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.

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