Melanoma diagnosis may be a pitfall for optical coherence tomography assessment of equivocal amelanotic or hypomelanotic skin lesions

Amelanotic and hypomelanotic skin lesions can be difficult to diagnose clinically and dermoscopically.1-3 Evidence is emerging that optical coherence tomography (OCT) can detect superficial basal cell carcinoma (sBCC) with good sensitivity (79-95.7%) and specificity (75.3-96%).4 Given that sBCC is a common problem4, and that it may be treated noninvasively5, the potential benefits from using OCT as an adjunct to clinical diagnosis are high. However, if OCT is used without histopathological confirmation in this setting, there is a risk that more clinically aggressive malignant pathology, such as amelanotic /hypomelanotic melanoma (AHM), may be misdiagnosed and left to progress if it is inadequately treated. Indeed, this research was prompted after experiencing a clinical case where a lesion had typical clinical-dermoscopic and OCT features for sBCC, but histopathology revealed an amelanotic melanoma. This article is protected by copyright. All rights reserved.