Application Of Reflectance Confocal Microscopy Research Articles

Reflectance Confocal Microscopy and Dermoscopy for the Diagnosis of Solitary Hypopigmented Pink Lesions: A Narrative Review.

Diagnosing solitary pink skin lesions poses a significant challenge due to the scarcity of specific clinical and dermoscopic criteria. Several benign lesions, such as cherry angioma, clear cell acanthoma, dermal nevus, keloid, hypertrophic scar, and Spitz nevus, often exhibit similar clinical and dermoscopic features. This similarity extends to some malignant lesions, including basal cell carcinoma, actinic keratosis, and amelanotic melanoma, making differentiation difficult. Recent studies highlight the enhanced diagnostic accuracy of reflectance confocal microscopy (RCM), which offers increased sensitivity and specificity compared to dermoscopy alone for diagnosing skin cancer. This study aims to summarize the application of dermoscopy and RCM in distinguishing between benign and malignant pinkish-reddish skin lesions. The integration of RCM with traditional dermoscopic techniques improves the ability to accurately identify and differentiate these lesions. However, it is crucial to note that for any suspicious lesions, a final diagnosis must be confirmed through surgical excision and histopathological evaluation. This comprehensive approach ensures accurate diagnosis and appropriate treatment, highlighting the importance of combining advanced imaging techniques in clinical practice.

Application of in vivo reflectance confocal microscopy in the diagnosis of Bowen's disease.

Bowen's disease (BD) is a relatively rare early-stage squamous cell carcinoma in situ, most commonly affecting the middle-aged and elderly, and occurring on the skin or mucous membranes of various parts of the body. Its onset is concealed, the course of the disease is chronic, and some patients have malignant tumors outside the skin; therefore, it is necessary to diagnose and evaluate the disease at an early stage. This study aimed to investigate the application of reflectance confocal microscopy (RCM) in the diagnosis of BD. We performed RCM imaging on the lesion site and underwent skin biopsy for histological diagnosis of 92 patients initially diagnosed with BD in clinic. A retrospective analysis of the RCM result as well as the histological examination revealed that after analyzing RCM images, out of 92 biopsy lesions, 61 were diagnosed with BD, of which 54 were consistent with RCM diagnosis. Among the 59 cases diagnosed with BD by RCM, 54 cases were consistent with the histological diagnosis. Afterwards, we analyzed the RCM characteristics in patients with BD verified by biopsy, and compared the RCM images of two different lesions, classic Bowen's disease and pigmented Bowen's disease, and further summarized the key points of BD under RCM. Finally, we focused on the differential characteristics between BD and other skin diseases in RCM. RCM is of great value in the diagnosis of BD. RESEARCH HIGHLIGHTS: A retrospective study of RCM and histological diagnosis in patients with clinical diagnosis of BD. Analyze the RCM characteristics of skin lesions verified by biopsy. RCM is of great value in the diagnosis and differentiation of BD.

Melasma and reflectance confocal microscopy: from baseline to treatment monitoring.

Melasma is a frequent condition worldwide, and it represents one of the most challenging disorders to treat in cosmetic dermatology. One of the critical factors for treatment prognosis is the assessment of the depth and distribution of pigment within the hyperpigmented area. Nowadays, non-invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to estimate pigment distribution and depth within different skin layers. This article aims to provide a systematic review of RCM applications in melasma, providing terminology and investigating characteristics of melasma at baseline and after medical and laser treatment. Our results support the recognition of two main types of melasma, epidermal and mixed type, thanks to the role of RCM in highlighting the precise pigment depth location in the skin non-invasively. RCM treatment monitoring enables the objectification of pigment variations after treatment and the identification of prognostic factors for different treatment modalities. After the era of the application of RCM as a technique applied strictly to skin cancers, additional cosmetic applications are emerging, such as the application of melasma treatment monitoring.

Applications of Reflectance Confocal Microscopy in the Diagnosis of Fungal Infections: A Systematic Review.

