Optical Imaging in Dermatology: Real-Time Diagnosis and Noninvasive Skin Cancer Monitoring
Clinical Summary
Bedside Optical Imaging for Dermatologic Diagnosis and Monitoring
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Bedside optical imaging, United States vs Europe: Currently used in limited U.S. centers but more commonly in Europe; supports noninvasive diagnosis of nonmelanoma skin cancers, treatment monitoring, lesion mapping before Mohs surgery or excision, and surveillance for recurrence.
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Optical imaging vs biopsy: Provides a noninvasive alternative that can reduce anxiety, scarring concerns, and repeat biopsies while enabling longitudinal lesion monitoring. Key limitation: light-based technologies generally image only to the superficial dermis and require user training.
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Optical coherence tomography (OCT) and AI integration: OCT, described as “like ultrasound but uses light,” faces adoption barriers including device cost, training, and workflow implementation. AI-assisted interpretation may reduce training requirements and expand future clinical use.
Reviewed by Jessica Garlewicz, Managing Digital Editor of Immunology Group
Dr Kristen Kelly discusses how bedside optical imaging technologies are transforming dermatologic diagnosis, treatment planning, and longitudinal monitoring for skin cancers and other conditions. Learn where optical imaging offers advantages over biopsy and dermoscopy, how AI may improve diagnostic accuracy, and what clinicians should consider regarding cost, training, and workflow integration.
Transcript
I'm Kristen Kelly, and I'm a professor and chair of the Department of Dermatology at the University of California, Irvine.
How is bedside optical imaging changing real-time diagnosis and decision-making for common and complex skin conditions?
Dr Kelly: So bedside optical imaging is not used widely in the United States now, except for a few centers just like ours at the University of California, Irvine. But I do think it's being used more often in Europe. And I think there's great opportunity here in the United States. We can use it for bedside diagnosis, for example, of non-melanoma skin cancers, as well as some other conditions. We can also use it to monitor therapy. For example, if we have treated a basal cell carcinoma to make sure the entire lesion is gone. You can also use it to map things out prior to, for example, Mohs surgery or other excisional methods. And then we can also use it for treatment monitoring to see if the lesion recurs and to non-invasively monitor things.
In what clinical scenarios does optical imaging provide the greatest value compared to traditional tools like dermoscopy or biopsy?
Dr Kelly: Well, the advantage of optical imaging compared to biopsy is, of course, it's non-invasive. So for most patients, a small biopsy is okay, but you can imagine, especially when a lesion, for example, is on the face, that there is some anxiety associated with that. Some patients are particularly concerned about a scar or just the pain that may go with the procedures. So this gives us an opportunity to non -invasively make a diagnosis. It also allows us to follow a lesion over time without repetitive biopsies and, again, potentially multiple scars. So there are definite advantages to this. There are limitations, however, as well. Optical imaging doesn't go particularly deep, so we can only go into the superficial dermis with light-based technologies, at least. There are some other technologies that can go a little bit deeper. And it does take a little bit of training in order to be able to use these. I will tell you though that AI is now getting into the picture and so there are going to be more and more opportunities for AI to help us make diagnoses so there'll be less need for special training.
What practical considerations—such as cost, training, and workflow integration—should clinicians keep in mind when adopting these technologies?
Dr Kelly: So for the light-based technologies, let's say optical coherence tomography, for example, which is kind of like ultrasound but uses light, there is cost associated with it in most clinics. In fact, almost all clinics in the United States do not have these devices. And so there is, again, a cost associated with it. There's also learning that has to go with it in order to be able to implement it well. There are, however, AI opportunities here in that the AI will help us to make the diagnosis so that there will be less training that'll need to be used. So it's something that I think has great opportunity in the United States. It could be very beneficial for our patients, decreasing the small risk of biopsies and help allaying fears, et cetera, but it will take some time to implement them.
