7 Jabotinsky st. Moshe Aviv tower, 19th floor. Ramat-Gan
7 Jabotinsky st. Moshe Aviv tower, 19th floor. Ramat-Gan
When a skin lesion looks suspicious but is not clear-cut, the dermoscope gives the physician information about the surface and upper layers of the skin, but this is not always enough to decide. Until recently, the way to resolve such doubt was, in most cases, a biopsy: removing a sample and sending it for laboratory examination.
LC-OCT (Line-field Confocal Optical Coherence Tomography) is a relatively new imaging technology that combines two principles: optical coherence tomography and confocal microscopy. Using light alone, it displays the skin in vertical cross-sections similar to a histological slice, in a horizontal view and in 3D, to a depth of about half a millimeter. This makes it possible to examine the internal structure of a lesion without touching it, which is why it is sometimes called a “virtual biopsy”.
Dr. Reiter trained in advanced imaging technologies during his fellowship at Memorial Sloan Kettering Cancer Center in New York, and later completed dedicated training in LC-OCT with Prof. Mariano Suppa in Brussels and Paris.
A small scanning probe is placed on the skin over the lesion and captures it in a continuous sequence. The doctor watches the images on the screen in real time and can switch between the vertical cross-section, the horizontal view and the 3D image.
The examination involves no cutting, anesthesia or ionizing radiation, and it is relatively short. The findings are combined with the clinical and dermoscopic examination, and the recommendation for next steps is explained to the patient during the same visit.
How does LC-OCT differ from confocal microscopy?
Confocal microscopy mainly displays horizontal images of the upper layers of the skin. LC-OCT adds vertical cross-sections and a greater imaging depth, so it lets the physician see the lesion in the context of the skin layers beneath it. The two methods complement each other, and the choice between them depends on the type and location of the lesion.
How accurate is the examination?
Studies show very high sensitivity for diagnosing basal cell carcinoma (BCC), and higher specificity than dermoscopy alone. In practice, this means fewer unnecessary biopsies. However, the examination is not perfect: imaging depth is limited, interpretation depends on the physician’s experience, and in some cases a biopsy will still be recommended.
What if the lesion looks suspicious?
The findings will be explained and a joint decision will be made on how to proceed. Sometimes a treatment that does not involve surgery can be considered, and in other cases pathological confirmation is needed, in which case a surgical biopsy will be recommended.
What about insurance?
The examination is classified as a diagnostic test, and some private insurance policies reimburse its cost, in full or in part. It is worth checking the terms of your policy with the insurance company before the examination.
LC-OCT gives the physician a window into the skin and, in suitable cases, makes it possible to reach a diagnosis without a cut. It complements the dermoscopic examination rather than replacing it, and the doctor decides whether it is suitable for your lesion.
A new or unusual lesion, or one that has recently changed, warrants an examination by a dermatologist who specializes in dermoscopy, without delay.
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