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Confocal scanning laser microscopy of benign and malignant melanocytic skin lesions in vivo,☆☆,,★★

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Abstract

Background: The ability of physicians for early diagnosis of cutaneous melanomas is less than perfect, prompting research into noninvasive methods for diagnosis. Objective: Our purpose was to evaluate confocal scanning laser microscopy (CSLM) for noninvasive imaging of benign and malignant melanocytic lesions in vivo. Methods: Forty pigmented skin lesions (including adjacent normal skin as control) in vivo were imaged with near-infrared CSLM. The confocal images were correlated to histopathology. Results: Nuclear, cellular, and architectural detail in the epidermis and superficial dermis is imaged with high resolution and contrast. Melanin causes the cytoplasm of pigmented cells to appear bright. Melanocytic nevi had cohesive nests of uniformly circular cells and increased microvascular blood flow. Melanomas had a polymorphous cytologic structure, containing atypical, pleomorphic cells in disarray and irregular dendritic cells. Conclusion: CSLM is capable of identifying distinct patterns and cytologic features of benign and malignant pigmented skin lesions in vivo. CSLM may be useful to noninvasively discriminate benign and malignant lesions in vivo. (J Am Acad Dermatol 2001;45:365-76.)

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.

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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.

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.

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