Laser ablation of basal cell carcinomas guided by confocal microscopy Journal Article

Authors: Sierra, H.; Cordova, M.; Nehal, K.; Rossi, A.; Chen, C. S. J.; Rajadhyaksha, M.
Article Title: Laser ablation of basal cell carcinomas guided by confocal microscopy
Title Series: Proceedings of SPIE
Abstract: Laser ablation offers precise and fast removal of superficial and early nodular types of basal cell carcinomas (BCCs). Nevertheless, the lack of histological confirmation has been a limitation. Reflectance confocal microscopy (RCM) imaging combined with a contrast agent can offer cellular-level histology-like feedback to detect the presence (or absence) of residual BCC directly on the patient. We conducted an ex vivo bench-top study to provide a set of effective ablation parameters (fluence, number of passes) to remove superficial BCCs while also controlling thermal coagulation post-ablation to allow uptake of contrast agent. The results for an Er:YAG laser (2.9 um and pulse duration 250us) show that with 6 passes of 25 J/cm2, thermal coagulation can be effectively controlled, to allow both the uptake of acetic acid (contrast agent) and detection of residual (or absence) BCCs. Confirmation was provided with histological examination. An initial in vivo study on 35 patients shows that the uptake of contrast agent aluminum chloride) and imaging quality is similar to that observed in the ex vivo study. The detection of the presence of residual tumor or complete clearance was confirmed in 10 wounds with (additional) histology and in 25 lesions with follow-up imaging. Our results indicate that resolution is sufficient but further development and use of appropriate contrast agent are necessary to improve sensitivity and specificity. Advances in RCM technology for imaging of lateral and deep margins directly on the patient may provide less invasive, faster and less expensive image-guided approaches for treatment of BCCs. © 2016 SPIE.
Keywords: sensitivity and specificity; basal cell carcinoma; confocal microscopy; skin cancer; histology; diagnosis; patient treatment; reflectance confocal microscopies; skin cancers; coagulation; ablation; aluminum chloride; image-guided therapy; laser ablation; ablation parameters; histological examination; image guided therapy; thermal coagulations
Journal Title: Proceedings of SPIE
Volume: 9689
ISSN: 0277-786X
Publisher: SPIE  
Date Published: 2016-01-01
Start Page: 96890R-1
End Page: 96890R-5
Language: English
DOI: 10.1117/12.2213280
PROVIDER: scopus
Notes: Conference Paper -- Conference code: 121711 -- Export Date: 1 July 2016 -- The Society of Photo-Optical Instrumentation Engineers (SPIE) -- 13 February 2016 through 14 February 2016 -- Source: Scopus
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MSK Authors
  1. Kishwer S Nehal
    160 Nehal
  2. Chih-Shan Jason Chen
    21 Chen
  3. Anthony Rossi
    91 Rossi
  4. Miguel A Cordova
    43 Cordova