18280 3D rendering of lentigo maligna features in vivo

Abstract

Reflectance confocal microscopy (RCM) is now available for clinical use to evaluate cutaneous lesions in vivo before biopsy. This technology is particularly valuable for patients where there is concern of melanoma on sun damaged skin (lentigo maligna) versus a benign lentigo or seborrheic keratosis. Trained physicians can identify lentigo maligna tumors using 2D horizontal RCM image stacks or mosaics. However, there is valuable information missing when assessing lesions in 2D. Instead of reviewing only the 2D confocal images, we have generated 3D renderings of image stacks to augment our ability to visualize relevant features. Presently our efforts are focused on 3 areas of interest. 1) The extent of melanocytic dendricity: a hallmark of lentigo maligna tumors evident in RCM. Dendrites reside in multiple planes, therefore their morphology can only be fully revealed with 3D reconstructions. 2) The location of melanocytic cells within the context of the 3D volume: making upper (epidermal) regions and lower (dermal) regions simultaneously apparent. 3) The normal undulation of the dermal-epidermal junction: this wave-like interface becomes flattened or eroded in lentigo maligna as compared with benign neoplasms. Visualization of the DEJ structure (or lack of) which transects the horizontal planes of RCM image stacks is only possible in 3D. The impact of 3D confocal images on clinical care and potential artificial intelligence (AI) diagnostic algorithms has yet to be fully determined. Currently 3D processing provides critical data regarding location, structure and morphology, thereby supporting the diagnostic capabilities of RCM.