Abstract
Confocal microscopy is a modern imaging device that has been extensively applied in skin oncology. More specifically, for tumor margin assessment, it has been used in two modalities: reflectance mode (invivo on skin patient) and fluorescence mode (on freshly excised specimen). Although invivo reflectance confocal microscopy is an add-on tool for lentigo maligna mapping, fluorescence confocal microscopy is far superior for basal cell carcinoma and squamous cell carcinoma margin assessment in the Mohs setting. This article provides a comprehensive overview of the use of confocal microscopy for skin cancer margin evaluation.
Highlights
Micrographic Mohs surgery is a precise and complete excision of a skin cancer guided by the examination of margins with frozen histopathology during surgery
Fluorescence confocal microscopy (FCM) has been used to assess the margins during micrographic mohs surgery (MMS) of eccrine syringomatous carcinoma.[32]
The need of defining skin cancer margins for a more accurate surgical excision has fueled the exploration of confocal microscopy in this special setting
Summary
Micrographic Mohs surgery is a precise and complete excision of a skin cancer guided by the examination of margins with frozen histopathology during surgery It was developed several years ago and is still applied in clinical dermatologic settings especially for some cancers, such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). In reflectance confocal microscopy (RCM) contrast is achieved because of different refractive indices of cell structures and organelles, such as keratin and melanin; these serve as “endogenous chromophores” in the reflectionmode because of a higher refractive indices compared with water. This device is used in vivo at the patient’s bedside. This article reviews the application of in vivo and ex vivo confocal microscopy in the Mohs surgery setting
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