Exploring the Utilization of Imaging Modalities in the Diagnosis of Basal Cell Carcinoma: A Scoping Review

Abstract

Basal cell carcinoma (BCC) is a common skin cancer that occurs due to various genetic and environmental factors. Diagnosis is made by a combination of clinical appearance, biopsy, imaging, and histopathological analysis. This review describes the current array of imaging modalities available to physicians to aid in the diagnosis of BCC. It is important to stay up-to-date with improvements in diagnostic screening, and knowledge of these options is instrumental in providing the best care to patients. Embase, Medline Industries, and PubMed were searched for articles within the past 10 years based on a search query that looked for imaging modalities used in the diagnosis and evaluation of a variety of dermatologic conditions. The search was further refined to focus on BCC and satisfy the inclusion/exclusion criteria determined by the authors. The research process was detailed in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. Dermoscopy is a non-invasive in vivo microscopic technique used to evaluate skin lesions. Features of dermoscopy cannot be visualized with the naked eye, and studies found that dermoscopy increased diagnostic accuracy. Reflectance confocal microscopy (RCM) examines skin morphology, and recent studies found that 100% of patients with BCC had tumor-free margins when diagnosed with RCM. It allows for a one-stop-shop for diagnosis. Optical spectroscopy samples multiple sites without removing tissue. It helps detect subtle biophysical differences, allowing for earlier diagnosis. High-frequency ultrasound (HFUS) helps determine tumor size, structure, depth of invasion and spread. Studies found statistically significant positive correlations between depth of spread and HFUS readings. Optical coherence tomography takes cross-sectional images to analyze histopathology and morphology. It produces high-resolution images, confers slightly more accurate results than a biopsy, and expedites the treatment process through an earlier diagnosis without a biopsy.These results will advance the fields of dermatology and radiology as they describe unique uses for these imaging modalities. There are a variety of ways to use microscopy, and these techniques may be applied to many different lesions and help revolutionize the diagnosis and treatment of skin cancer and other lesions without the need for multiple, sometimes disfiguring surgical procedures. With the increase in diagnostic accuracy and decrease in diagnosis time, advanced imaging studies will become an integral part of dermatologic diagnosis and be included in future management and treatment plans, especially in the case of BCC.

Keywords: basal cell carcinoma; bcc; dermoscopy; optical spectroscopy; reflectance confocal microscopy.

Figure 1. PRISMA diagram

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses