The current role of in vivo reflectance confocal microscopy within the continuum of actinic keratosis and squamous cell carcinoma: a systematic review

Nguyen, Kim Phuong; Peppelman, Malou; Hoogedoorn, L.; Erp, P.E.J. van; Gerritsen, Marie‐Jeanne P.

doi:10.1684/ejd.2016.2872

Cited by 39 publications

(30 citation statements)

References 44 publications

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“…A meta‐analysis evaluating 25 studies found an overall RCM sensitivity and specificity for SCC, AK, SCC in situ and KA to range from 79% to 100% and 78% to 100%, respectively …”

Section: Reflectance Confocal Microscopy Of Malignant Neoplasmsmentioning

confidence: 99%

In vivo reflectance confocal microscopy image interpretation for the dermatopathologist

et al. 2018

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Reflectance confocal microscopy (RCM) is a technology utilized for bedside diagnosis of cutaneous pathology by non-invasive, in vivo, cellular-level imaging. With the recent establishment of reimbursement codes by the US Centers for Medicaid and Medicare Services, RCM is now likely to be employed by clinical dermatologists and impact decision making on skin cancer management. Dermatopathologists, therefore, would benefit from learning how to interpret RCM images and how RCM findings correlate with histopathological criteria of diagnosis. This review briefly explains the principles behind RCM image acquisition, describes the key RCM features of normal skin, and delineates the RCM characteristics of frequently observed benign and malignant neoplasms.benign neoplasms, confocal microscopy, melanoma, nonmelanoma skin cancers | INTRODUCTIONThe most definitive diagnostic tool utilized by dermatologists in the assessment of skin lesions is a biopsy for histopathological microscopic analysis. However, the invasive nature of surgical biopsy engenders anxiety for some patients, can leave scars in cosmetically sensitive areas (e.g., the face and chest), and may have procedureassociated morbidity such as infection and delayed healing (e.g., on the lower extremities). To this end, reflectance confocal microscopy (RCM) offers non-invasive imaging of skin lesions at cellular-level magnification and resolution, and may facilitate curbing unnecessary Herein, we provide a succinct review of the principles of RCM imaging, describe key RCM terminology and delineate the fundamental RCM features of normal skin and neoplastic entities. | BASIC PRINCIPLESRCM utilizes a low-energy laser light source that focuses on a specific area of tissue. Light is back-scattered from certain tissue structures at the focal point, and enters the detector through a small-aperture gating pinhole; only light from the focal point at the tissue will enter and produce an image, while light from nearby tissue ("out of focus") will not be able to enter the detector.

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“…A meta‐analysis evaluating 25 studies found an overall RCM sensitivity and specificity for SCC, AK, SCC in situ and KA to range from 79% to 100% and 78% to 100%, respectively …”

Section: Reflectance Confocal Microscopy Of Malignant Neoplasmsmentioning

confidence: 99%

In vivo reflectance confocal microscopy image interpretation for the dermatopathologist

et al. 2018

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“…Moreover, certain dermoscopy criteria and in vivo reflectance confocal microscopy features are also available to distinguish KA from SCC. However, to date, there is only very limited evidence on their diagnostic value (Nguyen, Peppelman, Hoogedoorn, Van Erp, & Gerritsen, 2016;Rosendahl et al, 2012). Commonly, KA grows rapidly with a potential for tissue destruction and regresses spontaneously after about 3-10 months (Blessing, al Nafussi, & Gordon, 1994;Griffiths, 2004; Kwiek & Schwartz, 2016;Zito et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Intralesional therapy for the treatment of keratoacanthoma

Kiss

Avci

Bánvölgyi

et al. 2019

Dermatologic Therapy

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Keratoacanthoma (KA) is a common epidermal tumor that originates from the hair follicle of the skin. It is generally considered as a benign neoplasm, but in rare cases, it can also transform into squamous cell carcinoma. Although surgical excision with a safety margin is considered to be the gold standard treatment for most subtypes of KA, several other treatment options are also available. Intralesional therapy is one of these options, which could be cosmetically and functionally a better alternative to surgical removal, while it provides similar outcomes. It is more effective than topical treatments, yet fewer side effects may be seen than in systemic treatments. Based on the literature, the most commonly used intralesional agent is methotrexate, followed by 5‐fluorouracil and interferon alpha. Regardless of the advantages, which make intralesional therapy a desirable treatment alternative, guidelines for the intralesional treatment of KA are not yet established. A histopathological confirmation before the start of treatment is still recommended to prevent any possible misdiagnosis of KA for SCC. In our present study, we set out to review the current state of the art of the intralesional treatment of KA.

