title: In vivo assessment of optical properties of melanocytic skin lesions and differentiation of melanoma from non-malignant lesions by high-definition optical coherence tomography.
abstract: One of the most challenging problems in clinical dermatology is the early detection of melanoma. Reflectance confocal microscopy (RCM) is an added tool to dermoscopy improving considerably diagnostic accuracy. However, diagnosis strongly depends on the experience of physicians. High-definition optical coherence tomography (HD-OCT) appears to offer additional structural and cellular information on melanocytic lesions complementary to that of RCM. However, the diagnostic potential of HD-OCT seems to be not high enough for ruling out the diagnosis of melanoma if based on morphology analysis. The aim of this paper is first to quantify in vivo optical properties such as light attenuation in melanocytic lesions by HD-OCT. The second objective is to determine the best critical value of these optical properties for melanoma diagnosis. The technique of semi-log plot whereby an exponential function becomes a straight line has been implemented on HD-OCT signals coming from four successive skin layers (epidermis, upper papillary dermis, deeper papillary dermis and superficial reticular dermis). This permitted the HD-OCT in vivo measurement of skin entrance signal (SES), relative attenuation factor normalized for the skin entrance signal (µ raf1) and half value layer (z 1/2). The diagnostic accuracy of HD-OCT for melanoma detection based on the optical properties, µ raf1 , SES and z 1/2 was high (95.6, 82.2 and 88.9 %, respectively). High negative predictive values could be found for these optical properties (96.7, 89.3 and 96.3 %, respectively) compared to morphologic assessment alone (89.9 %), reducing the risk of mistreating a malignant lesion to a more acceptable level (3.3 % instead of 11.1 %). HD-OCT seems to enable the combination of in vivo morphological analysis of cellular and 3-D micro-architectural structures with in vivo analysis of optical properties of tissue scatterers in melanocytic lesions. In vivo HD-OCT analysis of optical properties permits melanoma diagnosis with higher accuracy than in vivo HD-OCT analysis of morphology alone.
authors.affiliation: Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. dr.boone@scarlet.be.
authors.forename: M A L M
authors.initials: MA
authors.lastname: Boone
authors.affiliation: Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Suppa
authors.affiliation: Research Department, Agfa HealthCare, Mortsel, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Dhaenens
authors.affiliation: Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Miyamoto
authors.affiliation: Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Marneffe
authors.affiliation: Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark.
authors.forename: G B E
authors.initials: GB
authors.lastname: Jemec
authors.affiliation: Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: Del Marmol
authors.affiliation: Research Department, Agfa HealthCare, Munich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Nebosis
mesh_terms: D000328:Adult; D000368:Aged; D020405:Dermis / Q000473:pathology; D046169:Dermoscopy / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods; D004817:Epidermis / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008544:Melanocytes / Q000473:pathology; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000175:diagnosis; D012189:Retrospective Studies; D012867:Skin / Q000166:cytology / Q000473:pathology*; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: Absorption; Benign nevi; Dysplastic nevi; High-definition optical coherence tomography; In vivo optical properties; Light attenuation; Melanocytic lesions; Melanoma; Reflectance; Scattering