In-vivo Reflectance Confocal Microscopy Research Articles

Atypical melanocytes of an Atypical Spitz Tumor observed with Optical Super-High Magnification Dermoscopy.

A 64-year-old woman presented with a 6-mm pigmented lesion on her thigh. Dermatoscopy revealed the “starburst” dermatoscopic pattern of a spitzoid tumor. Before excision, the lesion was examined under × 400 magnification dermoscopy using the videoscope Fotofinder Medicam 1000 (Fotofinder System, Bad Birnbach, Germany) and in-vivo Reflectance Confocal Microscopy (RCM) (Vivascope 1500®, MAVIG GmbH, Munich, Germany).

Abstract 4171: Utilizing biopsy-free virtual histology for improved clinical efficiency in the dermatologic surgical setting

Abstract The ability to accurately define tumor margins may enhance tissue sparing and increase efficiency in the dermatologic surgery process, but no device exists that serves this role. Reflectance Confocal Microscopy (RCM) provides non-invasive cellular resolution of the skin. The only clinically-approved RCM device is bulky, non-portable, and requires a tissue cap which makes mapping of the underlying tissue impossible. We recently combined “virtual histology”, a machine learning algorithm with RCM images from this standard RCM device to generate biopsy-free histology to overcome these limitations. Whether virtual histology can be used with a portable, handheld RCM device to scan for residual tumor and tumor margins is currently unknown. We hypothesize that combining a handheld RCM device with virtual histology could provide accurate tumor margin assessment. We determined whether our established virtual histology algorithm could be applied to images from a portable RCM device and whether these pseudo-stained virtual histology images correlated with histology from skin specimens. The study was conducted as a prospective, consecutive non-randomized trial at a Veterans Affairs Medical Center dermatologic surgery clinic. All patients greater than 18 years of age with previously biopsied BCC, SCC, or SCCis were included. Successive confocal images from the epidermis to the dermis were obtained 1.5 microns apart from the handheld RCM device to detect residual skin cancer. The handheld, in-vivo RCM images were processed through a conditional generative adversarial network-based machine learning algorithm to digitally convert the images into H&E pseudo-stained virtual histology images. Virtual histology of in-vivo RCM images from unbiopsied skin captured with the portable RCM device were similar to those obtained with the standard RCM device and virtual histology applied to portable RCM images correctly correlated with frozen section histology. Residual tumors detected with virtual histology generated from the portable RCM images accurately corresponded with residual tumors shown in the frozen surgical tissue specimen. Residual tumor was also not detected when excised tissue was clear of tumor following surgical procedure. Thus, the combination of virtual histology with portable RCM may provide accurate histology-quality data for evaluation of residual skin cancer prior to surgery. Combining machine learning-based virtual histology with handheld RCM images demonstrates promise in providing insights into tumor characteristics and has the potential to assist the surgeon and better guide practice decisions to more efficiently serve patients, leading to decreased layers and appointment times. Future work is needed to provide real time virtual histology, convert horizontal/confocal sections into vertical or 3D sections, and to perform clinical studies to map tumors in tissue. Citation Format: Rachel Wahhab, Nelly Kokikian, Jingxi Li, Jason Garfinkel, Stephanie Martin, David Beynet, Aydogan Ozcan, Philip Scumpia. Utilizing biopsy-free virtual histology for improved clinical efficiency in the dermatologic surgical setting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4171.

Accelerate Clinical Trials in Charcot-Marie-Tooth Disease (ACT-CMT): A Protocol to Address Clinical Trial Readiness in CMT1A.

