In vivo confocal laser scanning microscopy of melanocytic skin tumours: diagnostic applicability using unselected tumour images

Gerger, Armin; Hofmann‐Wellenhof, Rainer; Langsenlehner, Uwe; Richtig, Erika; Koller, Sílvia Helena; Weger, Wolfgang; Ahlgrimm‐Siess, Verena; Horn, Michael; Samonigg, Hellmut; Smolle, Josef

doi:10.1111/j.1365-2133.2007.08389.x

Cited by 71 publications

(59 citation statements)

References 14 publications

(49 reference statements)

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“…16,17 Imagens confocais têm sido avaliadas como qualitativamente e quantitativamente, correspondentes a cortes histológicos horizontais. 11,[18][19][20][21][22][23][24] A microscopia confocal, modo reflectante, e a dermatoscopia obtêm imagens no plano horizontal. Isto facilita a correlação entre as imagens obtidas nos dois exames, já tendo sido descrita a correlação entre alguns padrões globais e locais dermatoscópicos e suas características microscópicas confocais.…”

Section: Introductionunclassified

Microscopia confocal reflectante aplicada ao diagnóstico do melanoma cutâneo

Rito

Piñeiro-Maceira

2009

An. Bras. Dermatol.

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Resumo: O melanoma cutâneo é um problema de saúde pública a nível mundial. Sua incidência tem aumentado, de forma marcante, nos últimos anos, e o diagnóstico e excisão precoces são essenciais para o bom prognóstico dos pacientes. Neste contexto, a dermatoscopia ganhou grande importância, nas últi-mas duas décadas, melhorando, de forma significativa, a acurácia do diagnóstico do melanoma, em está-gios iniciais. Porém, existem algumas lesões benignas que apresentam dermatoscopia duvidosa, levando à realização de cirurgias desnecessárias. Mais recentemente, a microscopia confocal reflectante vem sendo introduzida como método diagnóstico auxiliar promissor, por ser um exame não-invasivo, realizado in vivo, de forma simples, indolor e de rápida execução. É a única técnica capaz de identificar estruturas celulares e examinar a epiderme e a derme papilar, com resolução semelhante à da histopatologia, com uma sensibilidade de 97,3%, e especificidade de 72,3% para o diagnóstico do melanoma cutâneo. É uma importante ferramenta diagnóstica, visto que não substitui o exame histopatológico realizado no pós-operatório, mas permite a abordagem racional das lesões com dermatoscopia duvidosa, evitando procedimentos cirúrgicos desnecessários. Palavras-chave: Diagnóstico; Melanoma; Microscopia confocal Abstract: Skin melanoma is an international public health issue, with a considerable increase in frequency over the past few years. Early diagnosis and excision are essential for good patient prognosis. Over the past two decades dermoscopy has gained significance due to a major improvement in the accuracy of skin melanoma diagnosis in its early stage. However, there are some benign lesions of questionable dermoscopy, which may lead to the performance of unnecessary surgery. Recently, reflectance confocal microscopy has been introduced as a promising supplementary diagnostic method. It is a noninvasive, in vivo, simple, painless and quick exam. It is the only technique capable of identifying cellular structures and to examine the epidermis and papillary dermis with a resolution similar to that of histopathology, with a sensitivity of 97.3% and specificity of 72.3 % in the diagnosis of cutaneous melanoma. This is an important diagnostic tool, because it does not substitute post-surgical histopathological examination and allows for the rational assessment of lesions of questionable dermoscopy, thus avoiding unnecessary surgical procedures. Keywords: Diagnosis; Melanoma; Microscopy,confocal REVISÃO INTRODUÇÃOO melanoma e o câncer de pele não-melanoma são, hoje, os mais comuns tipos de câncer na população de cor branca, segundo alguns autores. 1 Ambos os tumores têm demonstrado um aumento de incidên-cia, em todo o mundo. O melanoma cutâneo é o cân-cer o qual cresce mais rapidamente na população caucasiana, e sua morbidade tem aumentado dramaticamente, nos últimos anos. [1][2][3][4][5] Existe uma forte correlação inversa entre: a taxa de sobrevida e a espessura do tumor, já que não existem terapias efetivas, curativas para o melanoma ava...

