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Extramammary Paget disease (EMPD) is an uncommon adenocarcinoma of apocrine gland-rich areas, presenting significant diagnostic challenges due to its nonspecific clinical appearance and frequent misidentification as benign, inflammatory skin conditions. Traditional diagnostic methods such as biopsy are invasive and uncomfortable, often required repeatedly due to high recurrence rates. Dermoscopy and non-invasive imaging techniques have been used but provide limited diagnostic accuracy due to their constraints in depth penetration and resolution. Recent advancements in imaging technologies, such as line-field confocal optical coherence tomography (LC-OCT), show promise in enhancing diagnostic precision while minimizing invasive procedures. LC-OCT merges high-resolution imaging with deep penetration capabilities, capturing detailed horizontal and vertical skin images akin to histopathology. This study evaluated the diagnostic performance of LC-OCT in detecting EMPD and its recurrence in 17 clinically suspicious anogenital regions, belonging to six patients. Data were collected prospectively at the patient's bedside by an LC-OCT expert with poor training for EMPD, and, then, reviewed retrospectively by an independent LC-OCT expert with adequate training for EMPD and no concerns about time. The prospective examination yielded 64.7% accuracy (11 true results out of 17 total cases), 71.4% sensitivity (10 true positives out of 14 actual positives), and 33.3% specificity (1 true negative out of 3 actual negatives). The retrospective analysis achieved 94.1% accuracy (16 true results out of 17 total cases), 100% sensitivity (14 true positives out of 14 actual positives), and 66.7% specificity (2 true positives out of 3 actual positives), with the only false positive case being a difficult-to-diagnose concomitant presentation of a lichen sclerosus et atrophicus. Despite the need for specialized training, our results suggest that LC-OCT represents a valuable tool for accurately identifying EMPD and improving its management by reducing unnecessary biopsies. Further studies are needed to standardize its clinical application. [ABSTRACT FROM AUTHOR]

Byline: Linda. Tognetti, Diletta. Fiorani, Mariano. Suppa, Elisa. Cinotti, Margot. Fontaine, Veronique. Marmol, Pietro. Rubegni, Jean. Perrot Sir, Three women presented with a solitary eroded patch on the thenar eminence [...]

This article discusses a new dermoscopic criterion for diagnosing basal cell carcinoma (BCC) called "negative maple-leaf-like areas" (NMLLAs). NMLLAs are round, nonpigmented structures with a whitish background and well-defined borders. They are associated with superficial BCC and correspond to non-pigmented tumor nests at the dermal-epidermal junction level. The article also introduces a new technology called line-field confocal optical coherence tomography (LC-OCT), which combines the advantages of reflectance confocal microscopy (RCM) and conventional OCT. LC-OCT allows for a precise correlation of dermoscopic criteria with skin images. The article presents a case study that demonstrates the correlation between NMLLAs seen in dermoscopy and hemispheric BCC lobules observed with LC-OCT. The use of LC-OCT may help clinicians identify NMLLAs, which can be difficult to recognize. Further studies are needed to confirm this hypothesis. [Extracted from the article]

Epidermal three‐dimensional (3D) topography/quantification has not been completely characterized yet. The recently developed line‐field confocal optical coherence tomography (LC‐OCT) provides real‐time, high‐resolution, in‐vivo 3D imaging of the skin. This pilot study aimed at quantifying epidermal metrics (epidermal thicknesses, dermal‐epidermal junction [DEJ] undulation and keratinocyte number/shape/size) using 3D LC‐OCT. For each study participant (8 female, skin‐type‐II, younger/older volunteers), seven body sites were imaged with LC‐OCT. Epidermal metrics were calculated by segmentations and measurements assisted by artificial intelligence (AI) when appropriate. Thicknesses of epidermis/SC, DEJ undulation and keratinocyte nuclei volume varied across body sites. Evidence of keratinocyte maturation was observed in vivo: keratinocyte nuclei being small/spherical near the DEJ and flatter/elliptical near the skin surface. Skin microanatomy can be quantified by combining LC‐OCT and AI. This technology could be highly relevant to understand aging processes and conditions linked to epidermal disorders. Future clinical/research applications are to be expected in this scenario. [ABSTRACT FROM AUTHOR]

