Handheld reflectance confocal microscopy for the diagnosis of molluscum contagiosum: Histopathology and dermoscopy correlation

Handheld reflectance confocal microscopy may represent an adjunctive, fast, non‐invasive tool for the diagnosis of molluscum contagiosum, revealing microscopic details closely related to histopathology, as demonstrated by this study evaluating 19 molluscum lesions in 11 patients. It permits the rapid examination of one or multiple skin lesions in real time and it is perfectly suitable for children.     

乳房外Paget病反射式共聚焦显微镜和皮肤镜图像特征分析

目的:分析乳房外Paget病(EMPD)反射式共聚焦显微镜(RCM)和皮肤镜特征。方法:回顾性分析我院16例经组织病理证实为乳房外Paget病的RCM、皮肤镜影像资料。结果:16例患者反射式共聚焦显微镜特征均表现为低折光大而圆的Paget细胞散在或成巢分布。16例皮肤镜表现均出现乳红色背景、亮白色无结构区和点-球状血管。结论:本研究中EMPD患者有共同的皮肤镜和RCM特征,皮肤镜和RCM可作为EMPD早期诊断及治疗随访的辅助工具。     

Pigmented skin lesions displaying regression features: Dermoscopy and reflectance confocal microscopy criteria for diagnosis

Melanomas and nevi displaying regression features can be difficult to differentiate. To describe reflectance confocal microscopy features in benign and malignant pigmented skin lesions characterized by regression features in dermoscopy. Observational retrospective study. Inclusion criteria were presence of dermoscopic features of regression; availability of clinical, dermoscopic and RCM imaging; definite histopathologic diagnosis. The study sample comprised 217 lesions; 108 (49.8%) melanomas and 109 were benign lesions, of which 102 (47.0%) nevi and 7 (3.2%) lichen planus‐like keratosis (lplk). Patients with melanoma were significantly older than those with benign lesions (61.9 ± 15.4 vs 46.1 ± 14.8; P < 0.001) and a higher proportion of melanomas displayed dermoscopic regression structures in more than 50% of lesion surface (n = 83/108; 76.9%; P < 0.001). On RCM examination, pagetoid cells were significantly more reported in melanoma group, than in benign lesions (86.1% vs 59.6%; P < 0.001) and were more frequently widespread distributed (65.6% vs 20.0%; P < 0.001) and both dendritic and roundish (36.6% vs 15.4%; P < 0.001) in shape. Aspecific architecture at the dermo‐epidermal junction (DEJ) was more commonly seen among melanomas than benign lesions (23.1% vs 11.9%; P = 0.002) with higher presence of dendritic and both dendritic and roundish atypical cells at the DEJ (28.7% vs 18.3% and 19.4% vs 3.7%; P < 0.001, respectively). Focal pagetoid infiltration and ringed or clod patterns were more commonly seen in benign lesion. In conclusion, the correct interpretation of regressing lesions remains a challenge, assessing carefully the extent and characteristics of architectural and cytologic atypia on RCM is an additional piece of the complex puzzle of melanoma diagnosis.     

Distinct melanoma types based on reflectance confocal microscopy

Distinct melanoma types exist in relation to patient characteristics, tumor morphology, histopathologic aspects and genetic background. A new diagnostic imaging tool, reflectance confocal microscopy (RCM), allows in vivo analysis of a given lesion with nearly histologic resolution while offering a dynamic view of the tissue in its ‘natural’ environment. The aim of this study was to analyse cell morphology of consecutive melanomas as they appear on RCM and to correlate morphology with tumor and patient characteristics. One hundred melanomas were visualized by RCM before excision. Clinical data, confocal features and histologic criteria were analysed. Four types of melanomas were identified as follows: (i) Melanomas with a predominantly dendritic cell population (‘dendritic‐cell melanomas’) typically were thin by Breslow index; (ii) Melanomas typified by roundish melanocytes were smaller in size than dendritic cell MMs, but thicker by Breslow index, and predominantly occurred in patients with a high nevus count; (iii) Melanomas characterized by dermal nesting proliferation usually were thick by Breslow index at the time of diagnosis, although frequently smaller in size compared with the other types; and (iv) combined type melanomas may represent an evolution of dendritic cell and/or round cell types. Integration of confocal microscopy with clinical and histologic aspects may help in identifying and managing distinct tumors.     

