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Until now, the clinical differentiation between a nevus and a melanoma is still challenging in some cases. Line-field confocal optical coherence tomography (LC-OCT) is a new tool with the aim to change that. The aim of the study was to evaluate LC-OCT for the discrimination between nevi and melanomas. A total of 84 melanocytic lesions were examined with LC-OCT and 36 were also imaged with RCM. The observers recorded the diagnoses, and the presence or absence of the 18 most common imaging parameters for melanocytic lesions, nevi, and melanomas in the LC-OCT images. Their confidence in diagnosis and the image quality of LC-OCT and RCM were evaluated. The most useful criteria, the sensitivity and specificity of LC-OCT vs. RCM vs. histology, to differentiate a (dysplastic) nevus from a melanoma were analyzed. Good image quality correlated with better diagnostic performance (Spearman correlation: 0.4). LC-OCT had a 93% sensitivity and 100% specificity compared to RCM (93% sensitivity, 95% specificity) for diagnosing a melanoma (vs. all types of nevi). No difference in performance between RCM and LC-OCT was observed (McNemar’s p value = 1). Both devices falsely diagnosed dysplastic nevi as non-dysplastic (43% sensitivity for dysplastic nevus diagnosis). The most significant criteria for diagnosing a melanoma with LC-OCT were irregular honeycombed patterns (92% occurrence rate; 31.7 odds ratio (OR)), the presence of pagetoid spread (89% occurrence rate; 23.6 OR) and the absence of dermal nests (23% occurrence rate, 0.02 OR). In conclusion LC-OCT is useful for the discrimination between melanomas and nevi.

Diagnosing clinically unclear basal cell carcinomas (BCCs) can be challenging. Line-field confocal optical coherence tomography (LC-OCT) is able to display morphological features of BCC subtypes with good histological correlation. The aim of this study was to investigate the accuracy of LC-OCT in diagnosing clinically unsure cases of BCC compared to dermoscopy alone and in distinguishing between superficial BCCs and other BCC subtypes. Moreover, we addressed pitfalls in false positive cases. We prospectively enrolled 182 lesions of 154 patients, referred to our department to confirm or to rule out the diagnosis of BCC. Dermoscopy and LC-OCT images were evaluated by two experts independently. Image quality, LC-OCT patterns and criteria, diagnosis, BCC subtype, and diagnostic confidence were assessed. Sensitivity and specificity of additional LC-OCT were compared to dermoscopy alone for identifying BCC in clinically unclear lesions. In addition, key LC-OCT features to distinguish between BCCs and non-BCCs and to differentiate superficial BCCs from other BCC subtypes were determined by linear regressions. Diagnostic confidence was rated as “high” in only 48% of the lesions with dermoscopy alone compared to 70% with LC-OCT. LC-OCT showed a high sensitivity (98%) and specificity (80%) compared to histology, and these were even higher (100% sensitivity and 97% specificity) in the subgroup of lesions with high diagnostic confidence. Interobserver agreement was nearly perfect (95%). The combination of dermoscopy and LC-OCT reached a sensitivity of 100% and specificity of 81.2% in all cases and increased to sensitivity of 100% and specificity of 94.9% in cases with a high diagnostic confidence. The performance of LC-OCT was influenced by the image quality but not by the anatomical location of the lesion. The most specific morphological LC-OCT criteria in BCCs compared to non-BCCs were: less defined dermoepidermal junction (DEJ), hyporeflective tumor lobules, and dark rim. The most relevant features of the subgroup of superficial BCCs (sBCCs) were: string of pearls pattern and absence of epidermal thinning. Our diagnostic confidence, sensitivity, and specificity in detecting BCCs in the context of clinically equivocal lesions significantly improved using LC-OCT in comparison to dermoscopy only. Operator training for image acquisition is fundamental to achieve the best results. Not only the differential diagnosis of BCC, but also BCC subtyping can be performed at bedside with LC-OCT.

