Non-Melanoma Skin Cancer Clearance after Medical Treatment Detected with Noninvasive Skin Imaging: A Systematic Review and Meta-Analysis

Abstract

Background/Objectives: Non-melanoma skin cancer (NMSC) treated with nonsurgical therapies can be monitored with noninvasive skin imaging. The precision of dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) in detecting clearance is unclear. We aim to report the proportion of persisting tumors identified with noninvasive technologies available in the literature. Methods: A systematic literature search was conducted on the PubMed and Cochrane Public Library Databases for articles published prior to November 2021. Statistical analyses were conducted with MedCalc 14.8.1 software. Results: A total of eight studies (352 lesions) reporting noninvasive imaging for NMSC clearance following nonsurgical treatment were included. Most (n = 7) reported basal cell carcinoma (BCC), and one study reported squamous cell carcinoma (SCC) clearance. A meta-analysis of the BCC clearance revealed that the summary effect for RCM was higher, as compared to the other techniques. Interestingly, the sensitivity and specificity for OCT were 86.4% (95% CI: 65.1–97.1) and 100% (95% CI: 94.8–100.0), respectively, whilst, for RCM, they reached 100% (95%CI: 86.8–100) and 72.5% (95% CI: 64.4–79.7), respectively. Conclusions: Routine clinical examination and dermoscopy underperform when employed for NMSC clearance monitoring, although they represent the first approach to the patient. OCT and RCM seem to improve the detection of persistent BCC after medical treatment.

Confocal microscopy and optical coherence tomography of inflammatory skin diseases in hairs and pilosebaceous units: A systematic review

“…A new era is evolving around image-guided diagnostics in dermatology, especially concerning skin cancers, [49][50][51][52] but also in inflammatory skin diseases such as psoriasis 53 and lupus erythematosus. 33 However, this study shows that there is a wide range of other skin disorders that can easily be imaged by OCT and RCM.…”

Photodynamic Therapy for the Treatment of Bowen’s Disease: A Review on Efficacy, Non-Invasive Treatment Monitoring, Tolerability, and Cosmetic Outcome

“…Dermoscopy can be used as a valuable follow-up tool in cases where non-surgical therapeutic options are chosen for the management of BD [17,67,68]. An illustrative example from our clinical experience is shown in Figure 3.…”

Concordance of reflectance confocal microscopy and gene expression profiling for melanocytic lesions with uncertain malignant potential: A case series

“…These shortcomings can potentially be minimized through utilization of newer adjuvant diagnostic technologies, including in vivo reflectance confocal microscopy (RCM), a non‐invasive diagnostic tool that provides high‐resolution cellular imaging 3,4 . Evidence has showed RCM accuracy in the diagnosis of melanoma, 5–7 including amelanotic lesions, 8,9 as well as non‐melanoma skin cancers 10–13 …”

“…3,4 Evidence has showed RCM accuracy in the diagnosis of melanoma, [5][6][7] including amelanotic lesions, 8,9 as well as non-melanoma skin cancers. [10][11][12][13] Gene expression profiling (GEP) has increasingly been used for prognostication of diagnosed melanoma and has proven to be a highly accurate ancillary tool for melanocytic lesions with uncertain malignant potential. 14,15 GEP combines artificial intelligence with validated diagnostic algorithms to characterize the molecular profile of a suspicious lesion as benign, intermediate-risk, or malignant.…”