This PDF file contains the front matter associated with SPIE Proceedings Volume 10037, including the Title Page, Copyright information, Table of Contents, and Conference Committee listing.

Skin barrier function relies on well balanced water and lipid system of stratum corneum. Optimal hydration and oiliness levels are indicators of skin health and integrity. We demonstrate an accurate and sensitive depth profiling of stratum corneum sebum and hydration levels using short wave infrared spectroscopy in the spectral range around 1720 nm. We demonstrate that short wave infrared spectroscopic technique combined with tape stripping can provide morequantitative and more reliable skin barrier function information in the low hydration regime, compared to conventional biophysical methods.

Here we present a handheld, implementation of Spatial Frequency Domain Spectroscopy (SFDS) that employs line imaging. The new instrument can measure 1088 spatial locations that span a 3 cm line as opposed to our benchtop system that only collects a single 1 mm diameter spot. This imager, however, retains the spectral resolution (~ 1 nm) and range (450 to 1000 nm) of our benchtop system. The device also has tremendously improved mobility and portability, allowing for greater ease of use in clinical setting. A smaller size also enables access to different tissue locations, which increases the flexibility of the device. The design of this portable system not only enables SFDS to be used in clinical settings, but also enables visualization of properties of layered tissues such as skin.

Skin cancer is the most common form of cancer in the United States and is a recognized public health issue. Diagnosis of skin cancer involves biopsy of the suspicious lesion followed by histopathology. Biopsies, which involve excision of the lesion, are invasive, at times unnecessary, and are costly procedures (~$2.8B/year in the US). An unmet critical need exists to develop a non-invasive and inexpensive screening method that can eliminate the need for unnecessary biopsies. To address this need, our group has reported on the continued development of a noninvasive method that utilizes multimodal spectroscopy towards the goal of a “spectral biopsy” of skin. Our approach combines Raman spectroscopy, fluorescence spectroscopy, and diffuse reflectance spectroscopy to collect comprehensive optical property information from suspicious skin lesions. We previously described an updated spectral biopsy system that allows acquisition of all three forms of spectroscopy through a single fiber optic probe and is composed of off-the-shelf OEM components that are smaller, cheaper, and enable a more clinic-friendly system. We present initial patient data acquired with the spectral biopsy system, the first from an extensive clinical study (n = 250) to characterize its performance in identifying skin cancers (basal cell carcinoma, squamous cell carcinoma, and melanoma). We also present our first attempts at analyzing this initial set of clinical data using statistical-based models, and with models currently being developed to extract biophysical information from the collected spectra, all towards the goal of noninvasive skin cancer diagnosis.

Skin surface roughness is an important property for differentiating skin diseases. Recently, roughness has also been identified as a potential diagnostic indicator in the early detection of skin cancer. Objective quantification is usually carried out by creating silicone replicas of the skin and then measuring the replicas. We have developed an alternative in-vivo technique to measure skin roughness based on laser speckle. Laser speckle is the interference pattern produced when coherent light is used to illuminate a rough surface and the backscattered light is imaged. Acquiring speckle contrast measurements from skin phantoms with controllable roughness, we created a calibration curve by linearly interpolating between measured points. This calibration curve accounts for internal scattering and is designed to evaluate skin microrelief whose root-mean-square roughness is in the range of 10-60 micrometers. To validate the effectiveness of our technique, we conducted a study to measure 243 skin lesions including actinic keratosis (8), basal cell carcinoma (24), malignant melanoma (31), nevus (73), squamous cell carcinoma (19), and seborrheic keratosis (79). The average roughness values ranged from 26 to 57 micrometers. Malignant melanoma was ranked as the smoothest and squamous cell carcinoma as the roughest lesion. An ANOVA test confirmed that malignant melanoma has significantly smaller roughness than other lesion types. Our results suggest that skin microrelief can be used to detect malignant melanoma from other skin conditions.

Diffuse reflectance spectroscopy offers a noninvasive, fast, and low-cost alternative to visual screening and biopsy for skin cancer diagnosis. We have previously acquired reflectance spectra from 137 lesions in 76 patients and determined the capability of spectral diagnosis using principal component analysis (PCA). However, it is not well elucidated why spectral analysis enables tissue classification. To provide the physiological basis, we used the Monte Carlo look-up table (MCLUT) model to extract physiological parameters from those clinical data. The MCLUT model results in the following physiological parameters: oxygen saturation, hemoglobin concentration, melanin concentration, vessel radius, and scattering parameters. Physiological parameters show that cancerous skin tissue has lower scattering and larger vessel radii, compared to normal tissue. These results demonstrate the potential of diffuse reflectance spectroscopy for detection of early precancerous changes in tissue. In the future, a diagnostic algorithm that combines these physiological parameters could be enable non-invasive diagnosis of skin cancer.

