Histological correlates of optical coherence tomography in non-melanoma skin cancer

Background: Non-melanoma skin cancer (NMSC) is rarely fatal but is now the most common malignancy occurring in white populations, accounting for 70% of the cost of managing skin cancer. Optical coherence tomography (OCT) has the potential to improve diagnostic accuracy and help delineate pre-surgical margins in NMSC. Its widespread clinical acceptance awaits the accumulation of evidence from studies of direct histological comparisons. Method: In this study, seventy-eight subjects presenting with skin lesions, including 28 NMSCs, were imaged using the VivoSight (R) OCT scanner and a biopsy taken. Haemotoxylin and eosin stained histology sections were compared with the OCT images. Results: The depth of superficial basal cell carcinoma (BCC) lesions (<1 mm) can be measured accurately using OCT. A low-strength OCT signal at the periphery of the cell nests seen in superficial and nodular BCC is identified as corresponding to cellular palisading. A weak inverse linear correlation (r(2) = 0.3) is found between the optical attenuation coefficient measured on OCT and the nuclear-cytoplasmic ratio (N/C) of cells determined from histology. Conclusions: OCT has clinical value in providing accurate dimensional measurement of superficial BCC and in identifying the presence of peripheral palisading in nodular BCC.