Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Acad Dermatol


Basal cell carcinoma (BCC) is the most common skin cancer worldwide. Mohs micrographic surgery is a highly used BCC treatment, involving staged resection of the tumor with complete histologic evaluation of the peripheral margins. A reduction in the number of Mohs stages would significantly improve care and could result in substantial economic benefits, estimated at $36 million USD in savings per annum. Noninvasive imaging modalities can potentially streamline the surgical management of skin cancers by refining presurgical assessments of tumor size. We assessed the current imaging techniques in dermatology and their application for tumor margin assessment of BCCs prior to Mohs micrographic surgery. These include dermoscopy, photodynamic diagnosis (PDD), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), reflectance confocal microscopy (RCM), and optical polarization imaging (OPI). Each technology is limited or strengthened by its resolution, depth, speed of imaging, field of view, maneuverability, and billing. RCM, and a combination of RCM with video mosaicking technique and OCT, appear to be promising imaging techniques in pre-surgical margin assessment because of the superior resolution of RCM and the enhanced depth of imaging of OCT. OPI is also favorable for margin assessment based on its field of view and maneuverability. Further research and efficacy studies are necessary before such techniques can be implemented widely. It is imperative that general dermatologists and Mohs surgeons alike are well informed regarding the existing technologies given the increasing incidence of skin cancer and the associated rising costs.





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