Morphological Evaluation of Facial Pigmented Lesions with Line-Field Confocal Optical Coherence Tomography: Correlation with Reflectance Confocal Microscopy. A Pilot Study.

Abstract

Introduction: Facial pigmented lesions pose significant challenges for diagnosis and treatment planning due to their anatomical topography and complexity. Traditional methods like dermoscopy have limitations, and while reflectance confocal microscopy (RCM) offers in-vivo cellular resolution, it is hindered by shallow penetration. The recently developed line-field confocal optical coherence tomography (LC-OCT) combines the benefits of OCT and RCM, providing deeper penetration and three-dimensional cellular imaging.

Objectives: This study aims to assess the ability of LC-OCT in displaying morphological features correlated and compared with RCM and histopathological findings.

Methods: Over a period of 1-year, various pigmented facial lesions were selected, including solar lentigo, seborrheic keratosis, lichen planus-like keratosis, pigmented actinic keratosis, basal cell carcinoma, compound nevus, lentigo maligna, and invasive melanoma. LC-OCT and RCM were used for imaging, and their morphological features were compared. Lesions, except solar lentigo and compound nevus, were excised for histopathological evaluation. Morphological criteria from imaging were correlated with histopathological findings.

Results: LC-OCT matched RCM in spatial resolution while providing deeper tissue penetration and three-dimensional visualization. This advantage was particularly notable in pigmented actinic keratosis and basal cell carcinoma, where LC-OCT's vertical imaging offered unique diagnostic insights. It also enhanced the understanding of the architecture of melanocytic lesions.

Conclusion: LC-OCT adds new insight into the imaging and diagnosis of facial pigmented lesions, offering additional morphological features. This pilot study highlights its potential to improve diagnostic accuracy and patient care, with further research needed to assess its broader clinical applications.