Luca Ambrosio

Line‐field confocal optical coherence tomography (LC‐OCT) is an emerging non‐invasive imaging technique that provides real‐time vertical, horizontal, and three‐dimensional visualization of the skin at near‐cellular resolution. We systematically reviewed the available evidence on LC‐OCT in melanocytic lesions to identify diagnostic features associated with melanoma and to clarify its current clinical role. MEDLINE/PubMed, Scopus, Embase, and Web of Science were searched from inception to September 2026 in accordance with PRISMA recommendations. Thirty‐two studies were included, encompassing cutaneous melanoma, lentigo maligna, and facial pigmented lesions, benign and atypical melanocytic lesions, and mucosal melanoma. Across studies, melanoma‐associated findings included irregular or disorganized epidermal architecture, numerous or pleomorphic pagetoid cells, disruption or blurring of the dermoepidermal junction, atypical dermal nests, and clefting. In lentigo maligna and facial melanoma, peri‐adnexal atypia and follicular involvement emerged as particularly relevant features, whereas mucosal melanoma was characterized by diffuse pagetoid spread, epithelial disarray, atypical junctional cells, and discohesive melanocytic nests. Benign lesions more often showed preserved epidermal architecture, a well‐defined junction, organized nests, and a regular wave‐like dermal pattern. However, substantial overlap was observed with atypical nevi, spitzoid lesions, blue nevi, melanosis, and other intermediate entities. Although selected studies reported promising diagnostic performance, the evidence remains heterogeneous and is largely based on small, descriptive cohorts. LC‐OCT may therefore serve as a useful adjunct in clinically or dermoscopically equivocal melanocytic lesions, but prospective multicenter validation and assessment of reproducibility are required before widespread routine implementation. image

Background: Non‐invasive imaging techniques can support assessment of lesions suspicious for basal cell carcinoma (BCC) when dermoscopy is inconclusive. We compared reflectance confocal microscopy (RCM), line‐field confocal optical coherence tomography (LC‐OCT), and the device‐integrated LC‐OCT artificial intelligence (AI) output. Methods: This retrospective comparative observational study included 100 facial and scalp lesions evaluated by RCM and LC‐OCT before excisional biopsy. Two expert and two non‐expert dermatologists independently interpreted anonymized images while blinded to histopathology and recorded confidence on a four‐point scale. Diagnostic performance, inter‐reader agreement, reader‐specific receiver operating characteristic analyses, and an exploratory post hoc dermoscopically equivocal subgroup were assessed. The categorical AI output was analyzed at a single operating point. Results: Histopathology identified 69 basal cell carcinomas (BCCs) and 31 non‐BCC lesions. Expert mean sensitivity, specificity, and accuracy were 95.7%, 85.5%, and 92.5% for RCM versus 86.2%, 67.7%, and 80.5% for LC‐OCT. The AI output yielded 87.0% sensitivity, 83.9% specificity, and 86.0% accuracy. In the equivocal subgroup ( n = 51; 31 BCCs), RCM sensitivity was 96.8% across readers, with specificity ranging from 65.0% to 85.0%. RCM AUCs exceeded LC‐OCT AUCs for all readers, but no paired comparison remained significant after Holm adjustment. Inter‐reader agreement was higher for RCM than LC‐OCT (Fleiss' κ = 0.809 vs. 0.563). Conclusions: Both modalities provided diagnostic information as second‐level adjuncts. RCM showed higher observed performance and agreement, particularly in exploratory equivocal lesions, whereas the categorical LC‐OCT AI output showed comparatively high specificity. Prospective validation is required. image

Folliculitis decalvans (FD) and dissecting cellulitis of the scalp (DCS) are neutrophilic primary cicatricial alopecias characterized by chronic inflammation and irreversible hair loss, with distinct pathogenic mechanisms that make accurate diagnosis essential for appropriate management. This narrative review aims to provide a comprehensive overview of systemic therapeutic options for FD and DCS, to evaluate their efficacy in relation to underlying disease mechanisms, and to explore emerging targeted treatments. A literature search was conducted in PubMed/MEDLINE using relevant keywords related to neutrophilic cicatricial alopecias and therapeutic strategies, including studies reporting clinical outcomes in FD and DCS. Available evidence indicates that conventional therapies remain the cornerstone of management: antibiotics are typically first-line in FD, while isotretinoin represents the mainstay of treatment in DCS and a key option in refractory FD; however, these approaches are often associated with partial responses and frequent relapses. Biologic agents, particularly TNF-α inhibitors, have shown consistent benefit in refractory cases, while IL-17/23 and JAK inhibitors are supported by limited but emerging data. Overall, treatment response appears to reflect underlying pathogenic differences between FD and DCS, underscoring the importance of a tailored, mechanism-based approach. Further studies are needed to establish standardized treatment algorithms and confirm long-term efficacy and safety.