With therapeutic trials on the horizon for Charcot-Marie-Tooth type 1A (CMT1A), reliable, valid, and responsive clinical outcome assessments and biomarkers are essential. Accelerate Clinical Trials in CMT (ACT-CMT) is an international study designed to address important gaps in CMT1A clinical trial readiness including the lack of a validated, responsive functional outcome measure for adults, and a lack of validated biomarkers for multicenter application in clinical trials in CMT1A. The primary aims of ACT-CMT include validation of the Charcot-Marie-Tooth Functional Outcome Measure, magnetic resonance imaging of intramuscular fat accumulation as a lower limb motor biomarker, and in-vivo reflectance confocal microscopy of Meissner corpuscle sensory receptor density, a sensory biomarker. Initial studies have indicated that these measures are feasible, reliable and valid. A large prospective, multi-site study is necessary to fully validate and examine the responsiveness of these outcome measures in relation to existing outcomes for use in future clinical trials involving individuals with CMT1A. Two hundred 15 adults with CMT1A are being recruited to participate in this prospective, international, multi-center study. Serial assessments, up to 3 years, are performed and include the CMT-FOM, CMT Exam Score-Rasch, Overall Neuropathy Limitations Scale, CMT-Health Index, as well as nerve conduction studies, and magnetic resonance imaging and Meissner corpuscle biomarkers. Correlations using baseline data will be examined for validity. Longitudinal analyses will document the changes in function, intramuscular fat accumulation, Meissner corpuscle sensory receptor density. Lastly, we will use anchor-based and other statistical methods to determine the minimally clinically important change for these clinical outcome assessments and biomarkers in CMT1A. Reliable, and responsive clinical outcome assessments of function and disease progression biomarkers are urgently needed for application in early and late phase clinical trials in CMT1A. The ACT-CMT study protocol will address this need through the prospective, longitudinal, multicenter examination in unprecedented detail of novel and existing clinical outcome assessments and motor and sensory biomarkers, and enhance international clinical trial infrastructure, training and preparedness for future therapeutic trials in CMT and related neuropathies.

In-vivo reflectance confocal microscopy in patients with chromoblastomycosis

In-vivo reflectance confocal microscopy (RCM) is a non-invasive technique that provides real-time images of the skin structure in grey scale, at a resolution similar to histopathology, in planes parallel to the skin surface to the depth of the superficial dermis (Gonzalez, 2012). Highly reflective skin components, such as melanin, act as an endogenous source of contrast and appear bright white in RCM images. Chromoblastomycosis is an infectious disease characterized by the occurrence of verrucous plaques on the limbs.

Role of in-vivo reflectance confocal microscopy in the diagnosis of a histopathologic difficult melanoma.

article: Role of in-vivo reflectance confocal microscopy in the diagnosis of a histopathologic difficult melanoma - Italian Journal of Dermatology and Venereology 2021 June;156(3):401-3 - Minerva Medica - Journals

Nevus-associated melanoma: facts and controversies.

Nevus-associated melanoma (NAM) is defined on histopathological basis by the coexistence of melanoma and nevus components. Melanomas developing on pre-existing congenital or acquired nevi are usually of the superficial spreading subtype and harbor the BRAFV600E mutation. NAM accounts for almost one-third of melanoma cases As compared to de novo melanoma, NAM develops on younger patients, is more frequently located on the trunk, and is associated with a high nevus count, light eye color and history of frequent sunburns. NAM has been regarded as a model to investigate melanoma origin. Molecular analysis defining the mutation profile of NAM's nevus and melanoma components supported the existence of two pathways of melanoma development, the first not involving clinically visible precursors, the second involving melanocytic nevi as precursors. Concerning diagnosis, dermatoscopy may identify nevus and melanoma components when located side-by-side, but no specific criteria have been described when superimposed. In-vivo reflectance confocal microscopy significantly enhances the recognition of NAM by allowing the detection of nevus remnants when superficially located. Regarding prognosis, NAM is generally thinner and more frequently in-situ than de-novo melanoma. Furthermore, studies reporting survival analysis demonstrated a trend towards better overall, distant-metastasis-free and recurrence-free survival. Although a clinical, phenotypic and molecular profile of NAM has been defined, controversies still exist. In the current review, we widely report and discuss facts and controversies on NAM.

Morphological classification of melanoma metastasis with reflectance confocal microscopy.