This study explores the advanced imaging of skin vasculature using Line-Field Confocal Optical Coherence Tomography (LC-OCT), which offers high-resolution, three-dimensional (3D) visualization of vascular structures, especially within skin tumors. The research aims to improve the understanding of tumor angiogenesis and the complex vascular morphology associated with malignancies. The methodology involves converting original image stacks into negative images, manually tracing vessels using the Simple Neurite Tracer (SNT) plugin, and creating smoothed binary masks to reconstruct 3D models. The study’s results highlight the ability to visualize serpiginous, corkscrew-like, and irregular vessels across various skin cancers, including melanoma, squamous cell carcinoma, and basal cell carcinoma. These visualizations provide insights into vessel morphology, spatial arrangements, and blood flow patterns, which are crucial for assessing tumor growth and potential therapeutic responses. The findings indicate that 3D reconstructions from LC-OCT can uncover vascular details previously undetectable by two-dimensional imaging techniques, making it a valuable tool in dermatology for both clinical diagnostics and research. This method allows for better monitoring of skin cancer treatment and understanding of the role of vascular polymorphism in tumor development.

The prevalence of food and drug allergies has been steadily increasing in Germany. These conditions not only impair the quality of life of those affected but also place an additional burden on the health care system. At the same time, an increasing number of people are using the internet and other digital sources to seek health-related information. This study aimed to use the Google Ads Keyword Planner to identify the information needs and knowledge gaps of the internet-using population in Germany and to provide a foundation for future prevention and educational strategies regarding food and drug allergies. Relevant keywords related to selected food and drug allergies were extracted using the Google Ads Keyword Planner and analyzed according to predefined criteria. The observation period was from September 2022 to October 2024. A total of 633 keywords related to specific types of food and drug allergies were identified, generating a combined search volume of 3,649,390 queries. The most frequently searched terms nationwide were \"histamine allergy\" (368,980/3,649,390, 10.1%), \"penicillin allergy\" (266,410/3,649,390, 7.3%), and \"nut allergy\" (103,850/3,649,390, 2.8%). Although \"histamine allergy\" was the most frequently searched term in this analysis, most searches for \"histamine allergy\" likely referred to an intolerance rather than a true immunoglobulin E-mediated allergy. Seasonal patterns were also observed, with increased searches for the categories \"nut\" and \"penicillin\" in the winter months and for \"histamine\" in the spring months. This study demonstrates the potential of Google search query data analysis in a medical context and, in particular, underscores its relevance for understanding the public interest in food and drug allergies in Germany. The findings highlight the need for improved, easily accessible educational resources and for implementing allergy-specific, socially relevant health campaigns to address the unmet information needs of the population living in Germany regarding food and drug allergies.

Actinic keratosis (AK) is a common skin cancer in situ that can progress to invasive SCC. Line-field confocal optical coherence tomography (LC-OCT) has emerged as a non-invasive imaging technique that can aid in diagnosis. Recently, machine-learning algorithms have been developed that can automatically assess the PRO score of AKs based on the dermo-epidermal junction’s (DEJ’s) protrusion on LC-OCT images. A dataset of 19.898 LC-OCT images from 80 histologically confirmed AK lesions was used to test the performance of a previous validated artificial intelligence (AI)-based LC-OCT assessment algorithm. AI-based PRO score assessment was compared to the imaging experts’ visual score. Additionally, undulation of the DEJ, the number of protrusions detected within the image, and the maximum depth of the protrusions were computed. Our results show that AI-automated PRO grading is highly comparable to the visual score, with an agreement of 71.3% for the lesions evaluated. Furthermore, this AI-based assessment was significantly faster than the regular visual PRO score assessment. The results confirm our previous findings of the pilot study in a larger cohort that the AI-based grading of LC-OCT images is a reliable and fast tool to optimize the efficiency of visual PRO score grading. This technology has the potential to improve the accuracy and speed of AK diagnosis and may lead to better clinical outcomes for patients.

