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Objectives: The impact of optical tissue clearing on optical coherence tomography (OCT) for nail tissue imaging has not been investigated. This study seeks to compare the effects of an emollient and water on visualization of micromorphology and morphometric outcomes., Materials and Methods: Thirty-six healthy nail plates were processed with a fractional CO 2 laser, imaged with OCT, and measured with calipers in duplicates. All samples were reassessed after 12-hour long sequential immersion in water and an emollient (Crodamol™ STS). OCT images were evaluated for thickness and scattering signal of the nail., Results: Emollient-impregnation caused stronger scatter responses (P < .0001) and decreased nail thickness (MD 45 μm, P < .0001) measured on OCT. Caliper-derived measurements were not affected by Crodamol™ (MD 11 μm, P = .5538). Hydration increased nail thickness on OCT (MD 49 μm, P < .0001) but reduced thickness measurements taken with calipers (MD 41 μm, P < .0001). Emollient-impregnation improved visualization of onychocytes compared with dry (P = .0209) and hydrated samples (P < .0001), and reduced occurrence of refractive artifacts (P < .0001)., Conclusion: The use of an emollient for OCT imaging can enhance nail tissue visualization without significant effects on caliper measurements. Hydration of nails, in contrast with emollient-impregnation, may lead to disagreement between caliper- and OCT-measured nail thickness and should be practiced cautiously., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. These lesions do not exhibit typical dermoscopy features of SebK and sometimes mimic melanoma, thus complicating the differential diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive tool, which allows an in vivo imaging of the skin. The study objectives were to evaluate the agreement between RCM classification and histological diagnoses, and the reliability of well-known RCM criteria for SebK in the identification of SebK with atypical dermoscopy presentation., Materials and Methods: We retrospectively analysed at RCM excised lesions presenting in dermoscopy ≥1 score at revisited 7-point checklist. The study population consisted of cases showing no melanocytic RCM findings. Lesions were investigated for distinct non-melanocytic RCM features, blinded from histopathology diagnoses. Histopathology matching was then performed before statistical analysis., Results: The study consisted of 117 cases, classified at RCM as SebK (71 cases), dermatofibroma (18 cases), basal cell carcinoma (13 cases), squamous cell carcinoma (2 cases), and "non-specific" (13 cases). Overall K strength of agreement at histopathology matching proved 0.76. Of the 71 cases classified at RCM with SebK, agreement was achieved in 97%., Conclusion: Reflectance confocal microscopy classification proved high agreement with histopathology for SebK with atypical dermoscopy presentations, allowing an early differential diagnosis. RCM features in this group of lesions were similar to those described for typical cases of SebK, and may assist clinician therapy decision making, whilst avoiding unnecessary excisions., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)