Non-invasive determination of Breslow index
Résumé
Breslow index is defined as maximal thickness of cutaneous malignant melanoma measured in several slides from the top of the granular cell layer to the deepest point of invasion. Prognosis, prediction of sentinel lymph node status as well as excision margins are based on Breslow index determination. Non-invasive Breslow index determination would allow one-time procedure for melanoma clinical management which would be of utmost medical interest for several reasons: unimpaired sentinel lymph node status, low morbidity, pain and stress associated to surgical excision margins. However, as explained throughout the current chapter, such a determination requires melanoma diagnosis prior to Breslow determination. As a result, all techniques reported in this chapter (based on ultrasounds, optical waves or both), not only demonstrate their ability to determine Breslow thickness but also their ability to increase diagnosis accuracy. Ultrasonography and dermoscopy are currently evaluated in clinical environments. Diffuse reflectance spectroscopy, has been tested on tissue phantoms. Infrared microimaging and photoacoustic microscopy have shown preliminary results on fixed and paraffin-embedded tissues without staining and on xenografted tumours on mice respectively. Finally, optical coherence tomography and confocal microscopy may have a clinical interest in the management of very thin melanomas but require further studies to show their potential interest.
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