Cutaneous and adnexal fungal infections are typically diagnosed with potassium hydroxide (KOH) skin scrapings, fungal cultures, and Periodic acid-Schiff (PAS) biopsy staining. All three current methods of fungal diagnosis require sample processing and turnover time which leads to a delay in diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive, in vivo skin imaging technology that provides real-time dermatologic diagnoses. We present an updated systematic review of the applications of RCM in diagnosing fungal infections in an effort to explore the utility of RCM as an adjunct clinical tool in detecting cutaneous and adnexal fungi We systematically searched the MEDLINE (via PubMed) for studies published from January 2000 to October 2022 that described the utility of RCM in the setting of fungal infections. Of the 25 studies that met the inclusion criteria, 202 patients were included. The following information on the application of RCM in the setting of fungal infections was extracted from each study, if reported: study type, year published, number of patients included, diagnosis/diagnostic methods, and RCM description. Concordant within all included studies, fungal infections presented on RCM as bright, linear, branching, filamentous structures at the level of stratum corneum. A limitation of this review is that 11 of 25 studies were case reports (n = 1). Larger scale studies should be conducted to explore the utility of RCM in diagnosing fungal infections and to enrich the RCM descriptions of specific fungal conditions.

Automating reflectance confocal microscopy image analysis for dermatological research: a review.

.SignificanceReflectance confocal microscopy (RCM) is a noninvasive, in vivo technology that offers near histopathological resolution at the cellular level. It is useful in the study of phenomena for which obtaining a biopsy is impractical or would cause unnecessary tissue damage and trauma to the patient.AimThis review covers the use of RCM in the study of skin and the use of machine learning to automate information extraction. It has two goals: (1) an overview of information provided by RCM on skin structure and how it changes over time in response to stimuli and in disease and (2) an overview of machine learning approaches developed to automate the extraction of key morphological features from RCM images.ApproachA PubMed search was conducted with additional literature obtained from references lists.ResultsThe application of RCM as an in vivo tool in dermatological research and the biologically relevant information derived from it are presented. Algorithms for image classification to epidermal layers, delineation of the dermal–epidermal junction, classification of skin lesions, and demarcation of individual cells within an image, all important factors in the makeup of the skin barrier, were reviewed. Application of image analysis methods in RCM is hindered by low image quality due to noise and/or poor contrast. Use of supervised machine learning is limited by time-consuming manual labeling of RCM images.ConclusionsRCM has great potential in the study of skin structures. The use of artificial intelligence could enable an easier, more reproducible, precise, and rigorous study of RCM images for the understanding of skin structures, skin barrier, and skin inflammation and lesions. Although several attempts have been made, further work is still needed to provide a definite gold standard and overcome issues related to image quality, limited labeled datasets, and lack of phenotype variability in available databases.

Research Techniques Made Simple: Emerging Imaging Technologies for Noninvasive Optical Biopsy of Human Skin

Over the past few years, high-resolution optical imaging technologies such as optical coherence tomography (OCT), reflectance confocal microscopy (RCM), and multiphoton microscopy (MPM) have advanced significantly as new methodologies for clinical research and for real-time detection, diagnosis, and therapy monitoring of skin diseases. Implementation of these technologies into clinical research and practice requires clinicians to have an understanding of their capabilities, benefits, and limitations. This concise review provides insights on the application of OCT, RCM, and MPM for clinical skin imaging through images acquired invivo from the same lesions. The presented data are limited to pigmented lesions and basal cell carcinoma.

A plea for standardization of confocal microscopy and optical coherence tomography parameters to evaluate physiological and para-physiological skin conditions in cosmetic science.

