ReportsConfocal scanning laser microscopy of benign and malignant melanocytic skin lesions in vivo☆,☆☆,★,★★
Section snippets
Subjects
This study included 40 pigmented lesions in 29 patients. Patients were recruited prospectively from the pigmented lesion clinic at the Massachusetts General Hospital under an Institutional Review Board-approved protocol. These patients had been scheduled for excision to either remove atypical nevi or rule out melanoma or for cosmetic reasons. Those who volunteered to participate were sequentially recruited for confocal imaging. Ninety-five percent of the pigmented skin lesions (38/40) in the
Results
Patients' ages ranged from 19 to 95 years (mean, 39 years); 14 men and 15 women participated in the study (Table I). Thirty-four benign pigmented lesions were examined, including 3 junctional nevi, 7 compound nevi, 4 intradermal nevi, 1 congenital nevus, 1 nevus that was not examined histologically, and 18 dysplastic nevi. Six melanomas were examined, including 2 lentigo malignas, 1 superficial spreading melanoma in situ, 2 invasive superficial spreading melanomas, and 1 invasive acral
Discussion
Confocal images of nuclear, cellular, and morphologic features in normal human skin, with detailed correlation to horizontal (en face) histologic sections have been published previously.8, 9, 10 This is the first study of benign and malignant melanocytic lesions by in vivo confocal microscopy. Confocal microscopy provides instantaneous, high-resolution images of pigmented skin lesions, “at the bedside.” We discovered apparent differences in the CSLM characteristics of nevi, dysplastic nevi, and
Conclusion
In our study of 34 benign and 6 malignant melanocytic lesions viewed by CSLM, our preliminary findings suggest that there are distinct morphologic features between common nevi, dysplastic nevi, and melanomas. The further development of this instrument and delineation of these and other features could make CSLM a useful adjunct to the clinical diagnosis of melanomas and facilitate the detection of early curable melanomas.
References (13)
- et al.
In vivo epiluminescence microscopy of pigmented skin lesions. I. Pattern analysis of pigmented skin lesions
J Am Acad Dermatol
(1987) - et al.
In vivo epiluminescence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma
J Am Acad Dermatol
(1987) - et al.
In vivo confocal scanning laser microscopy of human skin: melanin provides strong contrast
J Invest Dermatol
(1995) - et al.
Histopathologic diagnosis of dysplastic nevi: concordance among pathologists convened by the World Health Organization Melanoma Programme
Hum Pathol
(1991) - et al.
Clinical characteristics
- et al.
Accuracy in the clinical diagnosis of malignant melanoma
Arch Dermatol
(1990)
Cited by (218)
Reflectance confocal microscopy: Melanocytic and nonmelanocytic
2021, Clinics in DermatologyCitation Excerpt :Disarray of the epidermis can be seen in one-third of cases, especially in areas with pagetoid melanocytes.46 Pagetoid infiltration is represented by large diameter cells with refractive cytoplasm and hyporeflective nuclei or spindle-shaped cells with thick dendritic branches often appearing in sheets, representing atypical melanocytes.46-48 In amelanotic melanomas, the pagetoid melanocytes often are less refractile owing to the absence of pigment and have been described as “black holes” in the epidermis.49
Reflectance confocal microscopy: Diagnostic criteria of common benign and malignant neoplasms, dermoscopic and histopathologic correlates of key confocal criteria, and diagnostic algorithms
2021, Journal of the American Academy of DermatologyIntegrating Skin Cancer–Related Technologies into Clinical Practice
2017, Dermatologic ClinicsMeasuring the red blood cell shape in capillary flow using spectrally encoded flow cytometry
2022, Biomedical Optics Express
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Supported by the Lalia B. Chase Fellowship of the Dalhousie Medical Research Foundation. Development of the confocal microscope prototype was funded in parts by Department of Energy grant DE-FG02-91ER61229 and by a grant from the Whitaker Foundation (to M. R.).
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Conflict of interest: Milind Rajadhyaksha (M. R.) and Peter Dwyer are presently employed by and own stock in Lucid Inc (Rochester, NY). The early confocal microscope prototype that was built by M. R. and is described in this article has been recently commercialized by Lucid. However, there is no mention of the commercial version in this article.
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Reprint requests: Richard G. B. Langley, MD, 4195 Dickson Bldg, QEII Health Sciences Center, Division of Dermatology, Department of Medicine, 1278 Tower Rd, Halifax, Nova Scotia, Canada B3H 1V8. E-mail: [email protected].
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Published online July 18, 2001.