Hyperspectral Imaging for Lateral Tumour Demarcation of High-risk Basal Cell Carcinomas during Mohs Micrographic Surgery
DOI:
https://doi.org/10.2340/actadv.v105.43614Keywords:
high-risk basal cell carcinoma, Mohs micrographic surgery, tumour demarcation, hyperspectral imagingAbstract
Hyperspectral imaging is a non-invasive imaging modality showing potential in delineating tumour margins preoperatively. This pilot study evaluated the feasibility of using hyperspectral imaging to demarcate lateral margins of high-risk facial basal cell carcinomas (BCC) prior to Mohs micrographic surgery. Thirty patients with high-risk BCCs were recruited from the Department of Dermatology, Sahlgrenska University Hospital, Sweden. Lesions were initially demarcated using dermoscopy, followed by hyperspectral imaging scans. During the first stage, a superficial vertical incision was performed along the demarcation line before adding a 3-mm clinical margin for the bowl-shaped excision of the tumour. Hyperspectral imaging-based tumour margins were compared with histopathologically verified borders, serving as ground truth. The data analysis used supervised learning; 2 complementary validation strategies were employed: a half-split approach where the left half of each annotated image was used for training and the right half for testing, and a leave-one-out cross-validation at the image level. A pixel-wise classification approach was used, treating each pixel as an independent sample. Hyperspectral imaging achieved a pixel-wise classification accuracy of 0.76, sensitivity of 0.75, specificity of 0.78, and an area under the receiver operating characteristic curve of 0.84. Hyperspectral imaging demonstrated potential for tumour demarcation, providing a basis for future research.
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Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol 2012; 166: 1069–1080. DOI: https://doi.org/10.1111/j.1365-2133.2012.10830.x
Kappelin J, Nielsen K, Nilsson F, Bjellerup M, Ahnlide I. Surgical treatment of basal cell carcinoma: a case series on factors influencing the risk of an incomplete primary excision. J Eur Acad Dermatol Venereol 2020; 34: 2518–2525. DOI: https://doi.org/10.1111/jdv.16327
Ceder H, Ekström A, Hadzic L, Paoli J. Clinicopathological factors associated with incomplete excision of high-risk basal cell carcinoma. Acta Derm Venereol 2021; 101: adv00496. DOI: https://doi.org/10.2340/00015555-3856
Peris K, Fargnoli MC, Kaufmann R, Arenberger P, Bastholt L, Seguin NB, et al. European consensus-based interdisciplinary guideline for diagnosis and treatment of basal cell carcinoma – update 2023. Eur J Cancer 2023; 192: 113254. DOI: https://doi.org/10.1016/j.ejca.2023.113254
Kunskapbanken. Available from: https://kunskapsbanken.cancercentrum.se/diagnoser/basalcellscancer/vardprogram/.
Kim JYS, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol 2018; 78: 540–559. DOI: https://doi.org/10.1016/j.jaad.2017.10.006
Reiter O, Mimouni I, Dusza S, Halpern AC, Leshem YA, Marghoob AA. Dermoscopic features of basal cell carcinoma and its subtypes: a systematic review. J Am Acad Dermatol 2021; 85: 653–664. DOI: https://doi.org/10.1016/j.jaad.2019.11.008
Ceder H, Backman E, Marghoob A, Navarrete-Dechent C, Polesie S, Reiter O, et al. Importance of both clinical and dermoscopic findings in predicting high-risk histopathological subtype in facial basal cell carcinomas. Dermatol Pract Concept 2024; 14: e2024212. DOI: https://doi.org/10.5826/dpc.1403a212
Reiter O, Mimouni I, Gdalevich M, Marghoob AA, Levi A, Hodak E, et al. The diagnostic accuracy of dermoscopy for basal cell carcinoma: a systematic review and meta-analysis. J Am Acad Dermatol 2019; 80: 1380–1388. DOI: https://doi.org/10.1016/j.jaad.2018.12.026
Que SKT. Research techniques made simple: noninvasive imaging technologies for the delineation of basal cell carcinomas. J Invest Dermatol 2016; 136: e33–e38. DOI: https://doi.org/10.1016/j.jid.2016.02.012