Background: In actinic keratosis (AK), clinical clearance after field-directed therapies does not necessarily correspond to histological resolution, resulting in subclinical persistence and risk of recurrence. Objective: To provide a practical, up-to-date framework for non-invasive monitoring of treatment response in AK, integrating clinical assessment and dermoscopy with high-resolution imaging techniques, reflectance confocal microscopy (RCM), line-field confocal optical coherence tomography (LC-OCT), and high-frequency ultrasound (HFUS), and to discuss emerging optical biomarkers based on Raman spectroscopy. Results: For each modality, we summarize pre- and post-treatment imaging patterns, proposed response criteria, recommended follow-up timing, and correlations with clinical outcomes (including clearance and AKASI) and, when available, histological findings. The available evidence is derived from a limited number of observational studies, predominantly involving RCM and LC-OCT, whereas data on HFUS and Raman spectroscopy remain comparatively scarce. RCM and LC-OCT allow in vivo assessment of epidermal architectural normalization and reduction of intraepidermal keratinocyte atypia. HFUS captures quantitative trajectories of superficial dermal remodeling, including changes in the subepidermal low-echogenic band (SLEB) and dermal echogenicity after photodynamic therapy and other field treatments. Dermoscopy remains the first-line tool for routine follow-up but may fail to detect minimal subclinical persistence. Finally, we discuss the potential role of in vivo Raman spectroscopy for dynamic molecular endpoints and its possible integration with artificial intelligence–based analytical approaches. Conclusions: A standardized multimodal follow-up strategy improves the accuracy of treatment-response assessment compared with clinical evaluation alone. We propose a technique-specific checklist of minimal response criteria and a pragmatic temporal assessment scheme, and outline a research roadmap to support validation and clinical implementation of non-invasive imaging-guided monitoring in actinic keratosis.

The periocular region represents a highly sensitive anatomical area due to its functional relevance and aesthetic importance. It is frequently affected by a broad spectrum of cutaneous tumors, due to chronic exposure to ultraviolet radiation, hence an accurate diagnosis and lesion margin assessment is essential to guide appropriate treatment. Herein we summarize the current evidence on the use of reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and line-field confocal optical coherence tomography (LC-OCT) for the assessment of periocular skin tumors. A comprehensive literature search was conducted in the main databases following PRISMA 2020 guidelines. Studies published between 2015 and 2025 evaluating the application of RCM, OCT, and LC-OCT in skin tumors of this area were included. RCM was the most extensively studied modality, demonstrating utility in the characterization of pigmented and non-pigmented periocular lesions and in the identification of basal cell carcinoma-specific features. OCT provided complementary information by enabling visualization of deeper tissue structures, particularly in non-melanoma skin cancers; LC-OCT showed high concordance with histopathology providing practical advantages in this area. As a conclusion, non-invasive imaging techniques represent valuable tools in the evaluation of periocular skin tumors, as they may enhance diagnostic confidence and support clinical decision-making.

Background. In actinic keratosis (AK), clinical clearance after field-directed therapies does not necessarily correspond to histological resolution, resulting in subclinical persistence and risk of recurrence. Objective. To provide a practical, up-to-date framework for non-invasive monitoring of treatment response in AK, integrating clinical assessment and dermoscopy with high-resolution imaging techniques, reflectance confocal microscopy (RCM), line-field confocal optical coherence tomography (LC-OCT), and high-frequency ultrasound (HFUS), and to discuss emerging optical biomarkers based on Raman spectroscopy. Results. For each modality, we summarize pre- and post-treatment imaging patterns, proposed response criteria, recommended follow-up timing, and correlations with clinical outcomes (including clearance and AKASI) and, when available, histological findings. The available evidence is derived from a limited number of observational studies, predominantly involving RCM and LC-OCT, whereas data on HFUS and Raman spectroscopy remain comparatively scarce. RCM and LC-OCT allow in vivo assessment of epidermal architectural normalization and reduction of intraepidermal keratinocyte atypia. HFUS captures quantitative trajectories of superficial dermal remodeling, including changes in the subepidermal low-echogenic band (SLEB) and dermal echogenicity after photodynamic therapy and other field treatments. Dermoscopy remains the first-line tool for routine follow-up but may fail to detect minimal subclinical persistence. Finally, we discuss the potential role of in vivo Raman spectroscopy for dynamic molecular endpoints and its possible integration with artificial intelligence–based analytical approaches. Conclusions. A standardized multimodal follow-up strategy improves the accuracy of treatment-response assessment compared with clinical evaluation alone. We propose a technique-specific checklist of minimal response criteria and a pragmatic temporal assessment scheme, and outline a research roadmap to support validation and clinical implementation of non-invasive imaging–guided monitoring in actinic keratosis.