New management of peri‐ocular basal cell carcinoma using in vivo and ex vivo confocal microscopes

Abstract

PurposeWe have been using a handheld dermatology in vivo reflectance confocal microscopy (IVCM) for the imaging of the whole ocular surface and ocular adnexa for more than two year (JAmAcadDermatol2014;71:912, AJO2015;159:324), mainly for noninvasive diagnosis before surgery. Ex vivo confocal microscopy (EVCM) is a new device that allows pseudo histology in freshly excised tissue. Aim: to assess a new management strategy for eyelids lesions suspected to be basal cell carcinoma (BCC) using these two complementary confocal microscopes (CM).MethodsIVCM and EVCM, both using vivascope CM (Lucid Inc, NY) were performed by 3 skilled dermatologists having more than 500 CM diagnoses each with pathology confirmation. Forty consecutive peri‐ocular BCC were diagnosed by IVCM. Two millimetre‐margin incisions were made during surgery. Freshly excised tissues were mounted, unstained, between two glass slides and analysed “en face” with EVCM to delimitated the tumour and the clearance of margins. Diagnosis and margins were confirmed by standard pathology and immunolabeling on fixed tissues.ResultsWe obtained the first “en face” EVCM to delimitated the tumour. The acquisition of the whole tumour took less than 3 minutes. Tissues were not damaged by flat mount nor by exposure to laser beam. Histology confirmed all IVCM diagnosis of BCC and all clear margins.ConclusionsAssociation of IVCM and EVCM allowed accurate management of peri ocular BCC, using micrographic surgery to reduced surgical margins. GRANT: project INNOVEYE GIRCI RAA.