Janowska A, Oranges T, Granieri G, Romanelli M, Fidanzi C, Iannone M, et al. Non-invasive imaging techniques in presurgical margin assessment of basal cell carcinoma: current evidence. Skin Res Technol 2023; 29: e13271. DOI: https://doi.org/10.1111/srt.13271
Soglia S, Pérez-Anker J, Lobos Guede N, Giavedoni P, Puig S, Malvehy J. Diagnostics using non-invasive technologies in dermatological oncology. Cancers (Basel) 2022; 14: 5886. DOI: https://doi.org/10.3390/cancers14235886
Niculet E, Craescu M, Rebegea L, Bobeica C, Nastase F, Lupasteanu G, et al. Basal cell carcinoma: comprehensive clinical and histopathological aspects, novel imaging tools and therapeutic approaches (Review). Exp Ther Med 2022; 23: 60. DOI: https://doi.org/10.3892/etm.2021.10982
Malvehy J, Pellacani G. Dermoscopy, confocal microscopy and other non-invasive tools for the diagnosis of non-melanoma skin cancers and other skin conditions. Acta Derm Venereol 2017; Suppl 218: 22–30. DOI: https://doi.org/10.2340/00015555-2720
De Carvalho N, Schuh S, Kindermann N, Kästle R, Holmes J, Welzel J. Optical coherence tomography for margin definition of basal cell carcinoma before micrographic surgery: recommendations regarding the marking and scanning technique. Skin Res Technol 2018; 24: 145–151. DOI: https://doi.org/10.1111/srt.12407
Paradisi A, Cornacchia L, Cappilli S, Abeni D, Federico F, Di Stefani A, et al. Preoperative evaluation of high-risk basal cell carcinoma with line-field confocal optical coherence tomography (LC-OCT) reduces Mohs micrographic surgery stage number: a case-control study. EJC Skin Cancer 2024; 2: 100015. DOI: https://doi.org/10.1016/j.ejcskn.2023.100015
Lu G, Fei B. Medical hyperspectral imaging: a review. J Biomed Opt 2014; 19: 10901. DOI: https://doi.org/10.1117/1.JBO.19.1.010901
Neittaanmäki N, Salmivuori M, Pölönen I, Jeskanen L, Ranki A, Saksela O, et al. Hyperspectral imaging in detecting dermal invasion in lentigo maligna melanoma. Br J Dermatol 2017; 177: 1742–1744. DOI: https://doi.org/10.1111/bjd.15267
Neittaanmäki-Perttu N, Grönroos M, Jeskanen L, Pölönen I, Ranki A, Saksela O, et al. Delineating margins of lentigo maligna using a hyperspectral imaging system. Acta Derm Venereol 2015; 95: 549–552. DOI: https://doi.org/10.2340/00015555-2010
Neittaanmäki-Perttu N, Grönroos M, Tani T, Pölönen I, Ranki A, Saksela O, et al. Detecting field cancerization using a hyperspectral imaging system. Lasers Surg Med 2013; 45: 410–417. DOI: https://doi.org/10.1002/lsm.22160
Räsänen J, Salmivuori M, Pölönen I, Grönroos M, Neittaanmäki N. Hyperspectral imaging reveals spectral differences and can distinguish malignant melanoma from pigmented basal cell carcinomas: a pilot study. Acta Derm Venereol 2021; 101: adv00405. DOI: https://doi.org/10.2340/00015555-3755
Salmivuori M, Neittaanmäki N, Pölönen I, Jeskanen L, Snellman E, Grönroos M. Hyperspectral imaging system in the delineation of ill-defined basal cell carcinomas: a pilot study. J Eur Acad Dermatol Venereol 2019; 33: 71–78. DOI: https://doi.org/10.1111/jdv.15102
Saari H, Pölönen I, Salo H, Honkavaara E, Hakala T, Holmlund C, et al. Miniaturized hyperspectral imager calibration and UAV flight campaigns. In: Sensors, systems, and next-generation satellites XVII. Proc SPIE 2013: p. 448–459. DOI: https://doi.org/10.1117/12.2028972
Barun VV, Ivanov AP, Volotovskaya AV, Ulashchik VS. Absorption spectra and light penetration depth of normal and pathologically altered human skin. J Appl Spectroscopy 2007; 74: 430–439. DOI: https://doi.org/10.1007/s10812-007-0071-2
Paoli J, Pölönen I, Salmivuori M, Räsänen J, Zaar O, Polesie S, et al. Hyperspectral imaging for non-invasive diagnostics of melanocytic lesions. Acta Derm Venereol 2022; 102: adv00815. DOI: https://doi.org/10.2340/actadv.v102.2045
Raita-Hakola AM, Annala L, Lindholm V, Trops R, Näsilä A, Saari H, et al. FPI based hyperspectral imager for the complex surfaces: calibration, illumination and applications. Sensors (Basel) 2022; 22: 3420. DOI: https://doi.org/10.3390/s22093420
Tan M, Le Q. EfficientNet: rethinking model scaling for convolutional neural networks. In: Kamalika C, Ruslan S, editors. Proceedings of the 36th International Conference on Machine Learning, 2019: p. 6105–6114.
