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: Basal cell carcinoma (BCC) is the most frequent skin cancer in Caucasian populations. While dermoscopy supports diagnosis, accurate subtype classification requires histopathology. Line-field confocal optical coherence tomography (LC-OCT) offers high resolution, adequate penetration, and three-dimensional imaging, bridging the gap between dermoscopy and histopathology. This study assessed the concordance between LC-OCT and histopathology for BCC criteria and subtypes. : We retrospectively analyzed 127 histopathologically confirmed BCCs from the Departments of Dermatology and Pathology, Hôpital Erasme, Brussels. LC-OCT images and corresponding histopathological slides were evaluated. Objective analysis used a predefined checklist of LC-OCT criteria compared with histopathology. Subjective analysis consisted of independent side-by-side assessments of global resemblance by three observers with varying expertise. Concordance rates and κ statistics were calculated. : The objective analysis showed the highest concordance (≥80%) for lobules, blood vessels, bright cells, lobule location, and dermal-epidermal junction disruption. Intermediate concordance (50-80%) was found for hemispheric morphology, outer bright rim, stromal stretching, and parakeratosis. Inner dark rim and palisading showed low concordance (<50%). Subjective evaluations demonstrated strong resemblance between LC-OCT and histopathology (overall concordance 81.1%), ranging from 86.6% to 98.4% across observers. Interobserver agreement was slight overall (κ = 0.10, = 0.02), with one moderate pairwise κ (0.41). : LC-OCT demonstrates good concordance with histopathology for key diagnostic and subtype-discriminating BCC features. Despite variability in subtle criteria, the findings support LC-OCT as a clinically relevant tool for non-invasive diagnosis and management of BCC.

Background: Line-field confocal optical coherence tomography is a novel technology able to reproduce a “virtual biopsy” of the skin. The aim of this review is to explore the application of line-field confocal optical coherence tomography (LC-OCT) in various skin diseases, covering skin cancers, inflammatory and infectious skin diseases, genetic diseases, cosmetic procedures, and less common disorders. Methods: Study selection was conducted based on LC-OCT and using pertinent MeSh terms, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from inception to March 2024; to evaluate the quality and risk of bias of studies, Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used. Results: the search retrieved 154 papers according to the selection criteria; after removing publications by one or more of the exclusion criteria, a total of 96 studies were found to be suitable for the analysis. Conclusions: Increasing evidence supports the use of LC-OCT as an adjunctive diagnostic tool for the in vivo diagnosis of a variety of skin tumors. As this device can be considered a “bridge” between dermoscopy and histopathology, widening applications in numerous fields of clinical dermatology, including inflammatory skin disease treatment, presurgical mapping, cosmetic procedures, and monitoring of non-invasive therapies, have been explored.

Background/Objectives: Pigmented lesions of the genital area are of commonly occurrence, with population-based incidence estimated around 10–20%. Historically, invasive biopsy or surgical removal were recommended to obtain a definite diagnosis. Line-field confocal optical coherence tomography (LC-OCT) is a novel multimodality imaging tool, able to reproduce a “virtual biopsy” of skin lesions, offering vertical, horizontal, and three-dimensional (3D) imaging down to the mid-dermis with high-resolution real-time visualization. The aims of the study were (i) to describe the LC-OCT features in a series of benign and malignant pigmented genital lesions (PGLs), (ii) to investigate the impact of LC-OCT on the diagnostic accuracy, (iii) and to estimate the diagnostic concordance between LC-OCT and histopathology. Methods: This was a retrospective, cross-sectional study including histologically confirmed PGL investigated with LC-OCT over 2 years. Descriptive statistics were calculated for continuous and categorical variables. Diagnostic accuracy of LC-OCT and dermoscopy was compared, and the LC-OCT–histopathology diagnostic concordance was estimated. Results: A total of 96 PGLs were analyzed in 23 male and 57 female patients. Pathologic reporting consisted of 56 melanoses, 21 nevi (15 compound nevi and 6 atypical genital nevi), 10 melanomas, and 9 angiokeratomas. LC-OCT obtained higher diagnostic accuracy rather than dermoscopy; diagnostic concordance LC-OCT/histopathology was 91% (87/96; 95% CI 83.7–95.3). Melanoses were characterized by a continuous undulated junction. Common genital nevi were identified by the presence of regular dense nests, while dischoesive nests were seen in atypical genital nevi. Features of epidermal disarray with pagetoid cells, junctional atypia, and discohesive nests were observed in melanoma. Angiokeratomas showed the presence of dark vascular lacunae. Conclusions: Providing in vivo key clues with a resolution close to classic histopathology, LC-OCT may have a valuable role in the clinical management of PGLs, particularly when lesions involve large areas or are multiple in number.