Non-invasive reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) have been extended to the dermo-cosmetic field, for skin pathophysiology understanding and therapeutics monitoring. However, standardized methodology and parameters to interpret structures and changes in these settings are still lacking. Present study aimed to propose a validated standard methodology and a list of defined parameters for objective non-pathological skin assessments in the cosmetically sensitive cheekbone area of the face. OCT and RCM quantitative, semi-quantitative and qualitative features were considered for assessments. Validation process included 50 sets of images divided into two age groups. Inter-rater reliability was explored to assess the influence of the proposed methodology. Quantitative OCT parameters of "epidermal thickness," "density and attenuation coefficients" and "vascular density" were considered and calculated. Severity scales were developed for semi-quantitative OCT features of "disruption of collagen" and "vascular asset," while extent scales were produced for semi-quantitative RCM "irregular honeycomb," "mottled pigmentation" and "polycyclic papillary contours." Qualitative assessment was obtained for RCM type of collagen, and comparison between age groups was performed for all features considered. Severity visual scales assistance proved excellent inter-rater agreement across all semi-quantitative and qualitative domains. The assistance of shareable software systems allows for objective OCT quantitative parameters measurement. The use of standard reference scales, within a defined assessment methodology, offers high inter-rater reliability and thus reproducibility for semi-quantitative and qualitative OCT and RCM parameters. Taken together, our results may represent a starting point for a standardized application of RCM and OCT in dermo-cosmetic research and practice.

反射式共聚焦显微镜在儿童疥疮诊疗中的应用

反射式共聚焦显微镜在儿童疥疮诊疗中的应用

Imaging of Vulva Syringoma With Reflectance Confocal Microscopy.

Objectives: To investigate the application of reflectance confocal microscopy (RCM) imaging in diagnosis of vulva syringoma.Methods: Patients with lesions suspicious of syringoma on vulva were enrolled in the study. After informed consent was taken, the lesions were photographed and imaged with RCM. The features of the lesion in confocal images were then analyzed and compared with the biopsy findings for histology correlation.Results: Eleven cases in total were included in the study. The typical RCM features observed in syringoma are the presence of round to oval high refractive, and relatively monomorphous mass of varying sizes in the superficial and middle dermis, usually surrounded with 1–2 layers of light-dark line structures, which were further confirmed by histological evaluation. Ten cases showed classic features of syringoma and 1 case exhibited milia in RCM images.Conclusions: Syringoma has distinct features in RCM imaging, which correlates well with histological findings, highlighting the potential role of RCM in the diagnosis and differential diagnosis of vulva syringoma.

反射式共聚焦显微镜在海姆泊芬光动力疗法治疗紫红型鲜红斑痣疗效评估中的应用

反射式共聚焦显微镜在海姆泊芬光动力疗法治疗紫红型鲜红斑痣疗效评估中的应用

High-speed combined reflectance confocal and moxifloxacin based two-photon microscopy.

Reflectance confocal microscopy (RCM) is a non-invasive high-resolution optical imaging technique used in clinical settings as a diagnostic method. However, RCM has limited diagnostic ability by providing non-specific morphological information only based on reflection contrast. Various multimodal imaging techniques have been developed to compensate the limitations of RCM, but multimodal techniques are often slow in imaging speed compared to RCM alone. In this report, we combined RCM with moxifloxacin based two-photon microscopy (TPM) for high-speed multimodal imaging. Moxifloxacin based TPM used clinically compatible moxifloxacin for cell labeling and could do non-invasive cellular imaging at 30 frames/s together with RCM. Performance of the combined microscopy was characterized in the imaging of mouse skin and cornea, in vivo. Detail tissue microstructures including cells, extra-cellular matrix (ECM), and vasculature were visualized. The combined microscopy was applied to human skin cancer specimens, and both cells and ECM in the skin cancer and normal skin regions were visualized at high imaging speeds. The combined microscopy can be useful in the clinical applications of RCM by providing multiple contrasts.

Application of reflectance confocal microscopy to investigate the non-ablative, micro-ablative, and ablative effects of CO2 fractional laser irradiation on skin.

