Correlation of Dermoscopic Structures of Melanocytic Lesions to Reflectance Confocal Microscopy

Abstract

To determine the utility of reflectance confocal microscopy (RCM) in the in vivo evaluation of dermoscopic structures of melanocytic lesions. Design: For each described dermoscopic feature, we evaluated by RCM at least 2 melanocytic lesions. A digital camera connected to the confocal computer enabled direct analysis of the dermoscopic structures. To ascertain precision of correlation, the orientation of the dermoscopic and RCM images were compared using a superimposed grid.Setting: Dermatology clinic specializing in pigmented lesions.Patients: Eleven patients with melanocytic lesions, including 2 melanomas, 1 Spitz nevus, 7 dysplastic nevi, and 1 compound nevus.Main Outcome Measure: Direct correlation of structures seen using dermoscopy with those seen using RCM.Results: There was a good correlation between the global dermoscopic pattern and findings on the 4ϫ4-mm mosaic of confocal images at the level of the dermoepidermal junction. The atypical network correlated with variability in the size and shape of dermal papillae. Globules corresponded with aggregates of bright cells, and darker shades of brown on dermoscopy appeared brighter on RCM. In peripheral streaks, RCM showed dense aggregates of pleomorphic cells of variable brightness and illdefined cellular borders. These aggregates were continuous with the bright mesh that composed the central bulk of the lesion. A blue-white veil correlated with disruption of the rimmed papillae meshlike pattern and sometimes with the presence of bright cells corresponding to melanophages. Conclusion:Correlating dermoscopic structures to RCM features is possible and a necessary step toward understanding the potential benefits of RCM in the clinical setting.

Spitz nevus and Reed nevus

“…It is also called dermatoscopy, surface microscopy and epiluminescence microscopy. 7,18,27 Three main dermoscopic patterns have been recognized: 1,8,14 1 -Starburst pattern, observed in 53% of the cases. This is a pattern with prominent central pigmentation, diffuse, bluish-gray or black, also called black lamella, corresponding to the region of greatest parakeratosis, and streaks distributed around the lesion that correlate to areas of cell nest compression observed in histopathology.…”

“…Previous studies have shown that asymmetry is an important indicator of histopathological atypia in Spitz nevus and that this feature deserves special attention in the context of this correlation. 7,27 In addition, dermoscopic examination may indicate the most suitable site for performing a biopsy of larger lesions. The combination of various diagnostic tools, starting with an appropriate clinical examination and including a well-executed dermoscopy with technical mastery and anatomopathological examination performed by a pathologist with experience in pigmented skin lesions will result in more reliable diagnoses, particularly with respect to lesions that may mimic other lesions, indicating which is the most appropriate conduct for the patient.…”

In vivo Diagnosis of Basal Cell Carcinoma Subtype by Reflectance Confocal Microscopy

“…The resolution of these images is comparable with conventional histology [15]. Nowadays, RCM imaging is mainly used for the diagnosis of melanoma and nonmelanoma skin cancer [16,17,18,19,20,21]. Besides, RCM has been shown to be a useful tool for monitoring and follow-up of therapy of inflammatory skin disorders and BCC [22,23].…”

Digital colposcopy: ready for use? An overview of literature

“…[66][67][68] Although the use of confocal microscopy to examine the cervix uteri in vivo is a novelty, it has been used in the field of dermatology, ophthalmology and gastroenterology. [69][70][71][72][73][74] Confocal optical imaging can detect superficial lesions and therefore seems to be suitable for the early detection of precancerous lesions.…”