Background: Raman spectroscopy is a non-invasive optical technique which can measure molecular vibrational modes within tissue. A large-scale clinical study (n = 518) has demonstrated that real-time Raman spectroscopy could distinguish malignant from benign skin lesions with good diagnostic accuracy; this was validated by a follow-up independent study (n = 127). Objective: Most of the previous diagnostic algorithms have typically been based on analyzing the full band of the Raman spectra, either in the fingerprint or high wavenumber regions. Our objective in this presentation is to explore wavenumber selection based analysis in Raman spectroscopy for skin cancer diagnosis. Methods: A wavenumber selection algorithm was implemented using variably-sized wavenumber windows, which were determined by the correlation coefficient between wavenumbers. Wavenumber windows were chosen based on accumulated frequency from leave-one-out cross-validated stepwise regression or least and shrinkage selection operator (LASSO). The diagnostic algorithms were then generated from the selected wavenumber windows using multivariate statistical analyses, including principal component and general discriminant analysis (PC-GDA) and partial least squares (PLS). A total cohort of 645 confirmed lesions from 573 patients encompassing skin cancers, precancers and benign skin lesions were included. Lesion measurements were divided into training cohort (n = 518) and testing cohort (n = 127) according to the measurement time. Result: The area under the receiver operating characteristic curve (ROC) improved from 0.861–0.891 to 0.891–0.911 and the diagnostic specificity for sensitivity levels of 0.99-0.90 increased respectively from 0.17–0.65 to 0.20–0.75 by selecting specific wavenumber windows for analysis. Conclusion: Wavenumber selection based analysis in Raman spectroscopy improves skin cancer diagnostic specificity at high sensitivity levels.

Non-melanoma skin cancer (NMSC) is the most common cancer. Treatment consists of surgical removal of the skin cancer. Traditional excision involves the removal of the visible skin cancer with a significant margin of normal skin. On cosmetically sensitive areas, Mohs micrographic tissue is the standard of care. Mohs uses intraoperative microscopic margin assessment which minimizes the surgical defect and can help reduce the recurrence rate by a factor of 3. The current Mohs technique relies on frozen section tissue slide preparation which significantly lengthens operative time and requires on-site trained histotechnicians. Full-Field Optical Coherence Tomography (FFOCT) is a novel optical imaging technique which provides a quick and efficient method to visualize cancerous areas in minutes, without any preparation or destruction of the tissue. This study aimed to evaluate the potential of FFOCT for the analysis of skin cancer margins during Mohs surgery. Over 150 images of Mohs specimens were acquired intraoperatively with FFOCT before frozen section analysis. The imaging procedure took less than 5 minutes for each specimen. No artifacts on histological preparation were found arising from FFOCT manipulation; however frozen section artifact was readily seen on FFOCT. An atlas was established with FFOCT images and corresponding histological slides to reveal FFOCT reading criteria of normal and cancerous structures. Blind analysis showed high concordance between FFOCT and histology. FFOCT can potentially reduce recurrence rates while maintaining short surgery times, optimize clinical workflow, and decrease healthcare costs. For the patient, this translates into smaller infection risk, decreased stress, and better comfort.

Reflectance confocal microscopy (RCM) imaging shows promise for guiding surgical treatment of skin cancers. Recent technological advancements such as the introduction of the handheld version of the reflectance confocal microscope, video acquisition and video-mosaicing have improved RCM as an emerging tool to evaluate cancer margins during routine surgical skin procedures such as Mohs micrographic surgery (MMS). Detection of residual non-melanoma skin cancer (NMSC) tumor during MMS is feasible, as demonstrated by the introduction of real-time perioperative imaging on patients in the surgical setting. Our study is currently testing the feasibility of a new mosaicing algorithm for perioperative RCM imaging of NMSC cancer margins on patients during MMS. We report progress toward imaging and image analysis on forty-five patients, who presented for MMS at the MSKCC Dermatology service. The first 10 patients were used as a training set to establish an RCM imaging algorithm, which was implemented on the remaining test set of 35 patients. RCM imaging, using 35% AlCl₃ for nuclear contrast, was performed pre- and intra-operatively with the Vivascope 3000 (Caliber ID). Imaging was performed in quadrants in the wound, to simulate the Mohs surgeon’s examination of pathology. Videos were taken at the epidermal and deep dermal margins. Our Mohs surgeons assessed all videos and video-mosaics for quality and correlation to histology. Overall, our RCM video-mosaicing algorithm is feasible. RCM videos and video-mosaics of the epidermal and dermal margins were found to be of clinically acceptable quality. Assessment of cancer margins was affected by type of NMSC, size and location. Among the test set of 35 patients, 83% showed acceptable imaging quality, resolution and contrast. Visualization of nuclear and cellular morphology of residual BCC/SCC tumor and normal skin features could be detected in the peripheral and deep dermal margins. We observed correlation between the RCM videos/video-mosaics and the corresponding histology in 32 lesions. Peri-operative RCM imaging shows promise for improved and faster detection of cancer margins and guiding MMS in the surgical setting.

