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Optical Coherence Tomography–Based Optimization of Mohs Micrographic Surgery of Basal Cell Carcinoma: A Pilot Study

Authors


  • The study was funded by Michelson Diagnostics.
  • Adam Meekings, an employee of Michelson Diagnostics' scientific staff, performed the retrospective analysis of OCT pictures to test the margin identification criteria in a blinded manner. Katie Xiaoyi Wang, who was employed by LISC for the study, performed OCT imaging. Gordon McKenzie is the founder of Michelson Diagnostics and is a board member and stockholder. Daniel M. Siegel is on the advisory board of Michelson Diagnostics.

Address correspondence and reprint requests to: Orit Markowitz, MD, FAAD, 5 East 98th Street, 5th Floor, New York, NY 10021, or e-mail: omarkowitz@gmail.com

Abstract

Background

Optical coherence tomography (OCT) is a noninvasive imaging technique that uses a low-power infrared laser to image up to 2 mm beneath the skin's surface.

Objective

To test the feasibility and diagnostic value of using in vivo OCT to define excision margins before Mohs micrographic surgery (MMS) of basal cell carcinoma (BCC).

Methods

Patients with biopsy confirmed BCC undergoing MMS were recruited (n = 52). Excision margins defined by experienced dermatologists were compared with those of OCT-assessed borders and validated with histologic assessments.

Results

Forty-one (79%) lesions were clear after one MMS procedure; 11 (21%) lesions required a second MMS stage after excision of the clinician-predicted boundary. Generally, the OCT instrument indicated that the estimated clinical margin was 0.4-mm larger than the OCT margin. For lesions requiring a single MMS stage, OCT indicated that lesions were 1.4 ± 1.3 mm smaller than the Mohs excision. Before excision of lesions requiring more than one MMS stage, OCT always indicated that the lesion boundary would extend outside the planned MMS defect boundary.

Conclusions

The present study shows the prospective utility of using OCT to refine clinically estimated borders for MMS. OCT assessment has the potential to reduce the excised area without compromising the integrity of tumor-free borders.

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