Background In the 2019/2020 winter semester, the University of Augsburg’s Faculty of Medicine introduced a competence-oriented model degree program with a spiral curriculum integrating theory and practice. A key feature, the clinical longitudinal course, emphasizes practical skills such as skin examination. Existing training materials for punch biopsies, e.g., foam models and fruit, have proven insufficient. This project aimed to create a realistic, cost-effective, reusable three-dimensional (3D) skin model to improve the teaching of punch biopsy and suturing techniques. Methods The 3D skin model was developed in a multistage process. It began with a 3D scan created via a handheld 3D scanner and refined in 3D modeling software. A fused deposition modeling (FDM) printer produced negative molds that were filled with silicone, resulting in a realistic model. After several iterations, a design was achieved that successfully simulated the tactile and functional aspects of punch biopsy and skin suturing. Student feedback was collected through an anonymous online questionnaire assessing perceived realism, usefulness for practicing punch biopsies and suturing, and impact on their confidence. Results The silicone-based skin simulator debuted in the 2023–2024 winter semester’s ‘examination of the skin’ course. A total of 82 students participated in the course, of whom 58 completed the evaluation questionnaire. The students used the model to perform punch biopsies and suturing, reporting that its material properties allowed these procedures to be practiced under course conditions. With a low production cost (of 0.62 € per model) compared to commercial models, it is a cost-efficient alternative to previous materials. The students provided positive feedback, reporting increased confidence in performing these procedures on humans for the first time. Conclusions The 3D training model is an important advancement in introducing 3D technologies in practical training, providing realistic, cost-effective practice for punch biopsy and suturing. Its successful integration into the curriculum highlights its potential for broader applications in medical education. The evaluation indicated that the model provided realistic skin properties and proved effective for practicing punch biopsies and suturing, thus addressing the limitations of traditional training materials.

Screening for gene mutations has become routine clinical practice across numerous tumor entities, including melanoma. gene mutations have been identified in various tumor types and acknowledged as a critical event in metastatic uveal melanoma, but their role in non-uveal melanoma remains inadequately characterized. A retrospective analysis of all melanomas sequenced in our department from 2014-2022 (n=2650) was conducted to identify mutated samples. Assessment of clinical and genetic characteristics was performed as well as correlations with treatment outcome. mutations were identified in 129 cases and distributed across the entire gene without any apparent hot spots. Inactivating mutations were more prevalent in uveal (55%) compared to non-uveal (17%) melanomas. Non-uveal mutated melanomas frequently exhibited UV-signature mutations and had a significantly higher mutation load than uveal melanomas. and mutations were common in uveal melanomas, while MAP-Kinase mutations were frequent in non-uveal melanomas with , V600 and Q61 mutations occurring in decreasing frequency, consistent with a strong UV association. Survival outcomes did not differ among non-uveal melanoma patients based on whether they received targeted or immune checkpoint therapy, or if their tumors harbored inactivating mutations. In contrast to uveal melanomas, where mutations serve as a significant prognostic indicator of an unfavorable outcome, mutations in non-uveal melanomas are primarily considered passenger mutations and do not appear to be relevant from a prognostic or therapeutic perspective.