CO2 fractional laser, as an ablative fractional laser, is commonly used in cosmetic treatment. We applied CO2 fractional laser irradiation to skin in vitro and used reflectance confocal microscopy (RCM) to image and detect the presence of any non-ablative, micro-ablative and ablative effects, in order to better understand the features of a CO2 fractional laser. In vitro irradiation of foreskin was performed using a CO2 fractional laser. Foreskin specimens were divided into 4 groups that received different amounts of irradiation energy, based on the number of irradiation passes they received: 5, 10, 15, and 20 passes, respectively. This corresponds to fluence energy of 16.3, 32.6, 48.9, 65.3 J/cm2. Immediately after irradiation, digital microscopy (DM), RCM, and histopathology were performed to observe whether the non-ablative, micro-ablative, and ablative phenomenon occurred, and the injury features of MTZs. Immediately after CO2 fractional laser irradiation, RCM and DM showed that when the numbers of passes were 5 and 10, a micro-ablative column (MAC) could not be observed or was very small. We mainly observed a thicker thermal coagulation zone (TCZ), representing non-ablative or micro-ablative effects. When the number of passes were increased to 15 and 20, the MAC was significantly enlarged and surrounded by a TCZ of medium thickness, representing ablative effects. For the first time, this study used RCM and DM to demonstrate that a CO2 fractional laser could achieve non-ablative, micro-ablative, and ablative effects on irradiated skin via different energy levels.

In vivo confocal microscopy of dermoscopic suspicious lesions in patients with xeroderma pigmentosum: A cross-sectional study

Xerodermapigmentosum (XP) is a rare genetic disease characterized by extreme photosensitivity, resulting in a higher incidence of cutaneous tumors. Reflectance confocal microscopy (RCM) is a noninvasive imaging method for diagnosing cutaneous lesions. To explore the application of RCM in the follow-up of patients with XP. Patients with XP underwent RCM for suspicious lesions from January 2010 through April 2019. Lesions with malignant RCM features were excised, and the results were compared with their histopathologic features. Benign lesions on RCM were monitored every 3months. We recorded the confocal features that were related to malignancy and specifically to melanoma. A total of 61 suspicious lesions from 13 patients with XP were included. Thirty-three lesions (54%) were malignant (14 melanomas, 15 basal cell carcinomas, and 4 squamous cell carcinomas). Nonvisible papillae (OR, 11.8; 95% CI, 2.6-53.1; P= .001) and atypical cells at the dermoepidermal junction (OR, 11.7; 95% CI, 2.7-50.3; P=.001) were independent predictors of malignancy. There were limited numbers of patients and lesions. Most cases were retrospectively included, and some did not have a histologic analysis. RCM is a valuable tool in the follow-up of patients with XP, reducing the need for excisions by 35%.

430 Application of reflectance confocal microscopy in the evaluation of murine healthy and lesional skin

Reflectance confocal microscopy (RCM) is a non-invasive imaging technology that allows real-time examination of the skin at nearly histologic resolution. It has been proved to be valuable in the clinics, but its application in animal models is limited. The main objectives were to identify characteristic confocal features in healthy murine skin, and evaluate the cutaneous alterations in the mouse model of oxazolone-induced dermatitis. A VivaScope® microscope was used to take horizontal optical sections of the skin from the stratum corneum to the dermis, up to the maximum optical depth of 250 μm. Imaging was performed on healthy or lesional skin of male C57BL/6 mice. The dermatitis was induced in the depilated nape of sensitized mice by repeated topical challenges with oxazolone, and imaged 24 hours after each challenge. The major architectural and cellular features of each stratum of the epidermis and dermis were identified in healthy skin. However, the patterns were not as pronounced as those described in humans, and the dermo-epidermal junction was indistinct. Features of spongiotic dermatitis were visualized in the model. In the acute stage, there were areas of increased intercellular brightness (spongiosis), circumscribed oval hyporefractive areas (vesicles), and single or clusters of refractile round cells at the level of the stratum spinosum (exocytosis) and dermis. With chronicity, the honeycomb pattern was increased in thickness (acanthosis), and inflammatory cells were often observed with haphazardly arranged, highly refractile fibrilar fibers (fibrosis). RCM represents a powerful tool to analyze skin changes in animal models, and complements histopathology when studying dynamic processes (blood flow), or structures and lesions usually altered by histological processing. Additionally, its non-invasive nature enables the monitoring of skin lesions in the same animal, which is particularly useful in models intended to mimic a chronic disease.

