Simone Soglia

Line-field confocal optical coherence tomography (LC-OCT) is a non-invasive optical imaging technique that combines cellular resolution with vertical, horizontal, and three-dimensional visualization of living skin. These features are attractive in aesthetic dermatology, where conventional clinical photography and biophysical measurements primarily assess visible changes and selected skin properties but provide limited information on tissue architecture. This narrative review examines the emerging use of LC-OCT to characterize skin aging, assess cosmetic and topical products, and monitor aesthetic procedures. Published studies demonstrate that LC-OCT, particularly when coupled with automated segmentation and artificial intelligence, can quantify epidermal organization, dermal–epidermal junction morphology, cellular features, pigment distribution, and superficial dermal fiber patterns. Early interventional work has applied these endpoints to brightening products, anti-aging formulations, sunscreens, and topical drugs. Procedural studies have visualized tissue responses after microdermabrasion, hydradermabrasion, chemical peeling, hair-removal lasers, fractional laser treatments, plasma radiofrequency, botulinum toxin, microwave thermolysis, and dermal filler injection. LC-OCT may therefore complement clinical outcomes by providing repeatable, in vivo microscopic endpoints and longitudinal imaging without biopsy. However, most studies remain exploratory, with small samples, short follow-up, heterogeneous acquisition protocols, and limited external validation. LC-OCT should currently be considered an advanced research and treatment-monitoring tool rather than a validated surrogate for clinical benefit. Multicenter studies, standardized acquisition protocols and blinded analyses will be required before routine adoption in aesthetic trials and practice.

Penile intraepithelial neoplasia (PeIN) is a rare but clinically significant condition that can progress to invasive squamous carcinoma. Early diagnosis is crucial but often challenging due to its heterogeneous clinical and dermoscopic presentation, which can mimic other benign or malignant lesions. In this study, we report two cases of pigmented penile lesions evaluated using non-invasive imaging techniques: reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT). Both methods revealed characteristic features such as hyperkeratosis, parakeratosis, acanthosis, nuclear pleomorphism of keratinocytes, and the presence of bright intraepithelial dendritic cells, correlating closely with histopathological findings of high-grade basaloid PeIN. Our findings highlight the valuable role of RCM and LC-OCT in improving the differential diagnosis of genital lesions, potentially reducing the need for invasive diagnostic procedures and ensuring early, appropriate management.

Background: Line‐field confocal optical coherence tomography (LC‐OCT) provides in vivo images with cellular resolution for melanocytic lesions. To date, no descriptions have associated cellular discohesion forming clefts (‘clefting’) with malignancy in melanocytic lesions using in vivo imaging techniques such as reflectance confocal microscopy (RCM) or LC‐OCT. Objectives: This study aimed to describe the feature of ‘clefting’ in melanocytic lesions and its correlation with histopathology and RCM. Methods: Consecutive benign, atypical and malignant melanocytic lesions were scanned with LC‐OCT at the Hospital Clinic of Barcelona, Hôpital Erasme and University Hospital of Saint‐Etienne. Images of body and facial lesions were reviewed according to study criteria. Only lesions with a univocal or unambiguous diagnosis (clinically or histologically) were selected. Results: Clefting was found in 36 of the 200 analysed lesions. It was present in 28 of the 70 melanomas (40%) and in eight of the 130 benign lesions (6%). The odds ratio for malignancy associated with the presence of clefting in a melanocytic lesion was 10.03 (CI 4.07–27.5; p < 0.001). The magnitude of clefting also showed significant differences: marked clefting was present in 17 of the 70 melanomas (24%) and in only two benign lesions (2%), with an OR of 20.22 (CI 4.55–186.2; p < 0.001). No differences were observed regarding the presence of this feature in different locations. It was strongly associated with other malignant features, such as epidermal consumption, nests in the epidermis and disruption of the dermo‐epidermal junction. Conclusions: This study highlights that clefting observed in melanocytic lesions is not an artefact created by sample preparation, but a specific feature related to malignancy. Moreover, marked clefting is apparently associated with deeper melanoma invasion.

Background/Objectives: Primary cutaneous lymphomas (PCL) are a heterogeneous group of non-Hodgkin lymphomas arising from malignant T (CTCL) or B (CBCL) cells, often mimicking other skin conditions. Recently, non-invasive diagnostic imaging modalities, including dermoscopy, Reflectance Confocal Microscopy (RCM), and Line-field Optical Coherence Tomography (LC-OCT), have become increasingly important, supporting clinicians in clinical practice. Hence, our study aimed to describe dermoscopic, RCM, and LC-OCT features of PCL and to explore their role in PCL management. Methods: Between December 2022 and January 2024, 40 lesions of 25 patients with PCL were retrospectively analyzed at the Dermatologic Unit of the University of Siena, Italy. Predefined dermoscopic, LC-OCT, and RCM criteria were assessed and their frequencies were calculated. Results: At dermoscopy, CTCL lesions were characterized by pinkish structureless areas (58,6%) and homogeneous distributed dotted vessels (35,7%), whereas 57.1% of CBCL presented with orange-yellow structureless areas. Considering CTCL, lymphocytes in the epidermis, dermal-epidermal junction, and dermis were detected by LC-OCT in 73.1%, 66.7%, and 51.9% and by RCM in 72.2%, 55.6%, and 61.1% of cases, respectively. The detection of lymphocytes was more precise using RCM than LC-OCT in CTCL (p < 0.001). Dermal infiltration of medium-reflective cells was visible in 80% and 40% of CBCL cases by LC-OCT and RCM, respectively. Conclusions: Non-invasive imaging techniques may support clinicians in managing PCL; however, further studies are mandatory in this field.