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Section: Introductionunclassified

Microscopia confocal reflectante aplicada ao diagnóstico do melanoma cutâneo

Rito

Piñeiro-Maceira

2009

An. Bras. Dermatol.

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“…Although the VivaScope® may improve patient care and management [3][4][5][6][7][8][9][10] there is a lack of data from the UK [2]. Therefore it is felt that the applicability of this evidence to a UK population is unclear Relevant differences between the UK and other countries are the underlying incidence of melanoma in populations, the fact that most treatment in the UK is performed by a public health system (the NHS), the fact that there are fewer dermatologists in the UK, and the fact that most screening in the UK occurs in primary care prior to seeing a specialist.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Diagnostic Accuracy of Reflectance Confocal Microscopy to Diagnose Skin Cancer: A Research Protocol (Preprint)

Herz¹,

Chalkidou²,

Reid³

et al. 2017

Preprint

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Skin cancer is the most common type of cancer in the UK, with over 100,000 cases diagnosed each year. Melanoma is a type of skin cancer that can develop from a mole. However, moles that are suspicious histologically are often difficult to diagnose clinically by eye, even for experts working in specialist skin cancer screening clinics. In the UK, 350,000 patients per year are referred to hospital clinics with suspicious moles, and approximately half undergo a biopsy to identify the 5-10% who require further treatment. If cancer cannot be ruled out clinically and on the basis of biopsy results, the lesion is surgically removed. One type of pre-cancerous mole, called lentigo maligna, is particularly challenging to treat. It develops insidiously, can become large, and is difficult to assess when it transforms into a lentigo maligna melanoma. It is also difficult to identify the margins by eye or with the aid of a dermatoscope. This results in high excision rates. Excision is often incomplete despite large areas of tissue removal (5 mm around tumour's visible margin), and there are high recurrence rates even when the lesion is considered successfully removed.Reflectance confocal microscopy is an imaging technique that can supplement dermoscopy in identifying if a clinically suspicious mole is malignant and can better assess lentigo maligna margins. It allows clinicians to see the skin lesion in greater detail than dermoscopy and therefore better guide more accurate diagnoses. This prospective study will examine patients with suspicious moles and lentigo maligna to determine whether confocal microscopy can both reduce the number of unnecessary biopsies of moles and more accurately guide the surgical excision margins of lentigo maligna.

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“…However, a confocal microscope [7,8] can provide high lateral and longitudinal resolutions by using a point source and a point detector. Furthermore, it has a special optical sectioning property that enables internal inspection of three dimensional structures [9][10][11]. Accordingly, the confocal microscope is believed to be a useful tool for O-PCB evaluation, since its characteristics enable noncontact and nondestructive inspection of an optical waveguide.…”

Section: Introductionmentioning

confidence: 99%

Measurement of the Internal Structure of an Optical Waveguide Embedded in a Flexible Optical Circuit Board by Enhancing the Signal Contrast of a Confocal Microscope

Lee

Kim

Beom‐Hoan

et al. 2011

Journal of the Optical Society of Korea

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In this study, the internal structure of an optical waveguide embedded in a flexible optical circuit board is observed with a confocal microscope. In order to increase the light reflection from an internal material interface with a very small index difference, and thus enhance the signal contrast, a theta microscopy scheme has been integrated into a conventional confocal microscope, and a high NA oil-immersion lens has been used. The interface reflectivity is increased from roughly 0.0015% to 0.025% by the proposed method, and the internal structure can thus be successfully measured.

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In vivo confocal laser scanning microscopy of melanocytic skin tumours: diagnostic applicability using unselected tumour images

Abstract: In vivo CLSM augurs a sea change in the way we will view skin tumour processes clinically at the bedside and merits application for use as a screening tool in skin oncology.

Cited by 71 publications

References 14 publications

Microscopia confocal reflectante aplicada ao diagnóstico do melanoma cutâneo

Microscopia confocal reflectante aplicada ao diagnóstico do melanoma cutâneo

Evaluating the Diagnostic Accuracy of Reflectance Confocal Microscopy to Diagnose Skin Cancer: A Research Protocol (Preprint)

Measurement of the Internal Structure of an Optical Waveguide Embedded in a Flexible Optical Circuit Board by Enhancing the Signal Contrast of a Confocal Microscope

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