The periocular region represents a highly sensitive anatomical area due to its functional relevance and aesthetic importance. It is frequently affected by a broad spectrum of cutaneous tumors, due to chronic exposure to ultraviolet radiation, hence an accurate diagnosis and lesion margin assessment is essential to guide appropriate treatment. Herein we summarize the current evidence on the use of reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and line-field confocal optical coherence tomography (LC-OCT) for the assessment of periocular skin tumors. A comprehensive literature search was conducted in the main databases following PRISMA 2020 guidelines. Studies published between 2015 and 2025 evaluating the application of RCM, OCT, and LC-OCT in skin tumors of this area were included. RCM was the most extensively studied modality, demonstrating utility in the characterization of pigmented and non-pigmented periocular lesions and in the identification of basal cell carcinoma-specific features. OCT provided complementary information by enabling visualization of deeper tissue structures, particularly in non-melanoma skin cancers; LC-OCT showed high concordance with histopathology providing practical advantages in this area. As a conclusion, non-invasive imaging techniques represent valuable tools in the evaluation of periocular skin tumors, as they may enhance diagnostic confidence and support clinical decision-making.

Limited data concerning the development of autoimmune skin diseases after COVID-19 vaccination are currently available. Recently, a few reports described the development, worsening or recurrence of alopecia areata after the administration of COVID-19 vaccines. High variability in terms of disease onset following vaccination as well as the heterogeneous topical and/or systemic treatment approaches have been described. Methods: All patient-related data and images were obtained as part of clinical routine. Diagnosis of alopecia areata was established according to clinical and trichoscopic findings, along with the exclusion of common differential diagnoses. Results. Twenty-four patients, 20 females (83.3%) and four males (16.7%), with a mean age of 39.1 years (age range: 14–66 years), were examined for the occurrence of alopecia areata within 16 weeks after COVID-19 vaccination. Out of 24, 14 patients (58.3%) experienced a patchy alopecia areata, while an extensive disease occurred in 10/24 patients (41.7%): six patients with whole scalp involvement (alopecia areata totalis) and four patients with the whole body affected (alopecia areata universalis). Twelve patients reported a history of autoimmune disease (50%). Treatment with topical corticosteroid was performed in almost all patients with patchy alopecia areata, whilst it was associated with systemic drugs (corticosteroids, minoxidil, cyclosporin) in the case of generalized alopecia areata and alopecia areata universalis. Mean baseline values of Severity of Alopecia Tool (SALT) score decreased from 43.4 to 36.6 after 12 weeks of treatment, with evidence of hair regrowth in 16/21 patients. Conclusion. This study described the occurrence of alopecia areata after COVID-19 vaccination and its management that implicates the use of both topical and systemic therapies.

Sonidegib is a Hedgehog pathway inhibitor (HHI) used as a first-line systemic treatment for patients with advanced basal cell carcinoma (aBCC). Alopecia is reported as a frequent adverse event (AE), occurring in 49% of patients. Forty-five patients with aBCC were treated with sonidegib between December 2022 and December 2023; among them, 11/45 patients developed alopecia. Trichoscopic features included yellow dots, black dots, exclamation mark hairs, and broken hairs. Upon LC-OCT examination, yellow dots were seen as dilated follicular dark spaces containing malted, nonhomogeneous material and outlined by bright collarets. Black dots corresponded to normal-sized follicular ostia filled with bright, homogeneous material and cadaverized hair. Exclamation mark hairs were short, dark dysmorphic hairs with different sizes of proximal and distal ends, and broken hairs were short dysmorphic hairs. LC-OCT may provide additional insights into early signs and clinical evolution of sonidegib-induced alopecia in patients with aBCC.

