Basal cell carcinoma: the utility of in vivo and ex vivo confocal microscopy

Abstract

The use of confocal microscopy is possible using two different modalities: first, at patient's bedside for a rapid in vivo diagnosis of basal cell carcinoma and second, in the operating room directly on freshly excised specimen for a fast ex vivo margin-controlled surgery. In the current review, we report the main application of confocal microscopy for basal cell carcinoma diagnosis and management in both modalities.

Lesions Mimicking Melanoma at Dermoscopy Confirmed Basal Cell Carcinoma: Evaluation with Reflectance Confocal Microscopy

“…The main RCM criteria for typical BCC diagnosis include the presence of tumor islands (nests of basaloid cells), peripheral palisading and peritumoral clefts[20, 21], and in the current study, these RCM features proved useful in identifying all the BCCs in this cohort of lesions with dermoscopic suspicion of melanoma. This finding has a significant impact for therapeutic patient management, as BCC patients can be offered differential diagnosis from MM, at the patients’ bedside, with a noninvasive procedure, saving the patient the concern of an uncertain MM diagnosis and eventually an unnecessary surgical excision, whilst enabling the physician to immediately commence correct treatment.…”

“…The RCM features associated with nsBCCs identified in the current study included the dermic location of large tumor islands with branch-like structures, peripheral palisading, peritumoral clefts, coiled vascular morphology and increased vascular diameter, collagen surrounding the tumor island and the absence of cords connected to the epidermis[20], many of which were underlined in a recent review[21]. The confounding feature in cluster analysis for differential diagnoses of sBCC or nsBCC was the presence of coiled vascular morphology in 3 of the 13 sBCCs.…”

Diagnostic accuracy of ex vivo fluorescence confocal microscopy in Mohs surgery of basal cell carcinomas: a prospective study on 753 margins

“…2 In the last few years, new tools have been developed in an attempt to speed up and obtain a more efficient skin cancer diagnosis pre-and intraoperatively. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Reflectance confocal microscopy has been successfully applied to skin cancer diagnosis in the clinical setting, with an emphasis on BCC. 10,11,13,15 However, reflectance confocal microscopy is mainly used for preoperative in vivo skin cancer diagnosis.…”

“…Ex vivo FCM is a new imaging tool that offers an attractive alternative to conventional frozen histology for the detection of margins in freshly excised tissue. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]20,[33][34][35][36][37][38] It was initially applied to skin cancer, in particular BCCs, and later to solid tumours in pivotal studies. [21][22][23][24][25][26][27][28][29][30][31][32] Basically, FCM scans a given surgical specimen and provides grey-scale high-resolution images that are automatically stitched together to create 'mosaics'.…”

‘Eternal sunshine of the spotless islands’: how dermoscopy may influence confocal microscopy when dealing with squamous cells carcinoma simulating basal cell carcinoma

“…As maternal antibody during the first two trimesters is minimal, biologics are thought to be safe in these trimesters, although no robust data to support this exist in the psoriasis literature. 5 Low-quality evidence from the rheumatology and gastroenterology literature suggests continuing biologic treatment throughout pregnancy to evade flares, which are associated with adverse pregnancy outcomes.…”