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Reflectance Confocal Microscopy for Skin Cancer Margins: How it Works

  • Medical Surgery (M Alam, Section Editor)
  • Published:
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Abstract

Since its first application to human skin imaging in 1995, confocal microscopy has continued to improve as both a noninvasive, in vivo imaging technique for intact skin and an efficient and cost-effective ex vivo imaging approach for excised skin. The purpose of this article is to present the principles behind confocal microscopy imaging of skin, provide a frame of reference regarding where the technology currently stands in its development towards widespread clinical practice, and elucidate how confocal microscopy can be used for preoperative and intraoperative delineation of skin cancer margins.

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References

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  1. Rajadhyaksha M et al. In vivo confocal scanning laser microscopy of human skin: melanin provides strong contrast. J Invest Dermatol. 1995;104(6):946–52.

    Article  CAS  PubMed  Google Scholar 

  2. Nwaneshiudu A et al. Introduction to confocal microscopy. J Invest Dermatol. 2012;132(12):e3.

    Article  CAS  PubMed  Google Scholar 

  3. Gonzalez S et al. Real-time evidence of in vivo leukocyte trafficking in human skin by reflectance confocal microscopy. J Invest Dermatol. 2001;117(2):384–6.

    Article  CAS  PubMed  Google Scholar 

  4. Rajadhyaksha M et al. In vivo confocal scanning laser microscopy of human skin II: advances in instrumentation and comparison with histology. J Invest Dermatol. 1999;113(3):293–303.

    Article  CAS  PubMed  Google Scholar 

  5. Gareau DS et al. Confocal mosaicing microscopy in Mohs skin excisions: feasibility of rapid surgical pathology. J Biomed Opt. 2008;13(5):054001.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Flores ES et al. Intraoperative imaging during Mohs surgery with reflectance confocal microscopy: initial clinical experience. J Biomed Opt. 2015;20(6):61103. This paper highlight the use of RCM in vivo on Mohs surgical wounds to evaluate detection of positive margins.

    Article  PubMed  Google Scholar 

  7. Kose K et al. Video-mosaicing of reflectance confocal images for examination of extended areas of skin in vivo. Br J Dermatol. 2014;171(5):1239–41. This manuscript details the work of utilizing video capture handheld RCM and converting these video frames into a strip mosaic for real time review.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Abeytunge S et al. Rapid confocal imaging of large areas of excised tissue with strip mosaicing. J Biomed Opt. 2011;16(5):050504.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Abeytunge S et al. Confocal microscopy with strip mosaicing for rapid imaging over large areas of excised tissue. J Biomed Opt. 2013;18(6):61227.

    Article  PubMed  Google Scholar 

  10. Huzaira M et al. Topographic variations in normal skin, as viewed by in vivo reflectance confocal microscopy. J Invest Dermatol. 2001;116(6):846–52.

    Article  CAS  PubMed  Google Scholar 

  11. Gerger A et al. Sensitivity and specificity of confocal laser-scanning microscopy for in vivo diagnosis of malignant skin tumors. Cancer. 2006;107(1):193–200.

    Article  PubMed  Google Scholar 

  12. Guitera P et al. In vivo confocal microscopy for diagnosis of melanoma and basal cell carcinoma using a two-step method: analysis of 710 consecutive clinically equivocal cases. J Invest Dermatol. 2012;132(10):2386–94.

    Article  CAS  PubMed  Google Scholar 

  13. Nori S et al. Sensitivity and specificity of reflectance-mode confocal microscopy for in vivo diagnosis of basal cell carcinoma: a multicenter study. J Am Acad Dermatol. 2004;51(6):923–30.

    Article  PubMed  Google Scholar 

  14. Aghassi D, Anderson RR, Gonzalez S. Confocal laser microscopic imaging of actinic keratoses in vivo: a preliminary report. J Am Acad Dermatol. 2000;43(1 Pt 1):42–8.

    Article  CAS  PubMed  Google Scholar 

  15. Rishpon A et al. Reflectance confocal microscopy criteria for squamous cell carcinomas and actinic keratoses. Arch Dermatol. 2009;145(7):766–72.

    Article  PubMed  Google Scholar 

  16. Astner S, U.M., Cuevas J, González S. Actinic keratosis. In: HA González S, Gill M, editors. Reflectance confocal of cutaneous tumors. London, UK: Informa Healthcare; 2007.

    Google Scholar 

  17. Horn M et al. The use of confocal laser-scanning microscopy in microsurgery for invasive squamous cell carcinoma. Br J Dermatol. 2007;156(1):81–4.