Reflectance confocal microscopy in the diagnosis of pigmented macules of the face: differential diagnosis and margin definition.

In vivo reflectance confocal microscopy (RCM) is a noninvasive high-resolution skin imaging tool that has become an important adjunct to clinical exam, dermoscopy and histopathology assessment, in the diagnosis and management of pigmented macules of the face. The diagnosis of early stage lentigo maligna (LM) and lentigo maligna melanoma (LMM) is challenging and RCM improves the diagnostic accuracy in the differential diagnosis of LM with other macules of the face such as solar lentigo (SL), pigmented actinic keratosis (PAK), seborrheic keratosis (SK) and lichen planus-like keratosis (LPLK). Here we review the state-of-the-art of RCM morphologic descriptors, standardized terminology, and diagnostic algorithms for the RCM assessment of pigmented macules of the face including melanocytic, and nonmelanocytic lesions. Clinical applications of RCM are broad and include diagnosis, assessment of large lesions on cosmetically sensitive areas, directing areas to biopsy, delineating margins prior to surgery, detecting response to treatment and assessing recurrence. The present review is intended to summarize the application of RCM for the correct diagnosis of challenging pigmented facial macules and to evaluate its application in LM margin mapping during the pre surgical phase.

Blue-gray plaque of the penis

We report the case of a 66-year-old white man with a 6-month history of a blue-gray plaque of the glans. The patient was heterosexual, with 2 sexual partners in the last 6 months, and denied condom use. There was no personal or family history of melanoma. Physical examination of the uncircumcised penis found a round, well-demarcated, smooth, blue-gray plaque measuring 8 × 10 mm, arising within an erythematous background plaque of the glans (Fig 1). The remaining physical examination was unremarkable, including the oral cavity. Within the plaque we observed regularly arranged gray dots surrounded by a white halo over a blue-white structureless background (Fig 2). We observed a cordlike pattern with refractile round cellular structures in the stratum corneum, suggesting parakeratosis.1Gonzalez S. [Clinical applications of reflectance confocal microscopy in the management of cutaneous tumors].Actas Dermosifiliogr. 2008; 99: 528-531PubMed Google Scholar We also observed a typical honeycomb pattern (Fig 3). A shave biopsy found the presence of parakeratosis, acanthosis, and papillomatosis of the epidermis. We also observed within the keratinocytes, abundant cytoplasm and irregularly hyperchromatic nuclei (koilocytosis) (Fig 4). Polymerase chain reaction of the biopsy was positive for human papillomavirus type 6.Key messageGenital warts are the most common sexually transmitted disease, and they are caused by the human papillomavirus.2Partridge J.M. Koutsky L.A. Genital human papillomavirus infection in men.Lancet Infect Dis. 2006; 6: 21-31Abstract Full Text Full Text PDF PubMed Scopus (211) Google Scholar This case highlights the difficulties encountered in the differential diagnosis of darkly pigmented planar lesions of the penis. Dermoscopic patterns in genital warts have been described by several investigators (fingerlike, knoblike, mosaiclike, and pattern combinations).3Dong H. Shu D. Campbell T.M. Fruhauf J. Soyer H.P. Hofmann-Wellenhof R. Dermatoscopy of genital warts.J Am Acad Dermatol. 2011; 64: 859-864Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar, 4Ozdemir F. Kilinc-Karaarslan I. Akalin T. A pigmented, hemorrhagic genital wart: clinical, dermoscopic, and histopathologic features.Arch Dermatol. 2008; 144: 1072-1073Crossref PubMed Scopus (6) Google Scholar, 5Ozkur E. Falay T. Turgut Erdemir A.V. Gurel M.S. Leblebici C. Vestibular papillomatosis: an important differential diagnosis of vulvar papillomas.Dermatol Online J. 2016; 22PubMed Google Scholar, 6Pastar Z. Lipozencic J. Significance of dermatoscopy in genital dermatoses.Clin Dermatol. 