Desmoplastic trichoepithelioma (DTE) is a rare benign adnexal tumor with follicular differentiation that appears most frequently on the face of young women. It can clinically mimic a variety of skin tumors such as intradermal nevus, sebaceous hyperplasia, and basal cell carcinoma (BCC).1 Because of its overlapping clinical features, the diagnosis of DTE is usually established on histopathology. However, given the predilection of DTE on cosmetically sensitive areas on the face, the indication for biopsy should be as accurate as possible. Several noninvasive imaging techniques have emerged in recent years, aiming for higher accuracy of in vivo diagnosis. These include dermoscopy, reflectance confocal microscopy (RCM), and conventional optical coherence tomography (OCT). High-definition (HD) OCT (Skintell; Agfa HealthCare, Brussels, Belgium) is a recently introduced technique based on the same principles of conventional OCT but differing on its ability to give optical imaging up to 570 μm deep within the skin, with high resolution of 3 μm both in axial and lateral directions. The field of view is 1.8 × 1.5 mm, and the total light power at the tissue is less than 3.5 mW. The system works in direct contact with the skin. The interference signal detected by the 2-dimensional imaging sensor is digitized, subsequently transferred to a computer, and displayed through a grayscale or color palette resulting in an OCT image. High-definition OCT is capable of capturing not only slice but also en face images in real time and fast 3-dimensional acquisition. Therefore, HD-OCT allows in vivo examination of the skin, enabling visualization of individual cells with a greater depth than RCM. It also provides cross-sectional imaging like the conventional OCT. Additional technical details are discussed elsewhere.
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