Invasive and Non-Invasive Dermatological Imaging: Dermatopathology, Dermoscopy, In Vivo High-Resolution Images, and Dermatoradiology

Dear Colleagues,

Imaging is very important in daily clinical practice in dermatology. A visual inspection can provide a useful first impression of patient condition. However, dermoscopy allows increased diagnostic sensitivity and specificity compared with naked-eye examination, is portable, and is very useful in many skin diseases. Digital photography and three-dimensional total body photography facilitate the documentation and communication of clinical findings. Reflectance confocal microscopy provides real-time, in vivo high-resolution images of cellular structures. In fluorescence confocal laser scanning microscopy, certain fluorophores are inserted into the tissue, and three-dimensional techniques are used for ex vivo examination or in operating rooms. Multiphoton microscopy enables the observation of the skin structure, collagen, and elastic fibres and the assessment of cellular metabolism based on fluorescence signals. Optical coherence tomography generates en face and cross-sectional images of skin structures and offers greater penetration depth (up to 1-2 mm) but with lower resolution. Line-field confocal optical coherence tomography combines the principles of both optical coherence tomography and reflectance confocal microscopy, utilizing line-field illumination to generate cell-resolved images of the skin in vivo, further allowing 3D reconstructions of the skin. Hyperspectral imaging, multispectral imaging, photoacoustic imaging, and laser speckle contrast imaging have been successfully applied in skin diseases. High-frequency ultrasound and ultra-high-frequency ultrasound use is growing over time to assess subcutaneous involvement and disease margins and to guide treatment in real time. Dermoscopy-guided high-frequency ultrasound is a recently developed technique employing a portable device capable of providing the simultaneous visualization of dermoscopic and high-frequency ultrasound images, feature that facilitates precise positioning, thereby potentially enhancing the reproducibility of dermatologic examinations but with field-of-view limitations. Conventional radiology can assess skeletal abnormalities associated with dermatological diseases, such as in Buschke–Ollendorff or McCune–Albright syndromes, and a chest X-ray is requested before starting these drugs to exclude active tuberculosis, particularly in cases with positive purified protein derivative readings or interferon gamma release assays. Tc-99m methylene diphosphonate whole-body bone scans, single-photon emission tomography, and non-contrast computed tomography could be used to better quantify the extension of diffuse calcium skin deposits in dermatomyositis, and chest computed tomography can evaluate associated interstitial lung disease. In paraneoplastic dermatoses such as paraneoplastic pemphigus, a thoracoabdominal computed tomography examination or positron emission tomography could be performed with the aim of identifying particularly closely associated neoplasms. Positron emission tomography can be performed to identify metastases in cases where neoplasms are already confirmed, such as melanoma, cutaneous squamous cell carcinoma, and Merkel cell carcinoma, or to determine the most metabolically active portion of a lesion and therefore help guide biopsy, such as in suspected liposarcomas. Moreover, positron emission tomography can be used to evaluate the response of Kaposi’s sarcoma to highly active antiretroviral therapy, sometimes in association with chemotherapy. Magnetic resonance imaging can evaluate the extension of a skin disease to deeper tissues, for example, to assess subcutis, fascia, and muscle involvement in morphea-like or scleroderma-like lesions, or to evaluate associated muscular and/or skeletal involvement in cases of vascular malformations, such as capillaro-venous ones. Moreover, when a large or quickly growing adipose subcutaneous lesion is found with ultrasonography, magnetic resonance imaging should be performed to better assess the lesion in its entirety. Mass spectrometry imaging maps molecules within tissue samples and provides insights into the distribution of lipids, proteins, and metabolites, contributing to our understanding of molecular composition and metabolic processes associated with dermatological disorders. Digital pathology and digital slides enable high-resolution imaging, facilitating remote consultations, second opinions, and telepathology. The digitalization of pathology laboratories enhances workflow efficiency and allows for large-scale data storage, retrieval, and analysis, paving the way for the development of robust diagnostic algorithms.

The purpose of this Special Issue is to gather original research manuscripts and reviews on invasive and non-invasive dermatologic imaging, such as digital photography, dermoscopy, confocal microscopy, optical coherence tomography, ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography, digital pathology and other invasive and non-invasive imaging techniques.

Dr. Corrado Tagliati
Guest Editor

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• dermatology
• digital photography
• dermoscopy
• confocal microscopy
• optical coherence tomography
• ultrasound
• computed tomography
• magnetic resonance imaging
• pathology
• nuclear medicine