Basal cell carcinoma (BCC) is the most frequent skin cancer with a rising incidence. It can imitate benign lesions for example, dermal nevus clinically and dermoscopically. Both entities show specific morphologic features in line‐field confocal optical coherence tomography (LC‐OCT) and optical coherence tomography (OCT). The aim was to differentiate both lesions via noninvasive imaging to prevent unnecessary surgery. A 63‐year‐old woman presented with a light brownish nodule on the left cheek and a brownish nodule on the right nasal slope/cheek, which were both evident since a few months. The clinical and dermoscopic appearance of both lesions was very similar including the differential diagnosis of a dermal nevus or BCC. Dynamic OCT of the lesion on the left cheek showed multiple hyporeflective nodules in the dermis with hypervascularization. Using LC‐OCT several hyporeflective round to ovoid nodules with hyporeflective clefting embedded in a hyperreflective surrounding connective tissue could be observed. These specific morphological criteria called millefeuille pattern led to the diagnosis of a nodular BCC. The lesion of the right cheek presented with a thickened epidermis and elongated rete ridges in dynamic OCT. Upon LC‐OCT examination a so‐called large wave like pattern presenting as undulating hyporeflective and hyperreflective lobular structures could be identified. Therefore, the diagnosis of a dermal nevus was made. Both lesions were identified correctly as confirmed histopathologically after shave excision. Since BCC can imitate benign lesions for example, dermal nevi, the use of OCT and LC‐OCT can facilitate the identification of BCC and its imitators. Noninvasive imaging can help to avoid unnecessary biopsy especially in areas where the skin is vulnerable to punch biopsy. Basal cell carcinoma can imitate dermal nevus clinically and dermoscopically. Both entities show specific morphologic features in line‐field confocal optical coherence tomography (LC‐OCT) and optical coherence tomography (OCT). Here we report a case of a 63‐year‐old woman who presented with two clinically very similar skin lesions on the face. We were able to differentiate both lesions via LC‐OCT and OCT correctly as confirmed histopathologically after excision. This case shows how non‐invasive imaging can help to avoid unnecessary surgery.

To date, therapeutic responses in plaque psoriasis are evaluated with clinical scores. No objective examination has been established. A recently developed non-invasive imaging tool, line-field confocal optical coherence tomography (LC-OCT), enables the in vivo live imaging of skin changes in psoriasis under therapy. The aim of this study was to measure therapeutic response clinically and with LC-OCT, comparing the subjectively scored epidermal changes with an AI-supported analysis. This prospective, observational study included 12 patients with psoriasis starting a systemic treatment with IL-17 inhibitors (secukinumab, ixekizumab, and bimekizumab). LC-OCT and clinical assessment with a local psoriasis and severity index of the study plaque and a control area were performed before the initiation of therapy as well as after 4 and 12 weeks of treatment. A manual and AI-supported measurement of the thickness of epidermis, stratum corneum, and undulation of the dermo-epidermal junction was carried out. Acanthosis and hyperkeratosis showed a significant reduction under treatment. AI-supported calculations were compared to subjective measurements showing good reliability with high correlation. AI-supported analysis of vascular changes may serve as a prognostic and therapeutic response marker in the future.

Background/Objectives: The surgical treatment of basal cell carcinoma (BCC) remains challenging due to the time-consuming, expensive and invasive nature of Mohs micrographic surgery. The objective is to develop a standardized protocol for managing diagnosis, surgery, and margin control within a single patient visit. Methods: Several protocols were tested to establish a “BCC-One-Stop-Shop”, combining in vivo and ex vivo margin mapping of BCC, pre- and postoperatively using Line-field confocal optical coherence tomography (LC-OCT). We introduce an algorithm enabling real-time localization of LC-OCT acquisitions on a previously acquired dermoscopy image. Additionally, an artificial intelligence model provides a BCC probability score based on LC-OCT images. Together, the co-localization algorithm and AI BCC model generate a color-coded visualization of the tumor within the dermoscopy image, allowing precise pre-operative in vivo margin assessment. Results: We found our protocol, the implementation of the co-localization tool and the AI model, to be quick to apply, easy to learn and helpful regarding the initial determination of BCC tumor margins. Patients responded positively to the recognizable visualization of the disease. Conclusions: Pre- and postoperative margin mapping using LC-OCT imaging appears to be effective and feasible and could reduce time, costs, resources, excision sizes and patient burden by sparing additional excision steps in micrographic surgery. The integration of real-time co-localization and the AI-calculated probability score represent meaningful and practical enhancements for routine clinical use. To further evaluate the efficacy and safety of the BCC-One-Stop-Shop-Method and the newly introduced device features, larger-scale studies are warranted and are currently being conducted.