Background: Line‐field confocal optical coherence tomography (LC‐OCT) is an emerging diagnostic tool with imaging depth reaching ~400 μm and a novel three‐dimensional (3D) cube providing cellular resolution. As far as we are aware, there are only a limited number of papers that have reported diagnostic criteria for melanocytic lesions using this technique, and none of them have been multicentric.Objectives: Our aim was to establish the diagnostic criteria for melanocytic lesions using LC‐OCT and identify the most significant architectural and cytologic features associated with malignancy.Methods: A retrospective evaluation of 80 consecutive melanocytic lesions from a prospective multicentric data set spanning three European centres was conducted. We excluded facial, acral and mucosal lesions from the study. Dermoscopic and LC‐OCT images were evaluated by a consensus of four observers. Multivariate logistic regression with backward elimination was employed.Results: The main melanoma diagnostic criteria include detecting >10 pagetoid cells in 3D acquisition, irregular 3D epidermal architecture, disrupted dermoepidermal junction (DEJ) and clefting. Significant risk factors were irregular 3D epidermal architecture, >10 pagetoid cells, dendritic cells at DEJ without underlying inflammation. Novel malignancy criteria in vertical view were DEJ disruption and clefting around atypical melanocyte nests. Exclusive melanoma features were epidermal nests, epidermal consumption, dense dermal nests with atypia. Protective features in the absence of any malignancy indicators were DEJ ring pattern, cobblestone, elongated rete ridges (vertical), well‐defined DEJ and wave pattern (vertical).Conclusions: A series of diagnostic criteria for the identification of melanocytic lesions with LC‐OCT have been established. Validation of these criteria in clinical practice through future studies is essential to further establish their utility.

Citation: Maione V, Tonon F, Soglia S, Venturuzzo A, Venturini M, Calzavara-Pinton P. Line-Field Confocal Optical Coherence Tomography of a Suspected Case of Galli-Galli Disease. Dermatol Pract Concept. 2024;14(1):e2024007. DOI: https://doi.org/10.5826/dpc.1401a7 Accepted: May 14, 2023; Published: January 2024 Copyright: ©2024 Maione et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding author: Dr. Francesco Tonon, Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, P. Le Spedali Civili 1 , 25123, Brescia, Italy. Phone: +390303995302 Email: f.tonon@unibs.it Keywords : Galli-Galli, LC-OCT, Reflectance confocal microscopy, non-invasive tools This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Background: Early melanoma detection is the main factor affecting prognosis and survival. For that reason, non‐invasive technologies have been developed to provide a more accurate diagnosis. Recently, line‐field confocal optical coherence tomography (LC‐OCT) was developed to provide an in vivo, imaging device, with deep penetration and cellular resolution in three dimensions. Combining the advantages of conventional OCT and reflectance confocal microscopy, this tool seems to be particularly suitable for melanocytic lesions.Objectives: The objective of this study was to identify and describe the correlation between specific dermoscopic criteria and LC‐OCT features in three dimensions associated with melanocytic lesions.Methods: Dermoscopic and LC‐OCT images of 126 melanocytic lesions were acquired in three different centres. The following dermoscopic criteria have been considered: reticular pattern, dots and globules, structureless areas, blue‐whitish veil, regression structures, negative network, homogeneous pattern, streaks and blotches.Results: 69 (55%) benign and 57 (45%) malignant lesions were analysed. A regular reticular pattern was found associated in the 75% of the cases with the presence of elongated rete ridges with pigmented cells along the basal layer, while atypical reticular pattern showed an irregular organization of rete ridges with melanocytic hyperplasia, broadened and fused ridges and elongated nests. Both typical and atypical dots and globules were found associated with melanocytic nests in the dermis or at the dermoepidermal junction (DEJ), as well as with keratin cysts/pseudocysts. Grey globules corresponded to the presence of melanin‐containing dermal inflammatory cells (melanophages) within the papillae. Structureless brown/black areas correlated with alterations of the DEJ. We observed the same DEJ alterations, but with the presence of dermal melanophages, in 36% of the cases of blue/white/grey structureless areas. A description of each LC‐OCT/dermoscopy correlation was made.Conclusions: LC‐OCT permitted for the first time to perform an in vivo, 3D correlation between dermoscopic criteria and pathological‐like features of melanocytic lesions.

The nose is a vital organ and an important aesthetic unit, being placed in the middle of the face. It is also one of the most frequently site involved by skin cancer, and surgical reconstruction can be sometimes challenging. We present two cases of full thickness nasal ala defect, managed with turnover flap with and without earlobe cartilage graft.