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

Abstract

Background: Reflectance confocal microscopy (RCM) is a noninvasive imaging technique. Currently, RCM is mainly used for the diagnosis of melanoma and nonmelanoma skin cancer including basal cell carcinoma (BCC). Until now, it has not been possible to distinguish between subtypes of BCC using RCM. Objective: To establish the RCM features for subtypes of BCC. Methods: 57 lesions were selected for RCM imaging. Clinical and dermatoscopic pictures were taken and a 3-mm biopsy was obtained. Results: It was demonstrated that tumor nests with peripheral palisading, branch-like structures, fibrotic septa and increase in vascular diameter were characteristic RCM features for nodular and micronodular BCC. The size and shape of the tumor nests allowed further distinction between these BCCs. Solar elastosis and tumor nests connected with the basal cell layer characterize superficial BCC. Conclusion: This study presents RCM features for BCC, which might allow in vivo diagnosis of the nodular, micronodular and superficial subtype of BCC. This could prevent a skin biopsy, resulting in direct proper treatment. Further, RCM allows to evaluate the total lesion, which makes it possible to detect mixed-type BCCs.

In vivo confocal microscopy of basal cell carcinoma: a systematic review of diagnostic accuracy

“…Six studies with a total of 331 BCC lesions were finally included in the systematic review . Study characteristics are shown in Table .…”

Non‐invasive diagnosis of pink basal cell carcinoma: how much can we rely on dermoscopy and reflectance confocal microscopy?

“…RCM application to BCC diagnosis has been tested and has been shown to be useful in improving its accuracy (24,25). RCM features proposed by Gonzalez and Tannous for BCC diagnosis, namely elongated monomorphic basaloid nuclei, polarization of these nuclei along the same axis of orientation, prominent inflammatory infiltrate, increased vasculature, and pleomorphism of the overlying epidermis indicative of actinic damage (26).…”

Reflectance confocal microscopy: non‐invasive distinction between actinic keratosis and squamous cell carcinoma

“…RCM has been proven to be a useful, non‐invasive tool for the in vivo diagnosis of melanocytic lesions and inflammatory skin conditions . Further, RCM knowledge and experience in the field of NMSC is increasing . Due to often clinical similar appearance, distinction between SCC and AK is still a challenge.…”