33655 Noninvasive, in vivo, characterization of cutaneous metastases using a novel multimodal RCM-OCT imaging device: A case-series

Background: Cutaneous metastases are clinically challenging, requiring an invasive biopsy for confirmation. A novel, noninvasive RCM-OCT device, combines the advantage of high-resolution reflectance confocal microscopy (RCM) images and deeper optical coherence tomography (OCT) images can aid in diagnosis. Objective: Characterize cutaneous metastases using RCM-OCT device. Methods: Seven patients with suspicious cutaneous metastases were consented and imaged with RCM-OCT device, an investigational device. Cutaneous metastases features were defined by comparing with their histopathology. Tumor depths were measured on OCT (under #99-099 and 17-078 IRB protocols) and on H&E-images and correlated using Pearson test. 3D-OCT images were reconstructed to enhance tumor visualization. Results: 6/7 lesions were cutaneous metastases, and 1 was vascular ectasia, on histopathology. Cutaneous metastases appeared as grayish-darkish oval to round structures within the dermis on RCM and OCT images. On RCM, individual tumor cells were seen, enabling identification of even small tumor foci; while, on OCT deeper tumors were detected. Inflammatory cells, dilated vessels, and coarse collagen was identified in the dermis. Pearson correlation had an r2 of 0.38 and a significant P value < .004 for depth measurements. Cutaneous metastases could be differentiated from ecstatic vessels on 3D reconstructed OCT image. Limitation: Small sample size and lack of clinical mimickers. Conclusion: RCM-OCT can detect cutaneous metastases and has potential in aiding noninvasive diagnosis and management.