Yeom SD, Lee SH, Ko HS, Chung KY, Shin J, Choi GS, et al. Effectiveness of dermoscopy in Mohs micrographic surgery (MMS) for nonmelanoma skin cancer (NMSC). Int J Dermatol 2017; 56: e136–e139. DOI: https://doi.org/10.1111/ijd.13501
Adan F, Kallen EJJ, Dermont G, Muche JM, Sinx KAE, Schilder A, et al. Diagnostic accuracy of optical coherence tomography in the assessment of in vivo primary basal cell carcinoma resection margins prior to Mohs Micrographic Surgery. J Eur Acad Dermatol Venereol 2022; 36: e270–e272. DOI: https://doi.org/10.1111/jdv.17804
Venturini M, Gualdi G, Zanca A, Lorenzi L, Pellacani G, Calzavara-Pinton PG. A new approach for presurgical margin assessment by reflectance confocal microscopy of basal cell carcinoma. Br J Dermatol 2016; 174: 380–385. DOI: https://doi.org/10.1111/bjd.14244
Lupu M, Voiculescu VM, Caruntu A, Tebeica T, Caruntu C. Preoperative evaluation through dermoscopy and reflectance confocal microscopy of the lateral excision margins for primary basal cell carcinoma. Diagnostics (Basel) 2021; 11: 120. DOI: https://doi.org/10.3390/diagnostics11010120
Wang KX, Meekings A, Fluhr JW, McKenzie G, Lee DA, Fisher J, et al. Optical coherence tomography-based optimization of Mohs micrographic surgery of basal cell carcinoma: a pilot study. Dermatol Surg 2013; 39: 627–633. DOI: https://doi.org/10.1111/dsu.12093
Larson B, Abeytunge S, Seltzer E, Rajadhyaksha M, Nehal K. Detection of skin cancer margins in Mohs excisions with high-speed strip mosaicing confocal microscopy: a feasibility study. Br J Dermatol 2013; 169: 922–926. DOI: https://doi.org/10.1111/bjd.12444
Cheng HM, Guitera P. Systematic review of optical coherence tomography usage in the diagnosis and management of basal cell carcinoma. Br J Dermatol 2015; 173: 1371–1380. DOI: https://doi.org/10.1111/bjd.14042
Ruini C, Schuh S, Sattler E, Welzel J. Line-field confocal optical coherence tomography: practical applications in dermatology and comparison with established imaging methods. Skin Res Technol 2021; 27: 340–352. DOI: https://doi.org/10.1111/srt.12949
Levy J, Barrett DL, Harris N, Jeong JJ, Yang X, Chen SC. High-frequency ultrasound in clinical dermatology: a review. Ultrasound J 2021; 13: 24. DOI: https://doi.org/10.1186/s13089-021-00222-w
Bassas P, Hilari H, Bodet D, Serra M, Kennedy FE, García-Patos V. Evaluation of surgical margins in basal cell carcinoma by surgical specialty. Actas dermo-sifiliograficas 2013; 104: 133–140. DOI: https://doi.org/10.1016/j.adengl.2012.06.022
Griffiths RW. Audit of histologically incompletely excised basal cell carcinomas: recommendations for management by re-excision. Br J Plast Surg 1999; 52: 24–28. DOI: https://doi.org/10.1054/bjps.1998.3018
Kumar P, Orton CI, McWilliam LJ, Watson S. Incidence of incomplete excision in surgically treated basal cell carcinoma: a retrospective clinical audit. Br J Plast Surg 2000; 53: 563–566. DOI: https://doi.org/10.1054/bjps.2000.3394
Masud D, Moustaki M, Staruch R, Dheansa B. Basal cell carcinomata: risk factors for incomplete excision and results of re-excision. J Plast Reconstr Aesthet Surg 2016; 69: 652–656. DOI: https://doi.org/10.1016/j.bjps.2015.12.024
Dieu T, Macleod AM. Incomplete excision of basal cell carcinomas: a retrospective audit. ANZ J Surg 2002; 72: 219–221. DOI: https://doi.org/10.1046/j.1445-2197.2002.02351.x
Su SY, Giorlando F, Ek EW, Dieu T. Incomplete excision of basal cell carcinoma: a prospective trial. Plast Reconstr Surg 2007; 120: 1240–1248. DOI: https://doi.org/10.1097/01.prs.0000279148.67766.e1
Christensen GB, Nagaoka T, Kiyohara Y, Johansson I, Ingvar C, Nakamura A, et al. Clinical performance of a novel hyperspectral imaging device for cutaneous melanoma and pigmented skin lesions in Caucasian skin. Skin Res Technol 2021; 27: 803–809. DOI: https://doi.org/10.1111/srt.13023
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