomography (OCT) has the potential to diagnose and measure depth of NMSC. OBJECTIVES: To compare accuracy of mean tumour thickness measurement in NMSC tumours < 2 mm of depth using OCT and 20-MHz high-frequency ultrasound (HFUS). In addition, OCT morphology of NMSC was studied in OCT images and the influence of histological and colorimetric values on the quality and penetration depth in OCT images was estimated. METHODS: In total, 93 patients were scanned and 34 lesions [23 basal cell carcinoma (BCC) and 11 actinic keratosis (AK) lesions] < 2 mm thick and easily identified in OCT images were studied. OCT and HFUS were compared with biopsies. The influence of skin pigmentation and infiltration analgesia on OCT image quality was studied. Skin colour was measured with a colorimeter. RESULTS: OCT presented narrower limits of agreement than HFUS. Both methods overestimated thickness but OCT was significantly less biased (0.392 mm vs. 0.713 mm). No relation between OCT penetration depth and skin colour was found. CONCLUSIONS: OCT appears more precise and less biased than HFUS for thickness measurement in AK and BCC lesions < 2 mm, but both OCT and especially HFUS tended to overestimate tumour thickness.

One-day or two-day procedure for sentinel node biopsy in melanoma?

PURPOSE: We compared the outcome of a 1-day and a 2-day sentinel node (SN) biopsy procedure, evaluated in terms of lymphoscintigraphic, surgical and pathological findings. METHODS: We studied 476 patients with melanoma from two melanoma centres using static scintigraphy and blue dye. A proportional odds model was used for statistical analysis. RESULTS: The number of SNs visualized at scintigraphy increased significantly with time from injection to scintigraphy and activity left in the patient at scintigraphy, and depended on the melanoma location. The number of SNs removed at surgery increased with the number of SNs visualized at scintigraphy and time from injection to surgery. The frequency of nodal metastasis increased with increasing thickness and Clark level of the melanoma, and was highest for two SNs visualized at scintigraphy. CONCLUSION: This study showed that early vs. late imaging and surgery do make a difference on the outcome of the SN procedure and confirmed the importance of the scintigraphic visualization of all true SNs.

Optical coherence tomography imaging of bullous diseases.

BACKGROUND: Optical coherence tomography (OCT) is a non-invasive optical imaging technique with a micrometer resolution that may potentially offer real-time bedside imaging of sufficient detail to allow for morphological discrimination between different types of bullae. OBJECTIVE: To explore the potential of OCT in bullous skin disorders by looking at a set of patients with skin blisters of known origin and study the OCT images for possible hallmarks of the blistering level. MATERIALS AND METHODS: OCT provides cross-sectional, tomographic images of the skin. A consecutive series of patients were recruited and their lesions imaged by OCT: 3 patients with bullous pemphigoid (BP), 1 patient with extensive bullae following burns, 1 patient with pemphigus, 1 patient with subcorneal pustular dermatosis, and a patient with Dariers disease. The latter two were included due to similarity to pemphigus with respect to the level of defect cell adhesion. RESULTS: In OCT images, BP bullae are easily depicted as dark, ovoid to round well-demarquated areas, and BP bulla morphology is clearly different from the burn blisters and the pemphigus-like disease with respect to the blistering level. DISCUSSION: Differentiation of epidermal and subepidermal blisters is demonstrated using OCT. The variation within pemphigoid lesions and pemphigus-like diseases is however too subtle to allow for differential diagnosis; this may be ascribed to limited resolution. Enhanced resolution of OCT may overcome this obstacle.

Experimental implant-related osteomyelitis induced withStaphylococcus aureus.

Experimental knee-implant infection was induced in the rabbit knee with a strain (1369,phage type 85,a laboratory strain) of Staphyloccus aureus. The experimental model was adapted from an experimental study in rabbits by Gudmund Blomgren, 1981. In these experiment's osteomyelitis was induced with an noculum of 100,000 bacteria in the tibia and femur. In one series we used gentamicin impregnated bone cement and in the other series dicloxacillin was given intravenously. The controlgroup, four rabbits had no supplemental antibiotics. The animals were monitored by clinical observation, microbiological, histological and antibody methods. Only in the controlgroup without supplemental antibiotics we would see manifest inflammation around the prosthesis with increased antibody titre. With supplemental antibiotics no bacteria was found around the prosthesis.The gentamicin concentration was measured in bone from femur, tibia and from the jointfluid. A high level of gentamicin was found in the bone but not in the joint fluid. The animal model was excellent to create a model for human total joint replacement to study the dissemination of localy and intravenously injected bacteria to the artificial joint. The use of either systemic or locally administered antibiotics as prophylaxis avoided development of infection.

[Squamous cell carcinoma developing in chronic fistulating osteomyelitis]. / Planocellulaert karcinom udviklet i kronisk fistulerende osteomyelitis.

Two cases of carcinoma which had developed in chronic fistulating osteomyelitis are presented. In one case the patient was cured by an above-the-knee-amputation. In the other case the patient was also treated by amputation, but died of metastases. The need for active surgical treatment of chronic osteomyelitis is emphasized.