++
SUMMARY
Traditionally, the diagnosis of skin cancer relies on physical examination (ie, with the unaided eye) and is often followed by a biopsy of suspicious lesions. Although histopathological examination is the gold standard for skin cancer diagnosis, it is an invasive procedure associated with potential complications, such as pain, infection, bleeding, scarring, and hypo- and hyperpigmentation, among others.
Recently, many noninvasive imaging techniques have been developed to overcome the existing limitations. These techniques include optical/light-based imaging techniques (such as dermoscopy, reflectance confocal microscopy [RCM], and optical coherence tomography [OCT]) and nonoptical imaging techniques (such as ultrasonography and magnetic resonance imaging), among others.
In this chapter, we will first review noninvasive imaging devices that are being used in daily clinical practice. Second, we will discuss imaging modalities that are being currently investigated and that we anticipate will be used in the future.
Major limitations for the widespread adaptation of noninvasive imaging devices are their cost, the learning curve for reading the images, and the lack of teaching-training programs. In the future, the use of artificial intelligence (AI) algorithms might be an aid towards global utilization and acceptance. We envision that a combination of noninvasive imaging aided by AI diagnosis has the potential to create a major paradigm shift in dermatology practice and patient care.
++
DON’T FORGET
Noninvasive imaging devices should always be used in conjunction with clinical and dermoscopy evaluation.
Negative findings in the case of a clinically suspicious melanoma should either be monitored closely or biopsied for histopathological confirmation.
++
CLINICAL PEARLS
Noninvasive imaging methods are being used primarily to triage lesions into those that need a biopsy and those that can be saved from biopsy and to aid in noninvasive treatment monitoring.
A combination of noninvasive methods may be required for the evaluation and management of a given lesion, such as RCM for diagnosing basal cell carcinoma (BCC) at high resolution and OCT or ultrasonography to determine the extent of the lesion.
++
PATIENT EDUCATION POINTS
Patients should be made aware of the noninvasive nature of these techniques. However, they should also understand that a biopsy may be needed in case of an inconclusive result.
For lesions not biopsied, patients should be advised to keep an eye for any progression of the lesion and to immediately contact their dermatologist, if needed.
Patients should be instructed to stay still during the process of imaging, which is quintessential for acquiring good quality images for diagnosis.
++
Traditionally, the diagnosis of skin cancer relies on physical examination (ie, with the unaided eye) and is often followed by a biopsy of suspicious lesions. Although histopathological examination is the gold standard for skin cancer diagnosis, it is an invasive procedure associated with potential complications, such as pain, infection, bleeding, scarring, and hypo- and hyperpigmentation, among others.1 Biopsies are especially problematic in the setting of multiple lesions and lesions located ...