Introduction Objectives Materials and Methods Results Conclusions Line‐field confocal optical coherence tomography (LC‐OCT) represents one of the newest non‐invasive in vivo skin imaging techniques. Previous studies described morphologic criteria of basal cell carcinoma (BCC) under LC‐OCT examination. Preliminary data on LC‐OCT diagnostic performance for BCC have recently been published but showed only a modest improvement compared to dermoscopy, possibly due to study limitations.The main objective of this study was to find diagnostic performance parameters of LC‐OCT for differentiating BCC from its clinical/dermoscopic mimickers and for discriminating among BCC subtypes. An additional objective was to suggest a simple, user‐friendly diagnostic algorithm based on the most powerful LC‐OCT features in the field of BCC and its imitators.Equivocal BCC lesions imaged with an LC‐OCT device prior to biopsy/excision were included. Three observers blinded for histopathological diagnosis retrospectively formulated clinical, dermoscopic and LC‐OCT diagnoses and evaluated LC‐OCT features for each study lesion.A total of 303 lesions (173 BCCs and 130 non‐BCCs) from 225 patients were included. For the differentiation of BCC from BCC imitators, the use of LC‐OCT increased the diagnostic accuracy compared to clinical examination by 24% and compared to dermoscopy by 12%. For the discrimination of sBCC from other BCC subtypes, LC‐OCT increased the diagnostic accuracy compared to clinical examination by 18% and compared to dermoscopy by 12%. The presence of lobule with millefeuille pattern was a significant feature for BCC diagnosis. Lobule shape and location allowed BCC subtype discrimination.The accuracy of BCC diagnosis can be increased by at least 12% with the use of LC‐OCT compared to clinical and dermoscopic examinations alone, both in terms of BCC differentiation from clinical/dermoscopic imitators and in terms of BCC‐subtype discrimination. A diagnostic algorithm based on significant features for BCC diagnosis is proposed, for which further validation is required. [ABSTRACT FROM AUTHOR]

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease for which certain risk factors are well known: obesity and smoking (in particular). However, the factors associated with more severe conditions, and therefore potential aggravators of the disease, remain a matter of debate. Our study aims to determine the clinical factors associated with severe HS using several severity scores., Methods: The data were obtained via the ERHS questionnaire from patients exclusively recruited at Erasme Hospital in Brussels. The severity of HS was firstly estimated by the Hurley score, and secondly by a metascore, a system combining the iHS4, HS-PGA, SAHS, and DLQI. Univariable and multivariable analyses were performed., Results: Six hundred and forty-seven patients were included in the Hurley analysis, and 456 patients in the metascore analysis. In multivariable analysis, men have a more severe metascore than women (odds ratio [OR] = 1.89, p = 0.022), smoking was associated with a more severe disease according to metascore, especially in mild cases (OR = 0.76, p = 0.043), and an elevated body mass index was associated with having Hurley stage III disease compared to Hurley I or II disease (OR = 1.09, p = 0.001). A significant association is also shown between blood pressure and Hurley stage (OR = 0.97, p = 0.025). Self-reports of nonsteroidal anti-inflammatory drugs aggravating the disease is also a factor associated with greater severity according to the metascore (OR = 0.12, p = 0.008). Finally, several locations of HS lesions were associated with greater severity, in particular the armpits according to the metascore (OR = 0.29, p < 0.001), and the perianal area according to the Hurley score (OR = 0.15, p < 0.001)., Conclusion: HS seems to be more severe in men; smoking seems to aggravate mild cases of HS, while increased body mass index plays a major role in the transition from Hurley II to Hurley III., (© 2024 S. Karger AG, Basel.)

Introduction: Line-field confocal optical coherence tomography (LC-OCT) is a recently introduced, non-invasive skin imaging technique combining the technical advantages of reflectance confocal microscopy and conventional OCT in terms of isotropic resolution and in-tissue penetration. Several studies have been published so far about the use of LC-OCT in melanocytic and non-melanocytic skin tumors. The aim of this review was to summarize the currently available data on the use of LC-OCT for benign and malignant melanocytic and non-melanocytic skin tumors., Evidence Acquisition: We searched scientific databases for any literature published up to 30 th April 2023 and concerning the use of LC-OCT for melanocytic and non-melanocytic skin tumors. Identified papers were evaluated, and relevant information was extracted., Evidence Synthesis: A total of 29 studies were found including original articles, short reports, and letters to the Editor: 6 applied to melanocytic skin tumors, 22 to non-melanocytic skin tumors and 1 to both. The use of LC-OCT increased the diagnostic accuracy for melanocytic and non-melanocytic skin lesions. The highest diagnostic performance was found for basal cell carcinoma (BCC), but significant improvements in the diagnostic accuracy were also detected for the differentiation of actinic keratosis (AK) from squamous cell carcinoma (SCC) and of melanoma from nevi. The LC-OCT features of other skin tumors were also described and successfully correlated with histopathology., Conclusions: LC-OCT proved to increase the diagnostic accuracy for melanocytic and non-melanocytic skin lesions, thanks to the combination of high resolution/penetration, 3D reconstructions, and integrated dermoscopy. Although BCC seems the most suitable tumors for LC-OCT examination, the device is extremely performant for the differentiation of AK from SCC and the discrimination of melanoma from nevi as well. Additional studies on diagnostic performance and new investigations about the presurgical assessment of tumor margins with LC-OCT and its association with human and artificial intelligence algorithms are in progress.