Optical mapping of nonmelanoma skin Cancers—A pilot clinical study

Background and Objective Nonmelanoma skin cancer (NMSC) is the most common human cancer. Because these tumors often affect the face, there is a strong need for both accurate removal of these neoplasms to prevent recurrence and maximal tissue preservation to prevent cosmetic or functional deformity. Polarization‐enhanced reflectance and fluorescence imaging (PERFI) is a new bedside method that uses fluorescent chromophores to image NMSC. While the feasibility of the technique has been successfully demonstrated in ex vivo studies, this is the first pilot study to extend the use of PERFI to in vivo intraoperative imaging of NMSC. Materials and Methods Subjects were recruited from a population of patients with biopsy‐confirmed NMSC, scheduled for Mohs micrographic surgery. Eight cases were studied. Sterile methylene blue (MB) was diluted in anaesthetic solution and infused into the peritumoral space. Digital photographs of the lesion were taken and Mohs surgery was performed. Then, the surgical bed was re‐imaged. Each excision was also imaged ex vivo and processed for routine histopathology. Optical images were processed and compared with histopathology. Results and Conclusions The injection of MB was well tolerated. We observed a transient blue staining of the treated area, which disappeared completely within 1 week in all of the patients. In all subjects, the contrast agent, MB, was preferentially retained in the tumor. The ex vivo images correlated well with histopathology. In vivo images qualitatively delineated the tumor margins. The results of our pilot trial indicate that PERFI may be useful for accurate and rapid delineation of NMSC during surgery. Lasers Surg. Med. 49:803–809, 2017. © 2017 Wiley Periodicals, Inc.