2014; 32: 315-318Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 7Veasey J.V. Framil V.M. Nadal S.R. Marta A.C. Lellis R.F. Genital warts: comparing clinical findings to dermatoscopic aspects, in vivo reflectance confocal features and histopathologic exam.An Bras Dermatol. 2014; 89: 137-140Crossref PubMed Scopus (25) Google Scholar, 8Zalaudek I. Giacomel J. Cabo H. et al.Entodermoscopy: a new tool for diagnosing skin infections and infestations.Dermatology. 2008; 216: 14-23Crossref PubMed Scopus (146) Google Scholar We present a case of genital wart that falls into none of the aforementioned patterns. The honeycomb pattern observed on confocal microscopy is normally observed in seborrheic keratoses. This case illustrates the complementarity of dermoscopy and confocal microscopy in the diagnosis of clinically atypical lesions of the genital mucosa. Genital warts are the most common sexually transmitted disease, and they are caused by the human papillomavirus.2Partridge J.M. Koutsky L.A. Genital human papillomavirus infection in men.Lancet Infect Dis. 2006; 6: 21-31Abstract Full Text Full Text PDF PubMed Scopus (211) Google Scholar This case highlights the difficulties encountered in the differential diagnosis of darkly pigmented planar lesions of the penis. Dermoscopic patterns in genital warts have been described by several investigators (fingerlike, knoblike, mosaiclike, and pattern combinations).3Dong H. Shu D. Campbell T.M. Fruhauf J. Soyer H.P. Hofmann-Wellenhof R. Dermatoscopy of genital warts.J Am Acad Dermatol. 2011; 64: 859-864Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar, 4Ozdemir F. Kilinc-Karaarslan I. Akalin T. A pigmented, hemorrhagic genital wart: clinical, dermoscopic, and histopathologic features.Arch Dermatol. 2008; 144: 1072-1073Crossref PubMed Scopus (6) Google Scholar, 5Ozkur E. Falay T. Turgut Erdemir A.V. Gurel M.S. Leblebici C. Vestibular papillomatosis: an important differential diagnosis of vulvar papillomas.Dermatol Online J. 2016; 22PubMed Google Scholar, 6Pastar Z. Lipozencic J. Significance of dermatoscopy in genital dermatoses.Clin Dermatol. 2014; 32: 315-318Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 7Veasey J.V. Framil V.M. Nadal S.R. Marta A.C. Lellis R.F. Genital warts: comparing clinical findings to dermatoscopic aspects, in vivo reflectance confocal features and histopathologic exam.An Bras Dermatol. 2014; 89: 137-140Crossref PubMed Scopus (25) Google Scholar, 8Zalaudek I. Giacomel J. Cabo H. et al.Entodermoscopy: a new tool for diagnosing skin infections and infestations.Dermatology. 2008; 216: 14-23Crossref PubMed Scopus (146) Google Scholar We present a case of genital wart that falls into none of the aforementioned patterns. The honeycomb pattern observed on confocal microscopy is normally observed in seborrheic keratoses. This case illustrates the complementarity of dermoscopy and confocal microscopy in the diagnosis of clinically atypical lesions of the genital mucosa.

Advances in the use of reflectance confocal microscopy in melanoma.

In vivo reflectance confocal microscopy (RCM) is a noninvasive high-resolution skin imaging tool that has become an important adjunct to clinical exam, dermoscopy and histopathology assessment, in the diagnosis and management of melanoma. RCM generates a horizontal view of the skin, whereby cellular and subcellular (e.g., nuclei, melanophages, collagen) structures, to the level of the upper dermis, are projected onto a screen at near-histological resolution. Morphologic descriptors, standardized terminology, and diagnostic algorithms are well established for the RCM assessment of melanoma, melanocytic, and nonmelanocytic lesions. Clinical applications of RCM in melanoma are broad and include diagnosis, assessment of large lesions on cosmetically sensitive areas, directing areas to biopsy, delineating margins prior to surgery, detecting response to treatment and assessing recurrence. This review will provide an overview of RCM technology, findings by melanoma subtype, clinical applications, as well as explore the accuracy of RCM for melanoma diagnosis, pitfalls and emerging uses of this technology ex vivo.