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“…A non‐invasive real‐time high‐resolution optical imaging modality such as reflectance confocal microscopy (RCM) offers a complementary approach: peri‐operative detection of margins directly on patients in vivo . RCM imaging diagnoses NMSCs in vivo with high sensitivity and specificity . Beyond diagnosis, we can detect margins, to potentially guide treatment and to augment the standard approaches of pathology.…”

Section: Introductionmentioning

confidence: 99%

“…RCM imaging diagnoses NMSCs in vivo with high sensitivity and specificity. [5][6][7] Beyond diagnosis, we can detect margins, to potentially guide treatment and to augment the standard approaches of pathology.…”

Section: Introductionmentioning

confidence: 99%

Peri‐operative delineation of non‐melanoma skin cancer margins in vivo with handheld reflectance confocal microscopy and video‐mosaicking

Flores

Yélamos

Córdova

et al. 2019

Acad Dermatol Venereol

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Background The surgical removal of non‐melanoma skin cancers (NMSCs) is guided by the pathologic examination of margins. However, the preparation of histopathology is time consuming, labour‐intensive and requires separate laboratory infrastructure. Furthermore, when histopathology indicates positive margins, patients must return for re‐excisions. Reflectance confocal microscopy (RCM) with a new video‐mosaicking approach can noninvasively delineate margins directly on patients and potentially guide surgery in real‐time, augmenting the traditional approaches of histopathology. Objective To assess a new peri‐operative RCM video‐mosaicking approach for comprehensive delineation of NMSC margins on patients in vivo. Methods Thirty‐five patients undergoing Mohs micrographic surgery (MMS) in the Mohs surgery unit at Memorial Sloan Kettering Cancer Center, New York, NY were included in the study. RCM imaging was performed before and after the first staged excision by acquiring videos along the surgical margins (epidermal, peripheral and deep dermal) of each wound, which were subsequently processed into video‐mosaics. Two RCM evaluators read and assessed video‐mosaics, and subsequently compared to the corresponding Mohs frozen histopathology. Results Reflectance confocal microscopy videos and video‐mosaics displayed acceptable imaging quality (resolution and contrast), pre‐operatively in 32/35 (91%) NMSC lesions and intra‐operatively in 29/35 lesions (83%). Pre‐operative delineation of margins correlated with the histopathology in 32/35 (91%) lesions. Intra‐operative delineation correlated in 10/14 (71%) lesions for the presence of residual tumour and in 18/21 (86%) lesions for absence. Sensitivity/specificity were 71%/86% and 86%/81% for two RCM video‐mosaic evaluators, and overall agreement was 80% and 83% with histopathology, with moderate inter‐evaluator agreement (k = 0.59, P ≤ 0.0002). Conclusions Peri‐operative RCM video‐mosaicking of NMSC margins directly on patients may potentially guide surgery in real‐time, serve as an adjunct to histopathology, reduce time spent in clinic and reduce the need for re‐excisions. Further testing in larger studies is needed.

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The current role of in vivo reflectance confocal microscopy within the continuum of actinic keratosis and squamous cell carcinoma: a systematic review

Cited by 39 publications

References 44 publications

In vivo reflectance confocal microscopy image interpretation for the dermatopathologist

In vivo reflectance confocal microscopy image interpretation for the dermatopathologist

Intralesional therapy for the treatment of keratoacanthoma

Peri‐operative delineation of non‐melanoma skin cancer margins in vivo with handheld reflectance confocal microscopy and video‐mosaicking

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