Genital warts: comparing clinical findings to dermatoscopic aspects, in vivo reflectance confocal features and histopathologic exam

Abstract

Genital warts can be diagnosed through physical examination and confirmed by histopathology. Noninvasive methods are useful for ruling out other diagnoses with no harm to the patient. In this study the clinical findings were compared to dermoscopy, reflectance confocal microscopy (RCM), and to histopathology findings, in order to determine possible patterns that can aid diagnosis of the lesion. It was possible to identify structural changes on reflectance confocal microscopy that are already known by dermoscopy, in addition to cellular changes previously seen only by histopathological examination. This study shows the use of reflectance confocal microscopy in cases of genital warts, providing important information that can be used in further studies.

Reflectance confocal microscopy of vulvar epithelial neoplasia: a pilot study

“…VIN was characterized by parakeratosis, disarranged honeycomb pattern, dyskeratotic cells and dilated blood vessels traversing dermal papilla, as described for cutaneous SCC and its precursors . Regarding the significance of large hyporeflective cells, they could represent koilocytes as described in condyloma, or dyskeratotic cells as described in cutaneous SCC, but our side‐by‐side correlation between confocal images and histological sections rather pointed to koilocytes. VSCC presented clinically as budding ulcerous lesion; therefore, the epidermis was not visible in the RCM images, and the clinically diagnosed inflammation translated into a leucocyte fibrinous exudate.…”

Reflectance confocal microscopy of tinea capitis: comparing images with results of dermoscopy and mycological exams

“…4 Similar to dermoscopy, it was initially developed for the analysis of melanocytic lesions and had its use expanded for the diagnosis of inflammatory and infectious lesions, 4 such as demodicosis, 5 molluscum contagiosum, 6 and genital warts. 7 In mycology, RCM was recently described in tinea nigra, where it was verified that the classic speckled pigment appearance presented at dermoscopy corresponds to the presence of dematiaceous hyphae parasitizing the keratin. The use of RCM in tinea capitis was already described in a study where RCM was performed in six cases of hair dermatophytosis.…”

“…Reflectance confocal microscopy is a noninvasive imaging method that allows an in vivo microscopic view of the epidermis and superficial dermis through an optical system formed by a light source (diode laser of 830 nm wavelength) and a set of objective lenses . Similar to dermoscopy, it was initially developed for the analysis of melanocytic lesions and had its use expanded for the diagnosis of inflammatory and infectious lesions, such as demodicosis, molluscum contagiosum, and genital warts . In mycology, RCM was recently described in tinea nigra, where it was verified that the classic speckled pigment appearance presented at dermoscopy corresponds to the presence of dematiaceous hyphae parasitizing the keratin …”

Alternative uses of dermoscopy in general dermatology

“…Several morphologic patterns such as finger-like, knob-like or mosaic-like along with vascular structure shave have been described [35,36] . Typically, single red dots can often be seen corresponding to glomerular vessels [37] .…”