ABSTRACT Objective To explore the feasibility of indocyanine green (ICG) near‐infrared fluorescence guidance and margin‐related outcomes in patients undergoing surgery for locally advanced oral squamous cell carcinoma (OSCC) after neoadjuvant immunotherapy. Methods This retrospective single‐center cohort included 30 consecutive patients who underwent curative‐intent surgery between May 2024 and March 2025. Fifteen underwent ICG‐guided surgery and 15 underwent conventional surgery, according to routine clinical implementation and imaging availability. The primary outcome was patient‐level positive margin status on final pathological assessment. Recorded margin‐to‐tumor distances, intraoperative margin findings and perioperative outcomes were assessed separately. Comparisons were exploratory and unadjusted. Results Tumor‐associated fluorescence was visualized in all 15 ICG‐treated patients (100%; exact 95% confidence interval [CI], 78.2%–100%). Mean recorded margin‐to‐tumor distance was 9.30 ± 1.21 mm with ICG guidance and 16.40 ± 2.41 mm with conventional surgery (mean difference, −7.10 mm; 95% CI, −8.55 to −5.65; p < 0.001). Corresponding medians were 9.0 and 16.0 mm, and minima were 8.0 and 13.0 mm. The operative summary describes additional intraoperative resection in two conventional‐group patients following frozen‐section assessment. No statistically significant between‐group differences in perioperative outcomes were detected, but confidence intervals were wide. Final pathological margin assessment identified no positive margins in either group (ICG‐guided 0/15, 0.0%; conventional 0/15, 0.0%; Fisher's exact p = 1.000). The two intraoperative frozen‐section–positive events in the conventional group were resolved to negative final margins after same‐operation resection extension. Conclusion ICG fluorescence imaging was feasible in this small retrospective cohort and was associated with shorter recorded margin‐to‐tumor distances. These findings are hypothesis‐generating and do not establish improved oncologic margin control, perioperative equivalence or functional benefit. Larger prospective studies with standardized pathological assessment and adequate follow‐up are needed.
ABSTRACT Objectives Reflectance confocal microscopy (RCM) improves diagnostic specificity for equivocal pigmented lesions; however, certain conditions may mimic melanoma and limit its accuracy. We aimed to characterize RCM features of thermally injured lesions that mimic melanoma. Methods We present three cases of pigmented lesions with recent thermal injury, including burn, cryotherapy, and laser exposure. Clinical, dermoscopic, and RCM findings were evaluated. Given the recent history of injury, lesions were monitored with serial follow‐up at 1, 3, and 6 months to assess evolution and guide management. Results Thermal injury produced architectural and cytological changes on RCM that mimicked melanoma, including epidermal and dermoepidermal junction disarray, pagetoid‐like cells, bright inflammatory cells, and dermal stromal alterations. These findings were observed shortly after thermal injury and were consistent across different injury types and anatomic sites. The integration of clinical history with serial follow‐up demonstrated progressive resolution of atypical features in all cases, supporting a benign etiology and allowing avoidance of biopsy. Conclusions Thermal injury is an important and reversible melanoma mimicker on RCM. Recognition of this diagnostic pitfall, combined with careful clinical correlation and short‐term follow‐up, may improve diagnostic accuracy, reduce unnecessary biopsies, and support more confident management of these lesions.