    Article  CAS  PubMed  Google Scholar 

  18. Pellacani G et al. The impact of in vivo reflectance confocal microscopy for the diagnostic accuracy of melanoma and equivocal melanocytic lesions. J Invest Dermatol. 2007;127(12):2759–65.

    Article  CAS  PubMed  Google Scholar 

  19. Lovatto L et al. In vivo reflectance confocal microscopy of equivocal melanocytic lesions detected by digital dermoscopy follow-up. J Eur Acad Dermatol Venereol. 2015;29(10):1918–25.

    Article  CAS  PubMed  Google Scholar 

  20. Menge TD et al. Concordance of handheld reflectance confocal microscopy (RCM) with histopathology in the diagnosis of lentigo maligna (LM): A prospective study. J Am Acad Dermatol. 2016. This article demonstrated excellent concordance of handheld RCM diagnosis and corresponding histopathological diagnosis in equivocal pigmented lesions suspicious for melanoma. In this study it is noted that experienced confocal users were reading the images

  21. Binder M et al. Epiluminescence microscopy of small pigmented skin lesions: short-term formal training improves the diagnostic performance of dermatologists. J Am Acad Dermatol. 1997;36(2 Pt 1):197–202.

    Article  CAS  PubMed  Google Scholar 

  22. Hazan C et al. Staged excision for lentigo maligna and lentigo maligna melanoma: a retrospective analysis of 117 cases. J Am Acad Dermatol. 2008;58(1):142–8.

    Article  PubMed  Google Scholar 

  23. Hibler BP et al. Intraoperative real-time reflectance confocal microscopy for guiding surgical margins of lentigo maligna melanoma. Dermatol Surg. 2015;41(8):980–3. This case study highlight the importance of handheld RCM to evaluate real time surgical margins in collaboration with surgical excision.

    Article  CAS  PubMed  Google Scholar 

  24. Chen CS et al. Multimodal in vivo optical imaging, including confocal microscopy, facilitates presurgical margin mapping for clinically complex lentigo maligna melanoma. Br J Dermatol. 2005;153(5):1031–6.

    Article  PubMed  Google Scholar 

  25. Guitera P et al. Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy. JAMA Dermatol. 2013;149(6):692–8.

    Article  PubMed  Google Scholar 

  26. Pan ZY et al. In vivo reflectance confocal microscopy of Basal cell carcinoma: feasibility of preoperative mapping of cancer margins. Dermatol Surg. 2012;38(12):1945–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Busam KJ et al. Detection of clinically amelanotic malignant melanoma and assessment of its margins by in vivo confocal scanning laser microscopy. Arch Dermatol. 2001;137(7):923–9.

    CAS  PubMed  Google Scholar 

  28. Rajadhyaksha M et al. Confocal examination of nonmelanoma cancers in thick skin excisions to potentially guide mohs micrographic surgery without frozen histopathology. J Invest Dermatol. 2001;117(5):1137–43.

    Article  CAS  PubMed  Google Scholar 

  29. Tannous Z, Torres A, Gonzalez S. In vivo real-time confocal reflectance microscopy: a noninvasive guide for Mohs micrographic surgery facilitated by aluminum chloride, an excellent contrast enhancer. Dermatol Surg. 2003;29(8):839–46.

    PubMed  Google Scholar 

  30. Scope A et al. In vivo reflectance confocal microscopy of shave biopsy wounds: feasibility of intraoperative mapping of cancer margins. Br J Dermatol. 2010;163(6):1218–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Patel YG et al. Confocal reflectance mosaicing of basal cell carcinomas in Mohs surgical skin excisions. J Biomed Opt. 2007;12(3):034027.

    Article  PubMed  Google Scholar 

  32. Karen JK et al. Detection of basal cell carcinomas in Mohs excisions with fluorescence confocal mosaicing microscopy. Br J Dermatol. 2009;160(6):1242–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Hartmann D et al. Correlation of histological and ex-vivo confocal tumor thickness in malignant melanoma. Lasers Med Sci. 2016. This study shows that RCM and FCM have good correlation with histopathology on melanoma tumor thickness in ex vivo tissue samples

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Correspondence to Anthony M. Rossi.

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Dr. Michael C. Cameron declares that he has no conflict of interest. Dr. Rossi reports travel from Mavic, outside the submitted work.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Medical Surgery

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Cameron, M.C., Rossi, A.M. Reflectance Confocal Microscopy for Skin Cancer Margins: How it Works. Curr Derm Rep 5, 172–178 (2016). https://doi.org/10.1007/s13671-016-0147-4

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