Dynamic Optical Coherence Tomography: A Non-Invasive Imaging Tool for the Distinction of Nevi and Melanomas

Abstract

Along with the rising melanoma incidence in recent decades and bad prognoses resulting from late diagnoses, distinguishing between benign and malignant melanocytic lesions has become essential. Unclear cases may require the aid of non-invasive imaging to reduce unnecessary biopsies. This multicentric, case-control study evaluated the potential of dynamic optical coherence tomography (D-OCT) to identify distinguishing microvascular features in nevi. A total of 167 nevi, including dysplastic ones, on 130 participants of all ages and sexes were examined by D-OCT and dermoscopy with a histological reference. Three blinded analyzers evaluated the lesions. Then, we compared the features to those in 159 melanomas of a prior D-OCT study and determined if a differential diagnosis was possible. We identified specific microvascular features in nevi and a differential diagnosis of melanomas and nevi was achieved with excellent predictive values. We conclude that D-OCT overcomes OCT´s inability to distinguish melanocytic lesions based on its focus on microvascularization. To determine if an addition to the gold standard of a clinical-dermoscopic examination improves the diagnosis of unclear lesions, further studies, including a larger sample of dysplastic nevi and artificial intelligence, should be conducted.

Imaging microvascular changes in nonocular oncological clinical applications by optical coherence tomography angiography: a literature review

“…In a more recent study, Welzel et al 24 assessed 159 melanomas from 156 consecutive patients and found that irregular vascular shapes, including blobs, curves and serpiginious vessels, were more common in high-risk and metastatic melanomas than in lowrisk lesions. Most recently, the same group 25 prospectively examined a total of 167 nevi, including dysplastic ones, in 130 participants and compared these microvascular features to those found earlier in 159 melanomas. 24 They found that increased blood vessel density and diameter and irregular tissue architecture were associated with melanomas, while nevi showed more regular structures and lower blood vessel density and diameter, indicating their benign nature (Figure 5).…”

“…Researchers also found excellent predictive diagnostic value of B C D A microvascular features (e.g., blobs, serpiginious vessels) for nevi (88.2% to 91%) and melanoma (95.5% to 96.8%) and concluded that OCTA "may be a valuable addition to the current clinical-dermoscopic gold standard". 25…”

Advancements in Dermatological Imaging Modalities

“…[ 23 ] The uses of dynamic OCT are summarized in Table 5 . [ 24 25 26 27 28 29 30 ] The disadvantages are similar to those of conventional OCT.…”