Laser ablation of basal cell carcinomas guided by confocal microscopy

Heidy Sierra; Miguel Cordova; Kishwer Nehal; Anthony Rossi; Chih-Shan Jason Chen; Milind Rajadhyaksha

doi:10.1117/12.2213280

21 March 2016 Laser ablation of basal cell carcinomas guided by confocal microscopy

Heidy Sierra, Miguel Cordova, Kishwer Nehal, Anthony Rossi, Chih-Shan Jason Chen, Milind Rajadhyaksha

Proceedings Volume 9689, Photonic Therapeutics and Diagnostics XII; 96890R (2016) https://doi.org/10.1117/12.2213280
Event: SPIE BiOS, 2016, San Francisco, California, United States

Abstract

Laser ablation offers precise and fast removal of superficial and early nodular types of basal cell carcinomas (BCCs). Nevertheless, the lack of histological confirmation has been a limitation. Reflectance confocal microscopy (RCM) imaging combined with a contrast agent can offer cellular-level histology-like feedback to detect the presence (or absence) of residual BCC directly on the patient. We conducted an ex vivo bench-top study to provide a set of effective ablation parameters (fluence, number of passes) to remove superficial BCCs while also controlling thermal coagulation post-ablation to allow uptake of contrast agent. The results for an Er:YAG laser (2.9 um and pulse duration 250us) show that with 6 passes of 25 J/cm², thermal coagulation can be effectively controlled, to allow both the uptake of acetic acid (contrast agent) and detection of residual (or absence) BCCs. Confirmation was provided with histological examination. An initial in vivo study on 35 patients shows that the uptake of contrast agent aluminum chloride) and imaging quality is similar to that observed in the ex vivo study. The detection of the presence of residual tumor or complete clearance was confirmed in 10 wounds with (additional) histology and in 25 lesions with follow-up imaging. Our results indicate that resolution is sufficient but further development and use of appropriate contrast agent are necessary to improve sensitivity and specificity. Advances in RCM technology for imaging of lateral and deep margins directly on the patient may provide less invasive, faster and less expensive image-guided approaches for treatment of BCCs.

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Heidy Sierra, Miguel Cordova, Kishwer Nehal, Anthony Rossi, Chih-Shan Jason Chen, and Milind Rajadhyaksha "Laser ablation of basal cell carcinomas guided by confocal microscopy", Proc. SPIE 9689, Photonic Therapeutics and Diagnostics XII, 96890R (21 March 2016); https://doi.org/10.1117/12.2213280

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KEYWORDS

Laser ablation

Tumors

Confocal microscopy

Aluminum

Mohs surgery

In vivo imaging

Er:YAG lasers

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