In this study we present a deep learning based classification algorithm for discriminating morphological patterns that appear in RCM mosaics of melanocytic lesions collected at the dermal epidermal junction (DEJ). These patterns are classified into 6 distinct types in the literature: background, meshwork, ring, clod, mixed, and aspecific. Clinicians typically identify these morphological patterns by examination of their textural appearance at 10X magnification. To mimic this process we divided mosaics into smaller regions, which we call tiles, and classify each tile in a deep learning framework. We used previously acquired DEJ mosaics of lesions deemed clinically suspicious, from 20 different patients, which were then labelled according to those 6 types by 2 expert users. We tried three different approaches for classification, all starting with a publicly available convolutional neural network (CNN) trained on natural image, consisting of a series of convolutional layers followed by a series of fully connected layers: (1) We fine-tuned this network using training data from the dataset. (2) Instead, we added an additional fully connected layer before the output layer network and then re-trained only last two layers, (3) We used only the CNN convolutional layers as a feature extractor, encoded the features using a bag of words model, and trained a support vector machine (SVM) classifier. Sensitivity and specificity were generally comparable across the three methods, and in the same ranges as our previous work using SURF features with SVM . Approach (3) was less computationally intensive to train but more sensitive to unbalanced representation of the 6 classes in the training data. However we expect CNN performance to improve as we add more training data because both the features and the classifier are learned jointly from the data. *First two authors share first authorship.

In this report we describe a computer vision based pipeline to convert in-vivo reflectance confocal microscopy (RCM) videos collected with a handheld system into large field of view (FOV) mosaics. For many applications such as imaging of hard to access lesions, intraoperative assessment of MOHS margins, or delineation of lesion margins beyond clinical borders, raster scan based mosaicing techniques have clinically significant limitations. In such cases, clinicians often capture RCM videos by freely moving a handheld microscope over the area of interest, but the resulting videos lose large-scale spatial relationships. Videomosaicking is a standard computational imaging technique to register, and stitch together consecutive frames of videos into large FOV high resolution mosaics. However, mosaicing RCM videos collected in-vivo has unique challenges: (i) tissue may deform or warp due to physical contact with the microscope objective lens, (ii) discontinuities or “jumps” between consecutive images and motion blur artifacts may occur, due to manual operation of the microscope, and (iii) optical sectioning and resolution may vary between consecutive images due to scattering and aberrations induced by changes in imaging depth and tissue morphology. We addressed these challenges by adapting or developing new algorithmic methods for videomosaicking, specifically by modeling non-rigid deformations, followed by automatically detecting discontinuities (cut locations) and, finally, applying a data-driven image stitching approach that fully preserves resolution and tissue morphologic detail without imposing arbitrary pre-defined boundaries. We will present example mosaics obtained by clinical imaging of both melanoma and non-melanoma skin cancers. The ability to combine freehand mosaicing for handheld microscopes with preserved cellular resolution will have high impact application in diverse clinical settings, including low-resource healthcare systems.

Multiphoton tomography (MPT) has become an important imaging method for non-invasive and high-resolution imaging of the skin in vivo. Due to the nonlinear excitation, by using near-infrared (NIR) light, 3D information is intrinsically provided. In combination with fluorescence lifetime imaging (FLIM), it is possible to obtain both structural and metabolic data. Human in vivo measurements are usually limited to easily accessible regions. However, often imaging of specific body parts such as the eyelid are of interest for cosmetic reasons. By using the clinically certified multiphoton imaging tomograph MPTflex this demand can be fulfilled. An articulated mirror arm and scan-detector head enable imaging at otherwise difficult-to-access areas. We show the characterization of the epidermal and upper dermal layers of the eyelid skin of human volunteers in vivo based on endogenous autofluorescence intensity, lifetime, and second-harmonic generation signals. Skin properties such as the epidermal thickness were also assessed. Furthermore, the influence of an anti-aging cream on the eyelid and forearm skin was investigated. Changes of the skin epidermis autofluorescence lifetime were observed after two-weeks long application of an anti-aging cream. The SHG-to-AF aging index of dermis (SAAID) increased during that time.

