Significance: Seborrheic keratoses (SKs) are harmless pigmented skin lesions (PSLs) that may be confused clinically not only with other benign conditions but also with cutaneous melanoma (CM). As SKs are one of the most common neoplasms in adults, the importance of their correct diagnosis is high. Misclassifying SK as malignant is not rare and leads to a high number of unnecessary biopsies. On the other hand, misdiagnosing CM as SK may have a large impact on prognosis or therapy.
Aim: In the non-invasive technique of dermatofluoroscopy, the fluorophores in melanocytes and keratinocytes are excited in vivo with nanosecond laser pulses and the resulting spectrally resolved, melanin-dominated fluorescence signals are used to differentiate between pigmented benign lesions and CM.
Approach: In this single-center, non-interventional study, 33 PSLs of 20 patients were scanned with dermatofluoroscopy in vivo. For all included cases, dermatofluoroscopic signals were compared to pathology classification.
Results: The characteristic spectral features of SK were identified, where the signals are dominated by keratin, NAD(P)H, and melanin. The fluorescence spectra of SKs differed substantially from those of CM: a characteristic spectrum of SK has been identified in 27 of 28 SKs.
Conclusions: The high-accuracy differential diagnosis between CM and SK is possible with dermatofluoroscopy.
A clinical multicenter study has been performed on patients with suspicious, potentially malignant, pigmented skin lesions to evaluate the femtosecond fiber laser based compact multiphoton tomograph MPTcompact for high-resolution clinical imaging. Label-free high-resolution optical skin biopsies have been obtained based on two-photon autofluorescence excited at 780 nm, second harmonic generation, dermoscopy with an additional white light imager, and confocal reflectance with the NIR ultrashort laser pulses at 80 MHz. Furthermore, fluorescence lifetime imaging (FLIM) based on time-correlated single photon counting has been performed. Here we report on first clinical results. Multimodal compact multiphoton 3D/4D tomographs may become important label-free clinical highresolution imaging tools to replace in part conventional skin histology based on physically taken tissue samples, fixation, slicing, staining, and 2D light microscopy.
Multiphoton tomography (MPT) has become a high-resolution label-free clinical imaging tool to obtain optical skin biopsies for rapid in vivo histology. Here, we report on the novel multimodal multiphoton tomograph MPT compact based on a chiller-free ultracompact 80 MHz femtosecond fiber laser operating at 780 nm. The 360°-measurement head contains the laser head and multiple photon detectors for (i) autofluorescence (AF) imaging, (ii) fluorescence lifetime imaging (FLIM) for optical metabolic imaging (OMI) and melanin detection, (iii) second harmonic imaging (SHG) of collagen, (iv) confocal reflection microscopy (CRM), and (v) white-light imaging (dermoscopy). Preliminary results of an ongoing multicenter clinical study in patients with suspicious pigmented lesions in two hospitals are presented.
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