In Vivo Non-Invasive High-Resolution Imaging for the Evaluation of the Periocular Skin Area: A Comprehensive Review of the Literature

The periocular region represents a highly sensitive anatomical area due to its functional relevance and aesthetic importance. It is frequently affected by a broad spectrum of cutaneous tumors, due to chronic exposure to ultraviolet radiation, hence an accurate diagnosis and lesion margin assessment is essential to guide appropriate treatment. Herein we summarize the current evidence on the use of reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and line-field confocal optical coherence tomography (LC-OCT) for the assessment of periocular skin tumors. A comprehensive literature search was conducted in the main databases following PRISMA 2020 guidelines. Studies published between 2015 and 2025 evaluating the application of RCM, OCT, and LC-OCT in skin tumors of this area were included. RCM was the most extensively studied modality, demonstrating utility in the characterization of pigmented and non-pigmented periocular lesions and in the identification of basal cell carcinoma-specific features. OCT provided complementary information by enabling visualization of deeper tissue structures, particularly in non-melanoma skin cancers; LC-OCT showed high concordance with histopathology providing practical advantages in this area. As a conclusion, non-invasive imaging techniques represent valuable tools in the evaluation of periocular skin tumors, as they may enhance diagnostic confidence and support clinical decision-making.