Background: Reflectance confocal microscopy (RCM) is a high-resolution imaging tool for in vivo noninvasive evaluation of skin lesions. Objective: We sought to describe the relevant RCM features for pigmented basal ce...Background: Reflectance confocal microscopy (RCM) is a high-resolution imaging tool for in vivo noninvasive evaluation of skin lesions. Objective: We sought to describe the relevant RCM features for pigmented basal cell carcinoma (BCC). Methods: Pigmented skin lesions with a differential diagnosis of pigmented BCC were imaged using dermoscopy and RCM, followed by excision for histologic analysis. Results: RCM demonstrated aggregations of tightly packed cells with palisading, forming cordlike structures and nodules with irregular borders and variable brightness; these represented nests of pigmented basaloid tumor cells on histopathology, and blue-gray ovoid areas on dermoscopy. These tumor nests were associated with bright dendritic structures, identified histologically as either melanocytes or Langerhans cells, together with numerous bright oval to stellate-shaped structures with indistinct borders representing melanophages, and with highly refractile granules of melanin. Limitations: The pigmented BCCs imaged in this study were predominantly nodular; a different set or additional criteria may be necessary for detection of infiltrative and metatypical BCCs. Conclusion: RCM may permit in vivo diagnosis of pigmented BCC.展开更多
Objective: To determine the utility of confocal scanning laser microscopy (CSLM) in the in vivo evaluation of congenitalmelanocytic nevi (CMNs) that are suggestive of having developed melanoma. Design: The CMNs sugges...Objective: To determine the utility of confocal scanning laser microscopy (CSLM) in the in vivo evaluation of congenitalmelanocytic nevi (CMNs) that are suggestive of having developed melanoma. Design: The CMNs suggestive of melanoma by clinical and dermoscopic examination were imaged by CSLM, and the findings correlated with the features seen on dermoscopic and histologic examination. Setting: Dermatology clinic specializing in pigmented lesions. Patients: Seven patients with clinically irregular small to medium CMNs. Interventions: The areas imaged by CSLM were sampled with 3- mm punch biopsy specimens. The entire lesion was subsequently excised. The punch biopsy specimens were step sectioned horizontally to correlate with the CSLM images. Excised samples were step sectioned and processed routinely. Histologic features observed on CSLM were correlated with the features seen on dermoscopic and light microscopic examination. Main Outcome Measure: Correlation of the structures seen using CSLM with the dermoscopic and histologic features of CMNs and melanoma. Results: The CSLM illustrated histologic characteristics of CMNs, including the presence of hyperpigmented keratinocytes, nevus cells, melanophages, and a normal “ honeycomb” epidermal architecture. Features suggestive of melanoma were not evident by CSLM in 6 histologically proven benign CMNs. Histologic features associated with melanoma, such as an increased number of intra epidermal atypical melanocytes (pagetoid) and loss of normal epidermal cellular architecture, were identified by CSLM in 1 lesion, which on histologic analysis revealed melanoma in association with a CMN. Conclusion: Our results illustrate that CSLM may be useful for clinicopathologic correlations and for the preliminary noninvasive diagnosis of pigmented neoplasms in vivo.展开更多
文摘Background: Reflectance confocal microscopy (RCM) is a high-resolution imaging tool for in vivo noninvasive evaluation of skin lesions. Objective: We sought to describe the relevant RCM features for pigmented basal cell carcinoma (BCC). Methods: Pigmented skin lesions with a differential diagnosis of pigmented BCC were imaged using dermoscopy and RCM, followed by excision for histologic analysis. Results: RCM demonstrated aggregations of tightly packed cells with palisading, forming cordlike structures and nodules with irregular borders and variable brightness; these represented nests of pigmented basaloid tumor cells on histopathology, and blue-gray ovoid areas on dermoscopy. These tumor nests were associated with bright dendritic structures, identified histologically as either melanocytes or Langerhans cells, together with numerous bright oval to stellate-shaped structures with indistinct borders representing melanophages, and with highly refractile granules of melanin. Limitations: The pigmented BCCs imaged in this study were predominantly nodular; a different set or additional criteria may be necessary for detection of infiltrative and metatypical BCCs. Conclusion: RCM may permit in vivo diagnosis of pigmented BCC.
文摘Objective: To determine the utility of confocal scanning laser microscopy (CSLM) in the in vivo evaluation of congenitalmelanocytic nevi (CMNs) that are suggestive of having developed melanoma. Design: The CMNs suggestive of melanoma by clinical and dermoscopic examination were imaged by CSLM, and the findings correlated with the features seen on dermoscopic and histologic examination. Setting: Dermatology clinic specializing in pigmented lesions. Patients: Seven patients with clinically irregular small to medium CMNs. Interventions: The areas imaged by CSLM were sampled with 3- mm punch biopsy specimens. The entire lesion was subsequently excised. The punch biopsy specimens were step sectioned horizontally to correlate with the CSLM images. Excised samples were step sectioned and processed routinely. Histologic features observed on CSLM were correlated with the features seen on dermoscopic and light microscopic examination. Main Outcome Measure: Correlation of the structures seen using CSLM with the dermoscopic and histologic features of CMNs and melanoma. Results: The CSLM illustrated histologic characteristics of CMNs, including the presence of hyperpigmented keratinocytes, nevus cells, melanophages, and a normal “ honeycomb” epidermal architecture. Features suggestive of melanoma were not evident by CSLM in 6 histologically proven benign CMNs. Histologic features associated with melanoma, such as an increased number of intra epidermal atypical melanocytes (pagetoid) and loss of normal epidermal cellular architecture, were identified by CSLM in 1 lesion, which on histologic analysis revealed melanoma in association with a CMN. Conclusion: Our results illustrate that CSLM may be useful for clinicopathologic correlations and for the preliminary noninvasive diagnosis of pigmented neoplasms in vivo.
