Multimodal In Vivo Imaging of Cutaneous Angiogenesis: A Structured Narrative Review of Dermoscopy, Dynamic OCT, and Line-Field Confocal OCT

Aims: This structured narrative review aimed to synthesize and critically appraise the available human evidence on in vivo assessment of cutaneous angiogenesis using dermoscopy, dynamic optical coherence tomography (D-OCT), and line-field confocal optical coherence tomography (LC-OCT), and to determine whether disease-specific microvascular phenotypes can be defined across selected neoplastic and inflammatory dermatoses. Type of review. Structured narrative review (SNAR), using SANRA as a narrative-review quality framework. The work was not designed as a systematic review of diagnostic accuracy and was not prospectively registered. Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to November 2025 using combinations of terms for angiogenesis, cutaneous vasculature, dermoscopy, OCT, D-OCT, LC-OCT, OCT angiography, melanoma, basal cell carcinoma, actinic keratosis, squamous neoplasia, Bowen disease, psoriasis, and Kaposi sarcoma. The clinical synthesis focused on original human studies; technical reviews and preclinical sources were used for background only. Findings: Findings were synthesized qualitatively because imaging protocols and vascular terminology were too heterogeneous for meta-analysis. Salient findings. Angiogenic architecture is disease-patterned rather than uniform. D-OCT studies associate melanoma vascular morphology with Breslow thickness, without establishing a validated optical staging test. Basal cell carcinoma shows hierarchically organized arborizing stromal vessels. Bowen disease shows glomerular, horizontally oriented units, whereas actinic keratosis shows milder, grade-dependent remodeling; multimodal imaging remains limited in separating hypertrophic actinic keratosis from early squamous cell carcinoma. Psoriasis shows elongated, regularly distributed dilated papillary loops, distinct from the less organized pattern of eczematous dermatitis. Kaposi sarcoma imaging evidence remains preliminary and does not establish stage-specific vascular criteria. Plexus depth is measurable and differs among some diseases and adjacent skin, but it is not a standalone marker of invasiveness. LC-OCT adds near-histologic three-dimensional morphology; D-OCT adds perfusion and depth; dermoscopy remains the accessible surface map. Conclusions: Multimodal in vivo imaging can link surface vascular clues to structural and functional substrates of cutaneous angiogenesis and can improve interpretive separation of disease-specific patterns from non-specific inflammatory remodeling. Most proposed quantitative biomarkers, including plexus depth, remain preliminary and require standardized descriptors and prospective multicenter validation, including studies with inflamed mimics, before routine clinical use.