We use a multiphoton microscopy (MPM)-based clinical microscope (MPTflex, JenLab, Germany) to describe changes in human skin following treatment with a fractional non-ablative laser (PicoWay, Candela). The treatment was based on a fractionated picosecond Nd:YAG laser (1064 and 532nm, 3mJ and 1.5mJ (no attenuation), respectively maximum energy/pulse, 100 microbeams/6mmx6mm). Improvements in skin appearance resulting from treatment with this laser have been noted but optimizing the efficacy depends on a thorough understanding of the specific skin response to treatment. MPM is a nonlinear laser scanning microscopy technique that features sub-cellular resolution and label-free molecular contrast. MPM contrast in skin is derived from second-harmonic generation of collagen and two-photon excited fluorescence of NADH/FAD+, elastin, keratin, melanin. In this pilot study, two areas on the arm of a volunteer (skin type II) were treated with the picoWay laser (1064nm, 3mJ; 532nm, 1.5mJ; 1pass). The skin response to treatment was imaged in-vivo at 8 time points over the following 4 weeks. MPM revealed micro-injuries present in epidermis. Damaged individual cells were distinguished after 3h and 24h from treatment with both wavelengths. Pigmented cells were particularly damaged in the process, suggesting that melanin is the main absorber and the primary target for laser induced optical breakdown. At later time points, clusters of cellular necrotic debris were imaged across the treated epidermis. These results represent the groundwork for future longitudinal studies on expanded number of subjects to understand the response to treatment in different skin types at different laser parameters, critical factors in optimizing treatment outcomes.

Intraoperative assessment of excision tissues during cancer surgery is clinically important. The assessment is used to be guided by the examination for residual tumor with frozen pathology, while it is time consuming for preparation and is with low accuracy for diagnosis. Recently, reflection confocal microscopy (RCM) and nonlinear microscopy (NLM) were demonstrated to be promising methods for surgical border assessment. Intraoperative RCM imaging may enable detection of residual tumor directly on skin cancers patients during Mohs surgery. The assessment of benign and malignant breast pathologies in fresh surgical specimens was demonstrated by NLM. Without using hematoxylin and eosin (H and E) that are common dyes for histopathological diagnosis, RCM was proposed to image in vivo by using aluminum chloride for nuclear contrast on surgical wounds directly, while NLM was proposed to detect two photon fluorescence nuclear contrast from acrdine orange staining. In this paper, we propose and demonstrate 3D imaging of H and E stained thick tissues with a sub-femtoliter resolution by using Cr:forsterite-laser-based NLM. With a 1260 nm femtosecond Cr:forsterite laser as the excitation source, the hematoxylin will strongly enhance the third-harmonic generation (THG) signals, while eosin will illuminate strong fluorescence under three photon absorption. Compared with previous works, the 1260 nm excitation light provide high penetration and low photodamage to the exercised tissues so that the possibility to perform other follow-up examination will be preserved. The THG and three-photon process provides high nonlinearity so that the super resolution in 3D is now possible. The staining and the contrast of the imaging is also fully compatible with the current clinical standard on frozen pathology thus facilitate the rapid intraoperative assessment of excision tissues. This work is sponsored by National Health Research Institutes and supported by National Taiwan University Hospital.

We have combined two optical techniques to enable simultaneous assessment of structure and composition of human skin in vivo: Pulsed photothermal radiometry (PPTR), which involves measurements of transient dynamics in midinfrared emission from sample surface after exposure to a light pulse, and diffuse reflectance spectroscopy (DRS) in visible part of the spectrum. Namely, while PPTR is highly sensitive to depth distribution of selected absorbers, DRS provides spectral information and thus enables differentiation between various chromophores. The accuracy and robustness of the inverse analysis is thus considerably improved compared to use of either technique on its own. Our analysis approach is simultaneous multi-dimensional fitting of the measured PPTR signals and DRS with predictions from a numerical model of light-tissue interaction (a.k.a. inverse Monte Carlo). By using a three-layer skin model (epidermis, dermis, and subcutis), we obtain a good match between the experimental and modeling data. However, dividing the dermis into two separate layers (i.e., papillary and reticular dermis) helps to bring all assessed parameter values within anatomically and physiologically plausible intervals. Both the quality of the fit and the assessed parameter values depend somewhat on the assumed scattering properties for skin, which vary in literature and likely depend on subject's age and gender, anatomical site, etc. In our preliminary experience, simultaneous fitting of the scattering properties is possible and leads to considerable improvement of the fit. The described approach may thus have a potential for simultaneous determination of absorption and scattering properties of human skin in vivo.

