Dynamic Optical Coherence Tomography: A Non-Invasive Imaging Tool for the Distinction of Nevi and Melanomas

SIMPLE SUMMARY: Nevi and melanomas are usually distinguished based on the current gold standard of a clinical-dermoscopic evaluation. Unclear cases, on the other hand, may require additional imaging. Optical coherence tomography (OCT) is a non-invasive imaging technique. It is routinely used for non-melanoma skin cancer but failed to recognize distinguishing features in melanocytic lesions. Dynamic OCT (D-OCT) visualizes microvascularization and has shown promise regarding non-melanoma skin cancer and melanomas. Currently, larger studies on nevi are lacking. Therefore, in this study, we described specific microvascular parameters in nevi and dysplastic nevi, compared them to melanomas, and evaluated D-OCT’s potential for differentiating melanocytic lesions. The addition to the clinical-dermoscopic examination may improve the diagnostic approach to unclear melanocytic lesions, limit unnecessary biopsies, and accelerate and individualize the treatment plan. ABSTRACT: Along with the rising melanoma incidence in recent decades and bad prognoses resulting from late diagnoses, distinguishing between benign and malignant melanocytic lesions has become essential. Unclear cases may require the aid of non-invasive imaging to reduce unnecessary biopsies. This multicentric, case-control study evaluated the potential of dynamic optical coherence tomography (D-OCT) to identify distinguishing microvascular features in nevi. A total of 167 nevi, including dysplastic ones, on 130 participants of all ages and sexes were examined by D-OCT and dermoscopy with a histological reference. Three blinded analyzers evaluated the lesions. Then, we compared the features to those in 159 melanomas of a prior D-OCT study and determined if a differential diagnosis was possible. We identified specific microvascular features in nevi and a differential diagnosis of melanomas and nevi was achieved with excellent predictive values. We conclude that D-OCT overcomes OCT´s inability to distinguish melanocytic lesions based on its focus on microvascularization. To determine if an addition to the gold standard of a clinical-dermoscopic examination improves the diagnosis of unclear lesions, further studies, including a larger sample of dysplastic nevi and artificial intelligence, should be conducted.