Reflectance confocal microscopy for pigmentary disorders

Please cite this paper as: Reflectance confocal microscopy for pigmentary disorders. Experimental Dermatology 2010; 19: 233–239. Abstract: In vivo reflectance confocal microscopy (RCM) is a non‐invasive, repetitive imaging tool that provides real‐time images at nearly cellular histological resolution. Application of this technology to skin imaging during the last decade has been a great advance in dermatology. As melanin is the strongest endogenous contrast in human skin, pigmentary disorders caused by abnormal amounts of melanin in the skin could be the most suitable candidates for RCM examination. This article reviewed the RCM applications in the characterization and management of pigmentary disorders. The application of RCM in pigmentary disorders has been expanded to describe hyper‐ and hypopigmentary disorders as well as pigmented skin tumors. The great advantages of non‐invasive and repetitive examination of RCM may provide its usefulness not only in the diagnosis and management of pigmentary disorders, but also in researching pathogenesis of pigmentary disorders.     

Reflectance confocal microscopy of facial lentigo maligna and lentigo maligna melanoma: a preliminary study

Background Facial lentigo maligna (LM) and lentigo maligna melanoma (LMM) may be difficult to diagnose clinically and dermoscopically. Reflectance confocal microscopy (RCM) enables the in vivo assessment of equivocal skin lesions at a cellular level. Objectives To assess cytomorphological and architectural RCM features of facial LM/LMM. Methods Four women and eight men aged 58–88 years presenting with facial skin lesions suspicious of LM/LMM were included. In total, 17 lesion areas were imaged by RCM before biopsy. The histopathological diagnosis of LM was made in 15 areas; the other two were diagnosed as early LMM. Results A focal increase of atypical melanocytes and nests surrounding adnexal openings, sheets of mainly dendritic melanocytes, cord‐like rete ridges at the dermoepidermal junction (DEJ) and an infiltration of adnexal structures by atypical melanocytes were found to be characteristic RCM features of facial LM/LMM. Areas with a focal increase of atypical melanocytes and nests surrounding adnexal openings were observed at the basal layer in three cases. The remaining cases displayed these changes at suprabasal layers above sheets of mainly dendritic melanocytes. Cord‐like rete ridges at the DEJ and an infiltration of adnexal structures by atypical melanocytes were observed in all cases. Previously described criteria for RCM diagnosis of melanoma, such as epidermal disarray, pleomorphism of melanocytes and pagetoid spreading of atypical melanocytes, were additionally observed. Conclusions We observed a reproducible set of RCM criteria in this case series of facial LM/LMM.     

反射式共聚焦显微镜在炎症性皮肤病诊疗中的应用

反射式共聚焦激光扫描显微镜(RCM)作为一种在体无创性皮肤检查设备,能够实时动态反应细胞形态及皮肤结构的变化,在某些皮肤病中其图像特征与组织病理学检查结果具有高度的一致性,本文就RCM在炎症性皮肤病的诊断、疗效评价和疾病进展中的应用作一综述。     

硬化性苔藓反射式共聚焦显微镜特征分析

观察一例硬化性苔藓在反射式共聚焦显微镜下的图像特征,并回顾相关文献。反射式共聚焦显微镜下可见毛囊角栓,表皮厚度略薄,表皮突变平,真皮乳头水肿,真皮浅层纤维排列致密,折光度增高,浅层血管周围见少量炎细胞浸润,与组织病理学检查结果高度相符。     

Reflectance confocal microscopy may enhance the accuracy of histopathologic diagnosis: A case series

Although histopathology is the time‐honored gold standard diagnostic measure in dermatology, several factors may detract from an accurate microscopic diagnosis. Limiting factors include: human error, suboptimal biopsy‐site selection or biopsy technique, and inherent restrictions of vertical tissue sectioning that lead to incomplete microscopic evaluation of the lesion. Reflectance confocal microscopy (RCM) is a non‐invasive imaging tool that allows for the cellular‐level examination of the lesion, at a horizontal plane, which may complement the subsequent vertical histopathological tissue examination. Herein, we report a case series whereby prebiopsy RCM examination enhanced the accuracy of histopathological diagnosis or allowed for a critical appraisal of initial histopathological misdiagnosis.