Reflectance confocal microscopic evaluation of nonmelanocytic lip lesions.

Lips display various benign and malignant lesions. Considering their functional and cosmetic importance, noninvasive diagnostic methods are required. In vivo reflectance confocal microscopy (RCM) has already been reported to be useful in the evaluation of various skin lesions. The aim of this study was to define the RCM features of nonmelanocytic lip lesions, compare them with healthy lip, and demonstrate the applicability of RCM as a noninvasive diagnostic method for nonmelanocytic lip lesions. Sixty-seven patients with premalignant/malignant, inflammatory, and infectious lip lesions and twenty-one healthy volunteers were included in the study. Following clinical and RCM examination, histopathological confirmation was obtained in all lesions except herpes labialis, verrucae, and aphthae. RCM features of individual lesions and corresponding groups were evaluated and compared. Pleomorphism was the common feature of premalignant/malignant lesions. Dermal invasion of dyskeratotic keratinocytes was visualized in all squamous cell carcinoma lesions. Spongiosis and inflammatory cells were the common features of inflammatory lesions. Hypergranulosis and necrotic keratinocytes were highly specific for lichen planus. The most specific features for discoid lupus erythematosus were irregular pattern, follicular plugs, and perifollicular inflammatory cells. Virus-infected keratinocytes were visualized in herpes and verrucae. RCM features showed high sensitivity and specificity to detect nonmelanocytic lip lesions. Although the penetration is limited to the papillary dermis in nonmucosal skin, imaging down to the mid-dermis with satisfactory resolution was possible on the lips.

Application of reflectance confocal microscopy in extramammary Paget′s disease

Extramammary Paget′s disease (EMPD) , a kind of cutaneous malignant tumor originating from apocrine glands, mostly occurs in the vulvar region in elderly men, and manifests as eczematoid lesions. EMPD usually progresses insidiously without specific clinical manifestations. Due to the mildness of symptoms at early stage, patients usually do not pay enough attention, and it is easily misdiagnosed. Most patients have a favorable prognosis, while long disease course, deep dermal infiltration and local lymph node metastasis indicate poor prognosis. The first-choice treatment of EMPD is extended surgical resection. However, the inaccuracy of macroscopic evaluation of tumor-free margins increases positive margin rates. Reflectance confocal microscopy (RCM) , as a kind of real time in vivo imaging technique, can be used for the diagnosis of EMPD and preoperative determination of tumor-free margins with reduced positive margin rates, recurrence rates and improved prognosis. Key words: Paget disease, extramammary; Diagnostic techniques and procedures; Therapeutic uses; Surgical procedures, operative; Reflectance confocal microscopy

Application of reflectance confocal microscopy to evaluate skin damage after irradiation with an yttrium-scandium-gallium-garnet (YSGG) laser.

The objective of this study was to observe the characteristics of the skin after irradiation with a 2790-nm yttrium-scandium-gallium-garnet (YSGG) laser using reflectance confocal microscopy (RCM). A 2790-nm YSGG laser was used to irradiate fresh foreskin (four doses, at spot density 3) in vitro. The characteristics of microscopic ablative columns (MAC), thermal coagulation zone (TCZ), and microscopic treatment zones (MTZ) were observed immediately after irradiation using digital microscope and RCM. The characteristics of MAC, TCZ, and MTZ with variations in pulse energy were comparatively analyzed. After irradiation, MAC, TCZ, and MTZ characteristics and undamaged skin between MTZs can be observed by RCM. The depth and width of MTZ obviously increased with the increase in pulse energy. At 80, 120, and 160mJ/microbeam (MB), the MTZ actual area and proportion were about two times that of the theoretical value and three times at 200mJ/MB. With increases in depth, the single MAC gradually decreased in a fingertip-shaped model, with TCZ slowly increasing, and MTZ slightly decreasing in a columnar shape. RCM was able to determine the characteristics of thermal injury on the skin after the 2790-nm YSGG laser irradiation with different pulse energies. Pulse energy higher than 200mJ/MB may have much larger thermal injury and side effect. RCM could be used in the clinic in future.