Burn wounds are often characterized by injury depth, which then dictates wound management strategy. While most superficial burns and full thickness burns can be diagnosed through visual inspection, clinicians experience difficulty with accurate diagnosis of burns that fall between these extremes. Accurately diagnosing burn severity in a timely manner is critical for starting the appropriate treatment plan at the earliest time points to improve patient outcomes. To address this challenge, research groups have studied the use of commercial laser Doppler imaging (LDI) systems to provide objective characterization of burn-wound severity. Despite initial promising findings, LDI systems are not commonplace in part due to long acquisition times that can suffer from artifacts in moving patients. Commercial LDI systems are being phased out in favor of laser speckle imaging (LSI) systems that can provide similar information with faster acquisition speeds. To better understand the accuracy and usefulness of commercial LSI systems in burn-oriented research, we studied the performance of a commercial LSI system in three different sample systems and compared its results to a research-grade LSI system in the same environments. The first sample system involved laboratory measurements of intralipid (1%) flowing through a tissue simulating phantom, the second preclinical measurements in a controlled burn study in which wounds of graded severity were created on a Yorkshire pig, and the third clinical measurements involving a small sample of clinical patients. In addition to the commercial LSI system, a research grade LSI system that was designed and fabricated in our labs was used to quantitatively compare the performance of both systems and also to better understand the “Perfusion Unit” output of commercial systems.

Skin roughness is an important parameter in the characterization of skin and skin lesions, particularly for the purposes of skin cancer detection. Our group had previously constructed a laser speckle device that can detect the roughness in microrelief of the skin. This paper reports on findings made for the further miniaturization of our existing portably-sized device. These findings include the feasibility of adopting a laser diode without temperature control, and the use of a single CCD camera for detection. The coherence length of a laser is a crucial criterion for speckle measurements as it must be within a specific range. The coherence length of a commercial grade 405 nm laser diode was found to be of an appropriate length. Also, after a short warm-up period the coherence length of the laser was found to remain relatively stable, even without temperature control. Although the laser’s temperature change during operation may affect its power output and the shape of its spectrum, these are only minor factors in speckle contrast measurements. Our second finding covers a calibration curve to relate speckle measurements to roughness using only parallel polarization from one CCD camera. This was created using experimental data from skin phantoms and tested on in-vivo skin. These improvements are important steps forward in the ongoing development of the laser speckle device, especially towards a clinical device to measure skin roughness and evaluate skin lesions.

Acne vulgaris is a chronic inflammatory skin condition commonly resulting in negative aesthetic and social impacts on those affected. Minocycline, currently available as an oral antibiotic for moderate to severe acne, has a known minimum inhibitory concentration (MIC) for the acne-causing bacterium Propionibacterium acnes (P. acnes) in vitro, with its anti-inflammatory properties also eliciting inhibitory effects on pro-inflammatory molecules. A novel topical gel composition containing solubilized minocycline (BPX-01) has been developed to directly deliver the drug to the skin. Because minocycline is a known fluorophore, fluorescence microscopy and concurrent quantitative measurements were performed on excised human facial skin dosed with different concentrations, in order to determine the spatial distribution of the drug and quantification of its local concentration in the epidermis and the pilosebaceous unit where P. acnes generally reside. Local minocycline delivery confirmed achievement of an adequate therapeutic dose to support clinical studies. Subsequently, a 4-week double-blind, randomized, vehicle controlled clinical study was performed to assess the safety and efficacy of 1% minocycline BPX-01 applied daily. No instances of cutaneous toxicity were reported, and a greater than 1 log reduction of P. acnes count was observed at week 4 with statistical significance from baseline and vehicle control. In addition, no detectable amounts of minocycline in the plasma were reported, suggesting the potential of this new formulation to diminish the known systemic adverse effects associated with oral minocycline. Follow-on clinical plans are underway to further establish the safety of BPX-01 and to evaluate its efficacy against inflammatory acne lesions in a 225 patient multi-center dose-finding study.

The integration of optical fibers into flexible textile structures, by using knitting or weaving processes can allow the development of flexible light sources. The paper aims to present a new technology: Light Emitting Fabrics (LEF), which can be used for example for PDT of Actinic Keratosis in Dermatology. The predetermined macro-bending of optical fibers, led to a homogeneous side emission of light over the entire surface of the fabric. Tests showed that additional curvatures when applying the LEF on non-planar surfaces had no impact on light delivery and proved that LEF can adapt to the human morphology. The ability of the LEF, coupled with a 635nm LASER source, to deliver a homogeneous light to lesions is currently assessed in a clinical trial for the treatment of AK of the scalp by PDT. The low irradiance and progressive activation of the photosensitizer ensure a pain reduction, compared to discomfort levels experienced by patients during a conventional PDT session.

