Abstract

Introduction: Recently, a combined reflectance confocal microscopy (RCM)–optical coherence tomography (OCT) has been tested for the diagnosis of basal cell carcinoma (BCC). Evaluating the role of RCM–OCT in management of complex BCCs has not been studied. The objective of the study was to investigate the utility of a new combined RCM–OCT device in the evaluation and management of complex BCCs in a descriptive study. Methods: Prospective study of consecutive cases (July 2018–June 2019) of biopsy-proven ‘complex’ BCC defined as BCC in the head-and-neck area with multiple high-risk criteria such as large size in the mask area, multiple recurrences, and high-risk subtype. All cases were evaluated with a combined RCM–OCT device that provided simultaneous image viewing on a screen. Lesions were evaluated bedside with RCM–OCT according to previously described criteria. Results: Ten patients with complex head-and-neck BCCs had mean age of 73.1 ± 13.0 years. Six (60%) patients were males. Mean BCC clinical size was 1.9 ± 1.2 cm (range 0.6–4.0 cm). RCM detected residual BCC in 8 out of 10 cases (80%) and OCT detected residual BCC in all 10 cases (100%). Six BCCs (60%) had a depth estimate of > 1000 µm under OCT. In five cases, (50%) RCM–OCT imaging results led to a change/modification in BCC management. Conclusion: The use of a combined RCM–OCT device may help in the evaluation of complex head-and-neck BCCs by guiding treatment selection and defining the extent of surgery.