Noninvasive imaging technologies are emerging as potential alternatives or supplements to traditional biopsies for diagnosing basal cell carcinoma. A recent review published in the JAAD International analyzed several imaging modalities to determine their accuracy in identifying the disease. The study examined 29 studies, 26 of which were included in the quantitative analysis, focusing specifically on optical coherence tomography (OCT), reflectance confocal microscopy (RCM), and line-field confocal optical coherence tomography (LC-OCT).
Researchers led by Norbert Kiss, M.D., Ph.D., of Semmelweis University in Budapest, Hungary, found that LC-OCT and RCM demonstrated “excellent diagnostic performance,” with sensitivity and specificity values above 90%. The pooled results indicated that LC-OCT had the highest sensitivity at 97%, followed by RCM at 95% and OCT at 92%. However, OCT was considerably less specific (84%) compared to RCM (95%) and LC-OCT (93%), which translates into a lower positive predictive value.
Comparing the accuracy of imaging tools
LC-OCT achieved 100% sensitivity for infiltrative basal cell carcinoma, while HD-OCT had 100% sensitivity for superficial basal cell carcinoma. The authors concluded that newer noninvasive imaging techniques hold promise for being more accurate than dermoscopy, and they judged HD-OCT and LC-OCT to be the most effective among those that had been approved by the FDA and the DMA.
While these technologies are promising, they are not yet ready to completely replace the standard histopathological examination. Kiss and his colleagues noted that LC-OCT and RCM should be understood as tools to refine lesion stratification after dermatologic assessment rather than replacing biopsy. These techniques may help identify cases that do not require immediate histopathological sampling while biopsy remains necessary for persistently equivocal lesions. OCT, because of its lower specificity, has more limited utility but may still provide information regarding lesion depth and tumor architecture in selected cases.
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Basal cell carcinoma is a very manageable condition that can be detected easily with a handheld dermatoscope. This tool allows the user to visualize the dermis and epidermis. Inexpensive dermatoscopes are available on the market for around $150, while high-quality models typically cost between $1,000 and $2,000. Because the disease presents in a dizzying array of subtypes, treatment strategies must vary significantly depending on the specific form of the cancer. For example, superficial basal cell carcinoma can often be treated with topical therapies, cryotherapy, or a simple excision. Conversely, the nodular form grows deeper in the skin, necessitating deeper surgical excision. Infiltrative basal cell carcinoma presents a higher risk of recurrence, often requiring Mohs surgery for complete removal.
The definitive method for diagnosing these subtypes and, consequently, selecting the appropriate treatment strategy, remains the histopathological examination that requires a biopsy. However, for reasons of convenience and patient comfort, researchers and clinicians are actively exploring the use of noninvasive imaging to either complement biopsies or potentially replace them in specific scenarios. 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.
The primary barrier to widespread adoption of these advanced imaging tools is cost. In the 2025 review, the authors noted that a dermatoscope costs less than $2,000, whereas the equipment for LC-OCT costs more than $100,000. Other sources indicate that the equipment for RCM costs 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.