Monitoring phase transition in adipose tissue and formation of lipid crystals is important in Cryo-procedures such as cryosurgery or Selective Cryolipolysis (SC). In this work, we exploited a Near-Infrared Spectroscopy (NIRS) method to monitor the onset of fat freezing/melting. Concurrent measurements using frequency domain NIRS and MR Spectroscopy during cooling/heating were performed on an in vitro porcine skin sample with a thick subcutaneous fat layer in a human MR scanner. The NIRS probe was placed on the skin measuring the average optical scattering of the fatty layer. Two fiber optic temperature probes were inserted in the area of the MRS and NIRS measurements. To further investigate the microscopic features of the phase-transition, an identical cooling/heating procedure was replicated on the same fat tissue while being imaged by Optical Coherence Tomography. The temperature relationships of optical scattering, MRS peak characteristics and OCT reflection intensity were analyzed to find signatures related to the onset of phase transition. The optical scattering in the fatty tissues decreases during the heating and increases by cooling. However, there is an inflexion in the rate of change of the scattering while the phase transition happens in the fatty layer. The methylene fat peaks on the MR Spectrum are also shown to be broadened during the cooling. OCT intensity displays a sharp increase at the transition temperature. The results from multiple samples show two transition points around 5-10 ˚C (cooling) and 15-20 ˚C (heating) through all three methods, demonstrating that adipose tissue phase change can be monitored non-invasively.

Many laser wavelengths with various power and pulse characteristics have been used in an attempt to improve cutaneous scars. No single configuration has produced such dramatic changes in quality of life as the high energy, low density, sub-millisecond pulsed ablative infrared laser. Hundreds of wounded military service members with burn and traumatic scars that resulted in disabling restriction in range of motion have been treated since 2008. By fractionating the pulse to produce a uniform thermal injury less than 400um wide and to a depth of 3mm into the scar, we have observed dramatic reductions in scar-induced pain, pruritus, and most significantly, improvements in range of motion. The clinical and histologic changes seen in restrictive scars following treatment correlates with a regeneration of tissue that appears and functions more like normal tissue rather than scar. This lecture will describe our experience in the military and the latest research to support our observations.

Hypericin (Hyp) has received attention due to its high phototoxicity against viruses and anti-tumor photoactivity. Using two-photon imaging, we demonstrated that Hyp induced photosensitized modification of collagen fibers in native tissues. Dynamics of photo-processes was monitored by time-lapse multiphoton imaging. We showed that Hyp–mediated processes in collagen tissues may be used for the selective modification of collagen fibers.

Non-healing ulcerative wounds, such as diabetic foot ulcers, are challenging to diagnose and treat due to their numerous possible etiologies and the variable efficacy of advanced wound care products. Thus, there is a critical need to develop new quantitative biomarkers and diagnostic technologies that are sensitive to wound status in order to guide care. The objective of this study was to evaluate the utility of label-free multiphoton microscopy for characterizing wound healing dynamics in vivo and identifying potential differences in diabetic wounds. We isolated and measured an optical redox ratio of FAD/(NADH+FAD) autofluorescence to provide three-dimensional maps of local cellular metabolism. Using a mouse model of wound healing, in vivo imaging at the wound edge identified a significant decrease in the optical redox ratio of the epidermis (p≤0.0103) between Days 3 through 14 compared to Day 1. This decrease in redox ratio coincided with a decrease in NADH fluorescence lifetime and thickening of the epithelium, collectively suggesting a sensitivity to keratinocyte hyperproliferation. In contrast to normal wounds, we have found that keratinocytes from diabetic wounds remain in a proliferative state at later time points with a lower redox ratio at the wound edge. Microstructural organization and composition was also measured from second harmonic generation imaging of collagen and revealed differences between diabetic and non-diabetic wounds. Our work demonstrates label-free multiphoton microscopy offers potential to provide non-invasive structural and functional biomarkers associated with different stages of skin wound healing, which may be used to detect delayed healing and guide treatment.

There are a number of commercially available low level light therapy (LLLT) devices in a market, and face whitening or wrinkle reduction is one of targets in LLLT. The facial improvement could be known simply by visual observation of face, but it cannot provide either quantitative data or recognize a subtle change. Clinical diagnostic instruments such as mexameter can provide a quantitative data, but it costs too high for home users. Therefore, we designed a low cost multi-spectral imaging device by adding additional LEDs (470nm, 640nm, white LED, 905nm) to a commercial USB microscope which has two LEDs (395nm, 940nm) as light sources. Among various LLLT skin treatments, we focused on getting melanin and wrinkle information. For melanin index measurements, multi-spectral images of nevus were acquired and melanin index values from color image (conventional method) and from multi-spectral images were compared. The results showed that multi-spectral analysis of melanin index can visualize nevus with a different depth and concentration. A cross section of wrinkle on skin resembles a wedge which can be a source of high frequency components when the skin image is Fourier transformed into a spatial frequency domain map. In that case, the entropy value of the spatial frequency map can represent the frequency distribution which is related with the amount and thickness of wrinkle. Entropy values from multi-spectral images can potentially separate the percentage of thin and shallow wrinkle from thick and deep wrinkle. From the results, we found that this low cost multi-spectral imaging system could be beneficial for home users of LLLT by providing the treatment efficacy in a quantitative way.

