Background: Traditional treatment methods for non-melanoma skin cancer (NMSC) include surgical excision with histological evaluation, yet advancements such as reflectance confocal microscopy (RCM) and superficial radiation therapy (SRT) offer non-invasive management alternatives. This study aims to evaluate the use of RCM for the evaluation of treatment outcomes after SRT in managing localized NMSC. Methods: A prospective interventional case series study was conducted on patients treated for NMSC with SRT between March 2020 and December 2023. Suspected NMSC lesions were initially evaluated with a handheld dermoscope and then imaged at multiple depths using a VivaScope 1500 RCM. Two dermatologists trained in RCM reviewed the images. Confirmed NMSC lesions were biopsied and treated with SRT, followed by RCM imaging at six months post-treatment to assess cancer clearance, scarring, and inflammation. Results: Of the 38 lesions (composed of SCC (24) and BCC (14)) treated affecting the 29 patients, all lesions showed no residual tumor activity upon conducting follow-up RCM (100% clearance). Scarring and mild erythema were noted clinically. Six lesions demonstrated moderate to severe inflammation at a 6-month follow-up. Conclusions: This study demonstrates successful non-invasive management of localized NMSC using RCM and SRT. RCM was able to non-invasively demonstrate complete tumor clearance achieved by SRT with minimal adverse effects. These findings support considering the use of RCM and SRT as primary diagnostic, monitoring, and treatment options for NMSC without the need for biopsies, especially for elderly patients or those unsuitable for surgery due to medical conditions.
背景：非黑色素瘤皮肤癌（NMSC）的传统治疗方法包括手术切除结合组织学评估，然而反射式共聚焦显微镜（RCM）和浅层放射治疗（SRT）等技术的进步提供了非侵入性管理方案。本研究旨在评估RCM在SRT治疗局限性NMSC后疗效评估中的应用。方法：对2020年3月至2023年12月期间接受SRT治疗的NMSC患者进行前瞻性干预性病例系列研究。疑似NMSC皮损首先通过手持皮肤镜进行评估，随后使用VivaScope 1500 RCM进行多深度成像。两位经过RCM培训的皮肤科医师对图像进行判读。确诊的NMSC皮损经活检后接受SRT治疗，并在治疗后六个月通过RCM成像评估肿瘤清除、瘢痕形成及炎症情况。结果：在29例患者治疗的38处皮损（包括24例鳞状细胞癌和14例基底细胞癌）中，随访RCM显示所有皮损均无残留肿瘤活性（清除率100%）。临床观察到瘢痕形成及轻度红斑，其中6处皮损在6个月随访时呈现中重度炎症。结论：本研究证实了RCM与SRT联合应用在局限性NMSC非侵入性治疗中的成功实践。RCM能够无创地证实SRT实现的肿瘤完全清除，且不良反应轻微。这些发现支持将RCM与SRT作为NMSC的主要诊断、监测和治疗方案，尤其适用于老年患者或因健康状况不适合手术的患者，无需进行活检。
Cutting-Edge Technology Without Cutting: Treating Skin Cancer in This Era—A Case Series
肿瘤(癌症)患者之家