Application and challenge of reflectance confocal microscopy in the diagnosis of pigmented nevus

Tang, Zhen; Huang, Jian; Lu, Jianyun; Chen, Jing; Guo, Aiyuan; Ding, Shilei

doi:10.1111/srt.12854

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…The diagnosis of condyloma is particularly challenging under RCM because koilocytes, which are the most relevant feature for the diagnosis, can be difficult to recognize. Koilocytes appear in the granular layer or the spinous layer, larger than normal skin keratinocytes with possible large nucleus, and the cytoplasm has a low refractive index [ 9 ]. A recent study on 75 patients with histologically proven genital warts found 36% false positive and 21% false negative results based on RCM [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Koilocytes appear in the granular layer or the spinous layer, larger than normal skin keratinocytes with possible large nucleus, and the cytoplasm has a low refractive index [ 9 ]. A recent study on 75 patients with histologically proven genital warts found 36% false positive and 21% false negative results based on RCM [ 9 ]. Misdiagnosis and missed diagnosis included bowenoid papulosis and squamous cell carcinoma in situ, which can have similar histologic features.…”

Section: Discussionmentioning

confidence: 99%

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Non-Invasive Imaging for the Diagnosis of Genital Warts and Their Imitators

Cinotti,

Barbarossa,

Cortonesi

et al. 2024

JCM

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Genital warts are the most frequent sexually transmitted disease. Their clinical diagnosis is not always easy, and invasive skin biopsies for histological examination should be performed in these cases. The aim of the study was to investigate the use of non-invasive imaging techniques for the diagnosis of genital warts and their imitators. We retrospectively evaluated dermoscopy, reflectance confocal microscopy (RCM), and line-filed confocal microscopy (LC-OCT) images of nine patients with 19 warts of the mucous membranes and five patients with lesions that clinically mimic genital warts, including 12 molluscum contagiosum, 1 Fordyce’s spot and one case of multiple acquired lymphangiomas. Most genital warts (15; 79%) showed dilated vessels surrounded by a whitish halo at dermoscopy. RCM and the new device LC-OCT could identify near histologic features such as the presence of hyperkeratosis, acanthosis, papillomatosis and enlarged vessels in all genital warts. However, the identification of koilocytes, which are the hallmark for the diagnosis of warts, was still difficult using both techniques. Non-invasive imaging techniques could also offer clues for the correct diagnosis of the imitators. This study confirmed the usefulness of dermoscopy in recognizing a precise pattern in warts and showed the potential use of RCM and LC-OCT to add additional findings to the clinical and dermoscopic examination.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Non-Invasive Imaging for the Diagnosis of Genital Warts and Their Imitators

Cinotti,

Barbarossa,

Cortonesi

et al. 2024

JCM

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“…In a retrospective analysis of 390 patients with clinically suspicious SK, dermatologists using RCM could not diagnose SK in 25% of participants [120]. SKs have previously been misdiagnosed as pigmented nevi, and RCM features have been reported as insufficient for distinguishing melanoacanthoma from melanoma [121][122][123].…”

Section: Other Optical Techniquesmentioning

confidence: 99%

Advances in the Etiology, Detection, and Clinical Management of Seborrheic Keratoses

Sun

Halpern

2021

Dermatology

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Seborrheic keratoses (SKs) are ubiquitous, generally benign skin tumors that exhibit high clinical variability. While age is a known risk factor, the precise roles of UV exposure and immune abnormalities are currently unclear. The underlying mechanisms of this benign disorder are paradoxically driven by oncogenic mutations and may have profound implications for our understanding of the malignant state. Advances in molecular pathogenesis suggest that inhibition of Akt and APP, as well as existing treatments for skin cancer, may have therapeutic potential in SK. Dermoscopic criteria have also become increasingly important to the accurate detection of SK, and other noninvasive diagnostic methods, such as reflectance confocal microscopy and optical coherence tomography, are rapidly developing. Given their ability to mimic malignant tumors, SK cases are often used to train artificial intelligence-based algorithms in the computerized detection of skin disease. These technologies are becoming increasingly accurate and have the potential to significantly augment clinical practice. Current treatment options for SK cause discomfort and can lead to adverse post-treatment effects, especially in skin of color. In light of the discontinuation of ESKATA in late 2019, promising alternatives, such as nitric-zinc and trichloroacetic acid topicals, should be further developed. There is also a need for larger, head-to-head trials of emerging laser therapies to ensure that future treatment standards address diverse patient needs.

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“…Many studies have reported that RCM was not only applied to diagnose skin mycosis but also nail and hair dermatophytosis [10,11]. Moreover, due to its advantages of painless, real time and convenience, [12] it has been used to detect inflammatory skin diseases, pigmented skin diseases, infectious skin diseases and skin tumors [13][14][15]. At present, it is not well known whether it can be applied to diagnose dermatomycosis independently and what is the potential diagnostic accuracy on dermatomycosis [16].…”

Section: Introductionmentioning

confidence: 99%

The challenge of Diagnosing Common Dermatomycosis by Reflectance Confocal Microscopy

Lu¹,

Zeng²,

Zhang³

et al. 2021

JDD

Self Cite

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Background: Traditional detection of fungal infections of the skin relies on microscopy techniques or fungal culture. Currently, reﬂectance confocal microscopy (RCM) has been widely applied to assist the diagnosis of commondermatomycosis with advantages of non-invasiveness, celerity, real time, and repeatability. Materials and Methods: A total of 478 clinically suspected dermatomycosis patients were enrolled in this study including 148 cases of tinea manus and pedis, 188 cases of tinea corporis and cruris and 142 cases of pityriasis versicolor. RCM examination was performed to image the lesions. Aim: This study aimed to summarize the image characteristics of in vivo RCM examination on common dermatomycosis and retrospectively evaluate its accuracy as compared with microscopy results. Furthermore, we attempted to tackle the challenges of RCM diagnosis on common dermatomycosis. Results: Based on RCM images, 231 of 478 (48.3%) patients were detected with hyphae. Among all RCM confirmed cases, 58 out of 148 (39.2%) were tinea manus and pedis, 145 out of 188 (77.1%) were tinea corporis and cruris, and 28 out of 142 (19.7%) were pityriasis versicolor. The remaining patients (51.7%) could not be diagnosed by the dermatologist according to RCM. Hyphae structures were primarily identified during diagnoses of dermatomycosis by RCM. Conclusions: RCM is a novel optical imaging technique that confers high-resolution images of fungi. RCM has certain advantages in the diagnosis of tinea manus and pedis. RCM is not suitable for the diagnosis of pityriasis versicolor.

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Application and challenge of reflectance confocal microscopy in the diagnosis of pigmented nevus

Cited by 6 publications

References 16 publications

Non-Invasive Imaging for the Diagnosis of Genital Warts and Their Imitators

Non-Invasive Imaging for the Diagnosis of Genital Warts and Their Imitators

Advances in the Etiology, Detection, and Clinical Management of Seborrheic Keratoses

The challenge of Diagnosing Common Dermatomycosis by Reflectance Confocal Microscopy

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