Background and Objectives: We have previously demonstrated the efficacy of a non-invasive, non-contact, fast and simple but robust fluorescence imaging (u-FEI) method to monitor the healing of skin wounds in vitro. This system can image highly-proliferating cellular processes (295/340 nm excitation/emission wavelengths) to study epithelialization in a cultured wound model. The objective of the current work is to evaluate the suitability of u-FEI for monitoring wound re-epithelialization in vivo. Study Design: Full-thickness wounds were created in the tail of rats and imaged weekly using u-FEI at 295/340nm excitation/emission wavelengths. Histology was used to investigate the correlation between the spatial distribution and intensity of fluorescence and the extent of wound epithelialization. In addition, the expression of the nuclear protein Ki67 was used to confirm the association between the proliferation of keratinocyte cells and the intensity of fluorescence. Results: Keratinocytes forming neo-epidermis exhibited higher fluorescence intensity than the keratinocytes not involved in re-epithelialization. In full-thickness wounds the fluorescence first appeared at the wound edge where keratinocytes initiated the epithelialization process. Fluorescence intensity increased towards the center as the keratinocytes partially covered the wound. As the wound healed, fluorescence decreased at the edges and was present only at the center as the keratinocytes completely covered the wound at day 21. Histology demonstrated that changes in fluorescence intensity from the 295/340nm band corresponded to newly formed epidermis. Conclusions: u-FEI at 295/340nm allows visualization of proliferating keratinocyte cells during re-epithelialization of wounds in vivo, potentially providing a quantitative, objective and simple method for evaluating wound closure in the clinic.

In dermatology the reflexes of vasoconstriction and vasodilation are known as important mechanisms of thermoregulation of the inner body. Imaging the physiology of microvasculature of the skin with high spatial resolution in three dimensions while reacting to changes in temperature is crucial for understanding the complex processes of vasodynamics, which result in constriction and dilation of vessels. However, previous studies using Laser-Doppler flowmetry and -imaging could not provide reliable angiographic images which allow to quantify changes in blood vessel diameter. Here, we report a different approach for angiographic imaging of microvasculature of a anaesthetized rodent model using speckle variance optical coherence tomography (svOCT) during and after localized cooling. Therefore a commercial OCT with a center wavelength of 1.3 μm and a spatial resolution of 13µm was used in combination with a custom built cooling device to image such reflexes at the mouse ear pinna and dorsal skinfold. Cooling was applied in steps of 2−5◦ C starting at the baseline temperature of 27◦ C down to −10◦ C. To our surprise and in contrast to the general opinion in literature, we were able to observe that the majority of vessels with a diameter larger than 20 μm maintain perfused with a constant diameter when the tissue is cooled from baseline to subzero temperatures. However, vasoconstriction was observed very rarely and only in veins, which led to their occlusion. The results of this experiment lead us to reconsider essential aspects of previous understanding of temperature-induced vasodynamics in cutaneous microvasculature.

All optical photoacoustic tomography (PAT) using a planar Fabry-Perot interferometer polymer film sensor has been demonstrated for in vivo human palm imaging with an imaging penetration depth of 5 mm. The relatively larger vessels in the superficial plexus and the vessels in the dermal plexus are visible in PAT. However, due to both resolution and sensitivity limits, all optical PAT cannot reveal the smaller vessels such as capillary loops and venules. Melanin absorption also sometimes causes difficulties in PAT to resolve vessels. Optical coherence tomography (OCT) based angiography, on the other hand, has been proven suitable for microvasculature visualization in the first couple millimeters in human. In our work, we combine an all optical PAT system with an OCT system featuring a phase stable akinetic swept source. This multimodal PAT/OCT/OCT-angiography system provides us co-registered human skin vasculature information as well as the structural information of cutaneous. The scanning units of the sub-systems are assembled into one probe, which is then mounted onto a portable rack. The probe and rack design gives six degrees of freedom, allowing the multimodal optical imaging probe to access nearly all regions of human body. Utilizing this probe, we perform imaging on patients with various skin disorders as well as on healthy controls. Fused PAT/OCT-angiography volume shows the complete blood vessel network in human skin, which is further embedded in the morphology provided by OCT. A comparison between the results from the disordered regions and the normal regions demonstrates the clinical translational value of this multimodal optical imaging system in dermatology.

