Advances in the use of Reflectance Confocal Microscopy in Melanoma

Waddell, A. N.; Star, Phoebe; Guitera, Pascale

doi:10.2217/mmt-2018-0001

Cited by 46 publications

(40 citation statements)

References 105 publications

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“…An area that warrants attention is that recurrence may relate to both a wide subclinical extension of atypical melanocytes and the limitations associated with histological margin assessment of WLE samples. RCM has, and will, become a more common adjunct to the clinical exam, dermoscopy, and histopathology assessment [ 40 ]. In MMS, the entire margin is examined whereas in standard pathological assessment this is reported to range from 0.5% to 5% [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision

Moura

Homer

McKirdy

2020

Journal of Skin Cancer

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Background. The incidence of melanoma in situ (MIS) is increasing faster compared to invasive melanoma. Despite varying international practice, a minimum of 5 mm surgical excision margin is currently recommended in the UK. There is no clear guidance on the minimum histological peripheral clearance margins. Aim. This study compares the histological peripheral clearance margins of MIS using wide local excision (WLE) to the rate of recurrence and progression to invasive disease. Methods. A retrospective single-center review was performed over a 5-year period. Inclusion criteria consisted of MIS diagnosis, ≥16 years of age, and treatment with WLE with curative intent. Those patients with a recurrence of a previous MIS or with a reported focus of invasion/regression were also included. Clinicopathological data and follow-up were recorded. Results. 167 MIS were identified in 155 patients, 80% of which were lentigo maligna subtype. Of patients with completely excised MIS on histology (>0 mm), 9% had recurrence with a median time to recurrence of 36 months. Three (1.8%) cases recurred as invasive disease. Age, MIS site, MIS subtype, and histological evidence of foci of invasion/regression did not predict recurrence nor progression to invasive disease ( p > 0.05 ). The recurrence rate of MIS with a histological excision margin ≤3.0 mm was 13% compared to 3% in those with histology margins of >3.0 mm ( p = 0.049 ). Conclusion. A histological peripheral clearance of at least 3.0 mm is advocated to achieve lower recurrence rates. The follow-up duration should be reviewed due to the median recurrence occurring at 36 months in our cohort. Cumulative work on MIS needs to be collated and completed in a large multicenter study with a long follow-up period.

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Section: Discussionmentioning

confidence: 99%

Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision

Moura

Homer

McKirdy

2020

Journal of Skin Cancer

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“…Morphologic biomarkers such as pagetoid melanocytes can be detected by RCT [ 85 ]. Other morphologic features detected by RCT are broken down by skin layers by Waddell et al [ 86 ]. In the superficial epidermis, atypical honeycomb pattern, atypical cobblestone pattern, and pagetoid cells are often seen in melanomas.…”

Section: Melanoma Biomarkersmentioning

confidence: 99%

“…In the basal cell layer and the dermo-epidermal layer (DEJ), cellular atypia, nonedged dermal papillae, and a disarranged DEJ can be appreciated. Lastly, the upper dermis can have cells distributed in sheet-like structures and sparse nests composed of round or pleomorphic cells [ 86 ].…”

Section: Melanoma Biomarkersmentioning

confidence: 99%

Melanoma Biomarkers and Their Potential Application for In Vivo Diagnostic Imaging Modalities

Hessler

Jalilian

et al. 2020

IJMS

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Melanoma is the deadliest form of skin cancer and remains a diagnostic challenge in the dermatology clinic. Several non-invasive imaging techniques have been developed to identify melanoma. The signal source in each of these modalities is based on the alteration of physical characteristics of the tissue from healthy/benign to melanoma. However, as these characteristics are not always sufficiently specific, the current imaging techniques are not adequate for use in the clinical setting. A more robust way of melanoma diagnosis is to “stain” or selectively target the suspect tissue with a melanoma biomarker attached to a contrast enhancer of one imaging modality. Here, we categorize and review known melanoma diagnostic biomarkers with the goal of guiding skin imaging experts to design an appropriate diagnostic tool for differentiating between melanoma and benign lesions with a high specificity and sensitivity.

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“…Devices like the VivaScope (MAVIG, Munich, Germany) [49] are based on reflectance confocal microscopy (RCM), in which backscattered light from unlabeled structures is analyzed, based on changes in refractive index. The in vivo applications of RCM lie predominantly in the diagnosis of various skin cancers [50], as its penetration depth is limited to the epidermis and upper part of the dermis. However, attempts to analyze collagen production after microneedling of acne scars have been described in vivo with a combination of dermoscopy and RCM [51].…”

Section: Confocal Microscopymentioning

confidence: 99%

Structural Assessment of Scars Using Optical Techniques

Haasterecht

Zuijlen

Groot

2020

Textbook on Scar Management

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The evaluation of scar treatment benefits from exact structural measurements. Accurate assessment of thickness, surface area, and relief is crucial in routine clinical follow-up. From an experimental perspective, precise visualization of the microstructural organization is necessary for a better understanding of the mechanisms underlying pathological scarring. Structural proteins in scars differ from healthy skin in terms of amount, type, and importantly, organization. The precise quantification of this extracellular matrix (ECM) organization was, until recently, limited to two-dimensional images from fixated and stained tissue. Advances in optical techniques now allow high-resolution imaging of these structures, in some cases in vivo. The enormous potential of these techniques as objective assessment tools is illustrated by a substantial increase in available devices. This chapter describes currently used devices and techniques used in the clinical follow-up of scar progression from a volumetric standpoint. Furthermore, some of the most powerful techniques for microstructural research are described including optical coherence tomography, nonlinear optical techniques such as second harmonic generation microscopy, and confocal microscopy.

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Advances in the use of Reflectance Confocal Microscopy in Melanoma

Cited by 46 publications

References 105 publications

Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision

Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision

Melanoma Biomarkers and Their Potential Application for In Vivo Diagnostic Imaging Modalities

Structural Assessment of Scars Using Optical Techniques

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