Abstract
Purpose :
Basal cell carcinoma (BCC) is the most common peri-ocular skin cancer. It is a slow growing tumour and early clinical diagnosis is often challenging. Admittedly, patients presenting with BCC report having the lesion for several years, having seen many health professionals before they are referred to oculoplastics.
In an era where telemedicine is the new norm, and in addition to stay-at-home orders in effect, patients are reluctant to seek medical attention in large specialized care centers. In attempt to facilitate referral of patients with suspicious lesions, primary eye care providers may benefit from an additional diagnostic tool.
Our team has previously shown how optical coherence tomography (OCT), a well-established and broadly available imaging modality, may facilitate the diagnostic of peri-ocular skin cancers. The aim of this project is to highlight common OCT features observed in BCC.
Methods :
This is part of an ongoing prospective study assessing patients with peri-ocular cancers; OCT images and clinical photos are obtained prior to surgical excision of the lesion. For this specific study, 51 patients with histopathologically confirmed BCC were selected. For each, OCT images were compared to their respective histopathological tissue sections.
Results :
A total 994 OCT images were obtained. The dermal-epidermal junction nearing the lesion is disrupted in 100% of malignancies. Hypo-reflective tumour nests underneath the epithelium are observed in 82% of BCC, while they are seldom observed in other malignancies. When present, hyperkeratosis and telangiectasia can also be viewed on OCT, however they are not pathognomonic of BCC.
The presence of sub-epithelial hypo-reflective nests on OCT appears to be a hallmark feature of nodular BCC, allowing to rule-in the diagnostic. This hypothesis is supported by a tight correlation between the OCT image and the microscopic histopathological findings for each lesion.
Conclusions :
Basal cell carcinoma on OCT shows a distinctive signature consisting of sub-epithelial hypo-reflective tumour nests with a neighboring disrupted epidermal-dermal junction.
Facilitating the early recognition of this slow-growing, often asymptomatic cancer provides eye care professionals with an additional tool to increase their confidence in the diagnosis of BCC and to encourage and expedite referral to a surgical specialist.
This is a 2021 ARVO Annual Meeting abstract.