Line-field confocal optical coherence tomography (LC-OCT) and reflectance confocal microscopy (RCM) have good specificity and sensitivity. Cost may be an issue.
Superficial BCC (sBCC)
Nodular BCC (nBCC)
Infiltrative BCC (iBCC)
Micronodular BCC (mnBCC)
Sclerodermiform BCC
Basosquamous BCC
Keratotic variant
Infundibulocystic variant
Fibroepithelioma of Pinkus
Mixed
Source: Boostani M et al., "FDA and EMA-approved noninvasive imaging techniques for basal cell carcinoma subtyping: A systematic review," JAAD International, August 2025.
Basal cell carcinoma is usually a very manageable condition. It can be detected easily with a handheld dermatoscope that allows the user to see into the dermis and epidermis. You can buy an inexpensive dermatoscope on Amazon for $150, although the high-quality models cost between $1,000 and $2,000. Basal cell carcinoma comes in a dizzying array of subtypes, and treatment varies with the subtype. Superficial basal cell carcinoma can usually be treated with a topical therapy or with cryotherapy or a simple excision. The nodular form grows deeper in the skin, so the excision needs to be deeper. Infiltrative basal cell carcinoma is more likely to recur, so
The definitive way of diagnosing the basal cell carcinoma subtypes (and, therefore, selecting a treatment strategy) has been histopathological examination that requires a biopsy. But for convenience and other reasons, researchers and clinicians are exploring the use of noninvasive imaging as a way to either complement biopsies or maybe even replace them in some cases.
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HD-OCT had 100% sensitivity for superficial basal cell carcinoma, but it had the lowest accuracy for the other subtypes, Kiss and his colleagues determined.
Kiss and his colleagues reported the
Based on this review, they endorsed LC-OCT and RCM as showing “excellent diagnostic performance” with sensitivity and specific values above 90%. The pooled results showed that LC-OCT had the highest sensitivity at 97%, followed by RCM at 95% and OCT at 92%. But OCT was considerably less specific (84% vs. 95% for RCM and 93% for LC-OCT), which translates into a lower positive predictive value.
Commenting on their results, Kiss and his colleagues said that LC-OCT and RCM can play a “supporting role” as second-step diagnostic tools. “Rather than replacing biopsy, these techniques should be understood as tools to refine lesion stratification after dermatologic assessment,” they continued. “They may help identify cases that do not require immediate histopathological sampling while biopsy remains necessary for persistently equivocal lesions.”
OCT, because of its low specificity, has more limited utility in their view, “but it may still provide information regarding lesion depth and tumor architecture in selected cases.”
In this review, Kiss and his colleagues did not mention cost issues. In the 2025 review, they did briefly at the end of the discussion section of the paper. They noted that the dermatoscope costs less than $2,000 whereas the equipment for LC-OCT cost more than over $100,000. Other sources say that the equipment for RCM cost more than $75,000. The capital expense to buy equipment is just one factor in how much it costs to conduct an imaging test, but it is not negligible.