Background and Aim: With inflammatory skin conditions such as atopic dermatitis (AD), epidermal thickness is mediated by both pathological hyperplasia and atrophy such as that resulting from corticosteroid treatment. Such changes are likely to influence the depth and shape of the underlying microcirculation. Optical coherence tomography (OCT) provides a non-invasive view into the tissue, however structural measures of epidermal thickness are made challenging due to the lack of a delineated dermal-epidermal junction in AD patients. Instead, angiographic extensions to OCT may allow for direct measurement of vascular depth, potentially presenting a more robust method of estimating the degree of epidermal thickening. Methods and results: To investigate microcirculatory changes within AD patients, volumes of angiographic OCT data were collected from 5 healthy volunteers and compared to that of 5 AD patients. Test sites included the cubital and popliteal fossa, which are commonly affected by AD. Measurements of the capillary loop and superficial arteriolar plexus (SAP) depth were acquired and used to estimate the lower and upper bounds of the undulating basement membrane of the dermal-epidermal junction. Furthermore, quantitative parameters such as vessel density and diameter were derived from each dataset and compared between groups. Capillary loop depth increased slightly for AD patients at the poplitial fossa and SAP was found to be measurably deeper in AD patients at both sites, likely due to localized epidermal hyperplasia.

Dermal fillers are a very popular anti-ag ing treatment with estimated sales in the billions of dollars and millions of procedures performed. As the aging population continues to grow, these figures are only e xpected to increase. Dermal fillers have various compositions depending on their intended applicati on. Reactions to dermal fillers can be severe, such as ischemic events and filler migration to the eyes. Howe ver, these adverse reactions are rare. Nevertheless, the capability to perform imag e-guided filler injections would minimize th e risk of such reacti ons. In addition, the biomechanical properties of various fillers have been evalua ted, but there has been no investigation on the effects of filler on the biomechanical properties of skin. In this work, we utilize optical cohe rence tomography (OCT) for visualizing dermal filler injections with micrometer-scale sp atial resolution. In addition, we utilize noncontact optical coherence elastography (OCE) to quantify the changes in the biomechan ical properties of pig skin after the dermal filler injections. OCT was successfully able to visualize the dermal filler injecti on process, and OCE showed that the viscoelasticity of the pig skin was increased locally at the filler injection sites. OCT may be able to provide real-time image guidance in 3D, and when combined with functional OCT techniques such as optical microangiography, could be used to avoid blood vessels during the injection.

Optical coherence tomography (OCT) has been shown to provide clinically valuable images that can aid in the assessment of the pre-surgical margin in basal cell carcinoma (BCC). The accuracy and speed with which these images can be used to help delineate margins in the clinic are currently constrained by the need to suspend imaging whilst a pen is used to mark the skin. This constraint has been circumvented here by the design of a trigger-activated ink-loaded nib integrated with the OCT probe. The adapted OCT probe enables a mark to be placed on the skin precisely where a region of interest can be seen in the OCT images, accurately and reproducibly. The adapted probe is described and a comparison of its performance and early experience of its clinical use are reported here. Initial results indicate that the integrated skin marking probe makes margin delineation under OCT image-guidance faster, more accurate and more clinically acceptable.

Non-melanoma skin cancer (NMSC) is considered the most commonly diagnosed cancer in the United States and Canada. Treatment options include radiotherapy, surgical excision, radiotherapy, topical therapies, electrocautery, and cryotherapy. For patients undergoing fractionated orthovoltage radiation therapy or photodynamic therapy (PDT), the lesions are typically delineated by clinical markup prior to treatment without providing any information about the underlying tissue thus increasing the risk of geographic miss. The development of biomarkers for response in NMSC is imperative considering the current treatment paradigm is based on clinical examination and biopsy confirmation. Therefore, a non-invasive image-based evaluation of skin structure would allow for faster and potentially more comprehensive microscopic evaluation of the treated region at the point of care. To address this, our group is investigating the use of optical coherence tomography (OCT) for pre- and post- treatment evaluation of NMSC lesions during radiation therapy and PDT. Localization of the OCT probe for follow-up is complex, especially in the context of treatment response where the lesion is not present, precluding accurate delineation of the planning treatment area. Further, comparison to standard white light pre-treatment images is limited by the scale of the OCT probe (6 mm X 6 mm) relative to target region. In this study we compare the set-up accuracy of a typical OCT probe to detect a theoretical lesion on a patient’s hand. White light images, optical surface imaging (OSI) and OCT will be obtained at baseline and used for probe set up on subsequent scans. Set-up error will be quantified using advanced image processing techniques.