Abstract Introduction: Basosquamous carcinoma is an uncommon subtype of basal cell carcinoma (BCC), characterized by aggressive local growth and metastatic potential, that mainly develops on the nose, perinasal area, and ears, representing 1.2–2.7% of all head-neck keratinocyte carcinomas. Although systemic therapy with hedgehog inhibitors (HHIs) represents the first-line medical treatment in advanced BCC, to date, no standard therapy for advanced basosquamous carcinoma has been established. Herein, we reported a case series of patients affected by locally advanced basosquamous carcinomas, who were treated with HHIs. Case Presentation: Data of 5 patients receiving HHIs for locally advanced basosquamous carcinomas were retrieved (2 women and 3 males, age range: 63–89 years, average age of 77 years). Skin lesions were located on the head-neck area; in particular, 4 tumors involved orbital and periorbital area and 1 tumor developed in the retro-auricular region. A clinical response was obtained in 3 out of 5 patients (2 partial responses and 1 complete response), while disease progression was observed in the remaining 2 patients. Hence, therapy was interrupted, switching to surgery or immunotherapy. Conclusion: Increasing evidence suggests considering HHIs for large skin tumors developing in functionally and cosmetically sensitive areas, in patients with multiple comorbidities, although their use for basosquamous carcinoma require more exploration, large cohort populations, and long follow-up assessment.

Background: Acral melanocytic lesions often pose a diagnostic and therapeutic challenge for many clinicians. Reflectance confocal microscopy (RCM) is an imaging technique widely used for the assessment of skin cancers. The aim of this review is to explore the applicability of RCM for the diagnosis of nevi and melanoma on the acral sites. Methods: Study selection was conducted based on the application of RCM for acral melanocytic lesions. All types of articles (original articles, short reports, and single case reports) were included in the analysis following PRISMA updated guidelines. Results: The search retrieved 18 papers according to the selection criteria; after removing duplicate records and additional articles by one or more of the exclusion criteria, a total of seven studies were carefully evaluated. Conclusions: RCM seems a valuable and useful additional tool for the diagnosis of acral melanocytic lesions, and its use may decrease the need for invasive procedures to some extent. Visualization of deeper layers may be achieved through mechanical removal of the superficial stratum corneum.

Background/Objectives: Hidrocystomas, eccrine and apocrine, are rare cystic lesions that form benign tumors of the sweat glands. This study aimed to describe the clinical features of hidrocystomas and evaluate the role of non-invasive imaging techniques, including dermoscopy, Line-field Confocal Optical Coherence Tomography (LC-OCT), Reflectance Confocal Microscopy (RCM), and Ultra-High-Frequency Ultrasound (UHFUS), in their diagnosis. Methods: In total, seven cases of hidrocystomas were collected from the Dermatologic Clinic of the University of Siena, Italy. Predefined dermoscopic, LC-OCT, RCM, and UHFUS features were retrospectively described. Results: Overall, hidrocystomas were located on the face, mainly presenting as blue/purple-bluish translucent papules (71%). Dermoscopic examination revealed a homogeneous purple-bluish color (71%), white pale halo (71%), and shiny globules at the periphery (57%). LC-OCT identified a hyporeflective cupoliform round structure in the dermis with a bright and thick contour, while UHFUS showed a round structure in the dermis filled with hypoechoic content. Conclusions: Non-invasive imaging techniques could significantly enhance the diagnostic accuracy of hidrocystomas, aid in differentiation from other lesions, and minimize unnecessary biopsies.