Cutaneous malignant melanoma metastases differential diagnosis is challenging, as clinical and dermoscopic features can simulate primary melanoma or other benign or malignant skin neoplasms, and in-vivo reflectance confocal microscopy could assist. Our aim was to identify specific reflectance confocal microscopy features for cutaneous malignant melanoma metastases, and epidermal and dermal involvement. A retrospective, multicentre observational study of lesions with proven cutaneous malignant melanoma metastases diagnosis between January 2005 and December 2016. Lesions were retrospectively assessed according to morphological features observed at reflectance confocal microscopy. Potential homogeneous subgroups of epidermal or dermal involvement were investigated with cluster analysis. Cutaneous malignant melanoma metastases (51 lesions in 29 patients) exhibited different frequencies of features according to metastasis dermoscopy patterns. Lesions classified at dermoscopy with nevus-like globular and non-globular patterns were more likely to be epidermotropic, showing characteristics of epidermal and dermal involvement at reflectance confocal microscopy. Other dermoscopy pattern classifications were more likely to be dermotropic, showing characteristics od dermal involvement at reflectance confocal microscopy. Distinguishing features at reflectance confocal microscopy included irregular (78%) and altered (63%) epidermis, pagetoid infiltration (51%), disarranged junctional architecture (63%), non-edged papillae (76%), dense and sparse, and cerebriform nests in the upper dermis (74%), and vascularity (51%). Cluster analysis identified three groups, which were retrospectively correlated with histopathological diagnoses of dermotropic and epidermotropic diagnoses (P<0.001). The third cluster represents lesions with deep dermis morphological changes, which were too deep for evaluation with reflectance confocal microscopy. Specific reflectance confocal microscopy features of cutaneous malignant melanoma metastases for correct diagnosis, and subtype diagnosis, seem achievable in most cases where morphological alterations are located above the deep dermis.

Reflectance confocal microscopy features of thin versus thick melanomas.

In-vivo reflectance confocal microscopy (RCM) plays an increasingly important role in differential diagnosis of melanoma. The aim of the study was to assess typical confocal features of thin (≤1 mm according to Breslow index) versus thick (>1mm) melanomas. Thirty patients with histopathologically confirmed cutaneous melanoma were included in the study. RCM was performed with Vivascope equipment prior to excision. Fifteen melanomas were thin (Breslow thickness ≤1 mm) and 15 were thick (Breslow thickness >1 mm). In the RCM examination, the following features were more frequently observed in thin compared to thick melanomas: edged papillae (26.7% vs. 0%, P=0.032) and areas with honeycomb or cobblestone pattern (33.3% vs. 6.7%, P=0.068). Both features are present in benign melanocytic lesions, so in melanoma are good prognostic factors. The group of thick melanomas compared to the group of thin melanomas in the RCM images presented with greater frequency of roundish cells (100% vs. 40%, P=0.001), non-edged papillae (100% vs. 60%, P=0.006), numerous pagetoid cells (73.3% vs. 33.3%, P=0.028), numerous atypical cells at dermal-epidermal junction (53.3% vs. 20%, P=0.058) and epidermal disarray (93.3% vs. 66.7%, P=0.068). Non-invasive imaging methods helps in deepening of knowledge about the evolution and biology of melanoma. The most characteristic features for thin melanomas in confocal examination are: fragments of cobblestone or honeycomb pattern and edged papillae (as good prognostic factors). The features of thick melanomas in RCM examination are: roundish cells, non-edged papillae, numerous pagetoid cells at dermal-epidermal junction and epidermal disarray.

Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Eyelid Margin and Conjunctival Tumors

The clinical diagnosis of conjunctival and eyelid margin tumors is challenging, and new noninvasive imaging techniques could be valuable in this field. To assess the diagnostic accuracy of handheld in vivo reflectance confocal microscopy (IVCM) for the diagnosis of eyelid margin and conjunctival tumors. A prospective observational study was conducted at University Hospital of Saint-Etienne from January 2, 2011, to December 31, 2016 (inclusion of patients until December 31, 2015, and follow-up until December 31, 2016). A total of 278 consecutive patients with eyelid margin or conjunctival lesions were included. Conjunctival lesions were diagnosed with a conventional clinical examination using a slitlamp and by handheld IVCM. Final diagnoses were established by histopathologic examination for 155 neoformations suspicious for being malignant through clinical and/or IVCM examination that were excised and on follow-up of 12 months or longer for the remaining 140 lesions. Sensitivity, specificity, and positive and negative predictive values for malignant tumors of the conjunctiva and eyelid margin were calculated using clinical examination with slitlamp and handheld IVCM. In the 278 patients (136 [48.9%] females; mean [SD] age, 59 [21] years), a total of 166 eyelid margin and 129 conjunctival lesions were included in the analysis. Of the 155 excised neoformations with a histopathologic diagnosis, IVCM showed higher sensitivity compared with clinical examination conducted with the slitlamp for malignant tumors of the eyelid margin (98% vs 92%) and conjunctiva (100% vs 88%). The specificity for malignant eyelid margin tumors was higher for IVCM than for slitlamp examination (74% vs 46%), but slightly less for malignant conjunctival tumors (78% vs 88%). Analysis of all neoformations (155 excised and 140 in follow-up) confirmed these differences in the diagnostic accuracy of the clinical examination and IVCM. The presence of hyperreflective Langerhans cells mimicking malignant melanocytes was the main cause for misdiagnosis of malignant conjunctival tumors with IVCM. Handheld IVCM could be a useful tool for the identification of malignant conjunctival tumors. Further studies are required to confirm the usefulness of this device and identify possible features that can differentiate Langerhans cells from malignant melanocytes to prevent the misdiagnosis of melanoma using IVCM.

In-vivo reflectance confocal microscopy of Meissner's corpuscles in diabetic distal symmetric polyneuropathy

ObjectiveTo evaluate in-vivo reflectance confocal microscopy (RCM) of Meissner's corpuscles (MC) in diabetic distal symmetric polyneuropathy (DSP). MethodsForty-three adults with diabetes and 21 control subjects underwent RCM of MC density at the fingertip of digit V, thenar eminence (TE), and arch of the foot, ankle skin biopsy for epidermal nerve fiber density (ENFD), electrophysiological studies, monofilament threshold testing, and timed vibration at the toe. Subjects with diabetes were subdivided into groups with and without clinical DSP using the American Academy of Neurology (AAN) case definition and neuropathy outcomes were compared across groups. ResultsBoth diabetic groups (with and without AAN clinical DSP criteria) had objective evidence of peripheral sensory involvement using conventional sensory measures, although those with clinical DSP criteria had greater abnormalities. MC densities were lower in the entire diabetic group at the TE and digit V relative to controls. MC densities at all imaging sites were associated with corresponding conventional sensory measures. MC densities were reduced in subjects without AAN clinical DSP criteria at the TE and digit V compared to controls whereas conventional upper limb sensory measures did not differ between these groups. ConclusionsIn-vivo RCM of MC density at digit V is a non-invasive, painless, objective marker in diabetes that offers a window into early large fiber sensory nerve terminal loss. Further studies are needed to determine whether RCM of MCs can identify quantitative changes in DSP associated with disease progression or treatment.

InVivo and ExVivo Confocal Microscopy for Dermatologic and Mohs Surgeons.

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.

In vivo reflectance confocal microscopy for evaluating melanoma of the lip and its differential diagnoses

To improve prebiopsy diagnostic accuracy and surgical management of pigmented appearing lesions on the lips, particularly melanoma, using invivo reflectance confocal microscopy (RCM). Prospective case series over a 12-month period between 2015 and 2016. The setting was two specialist dermatology referral centers with expertise in confocal microscopy. The study population was a consecutive sample of patients with pigmentation of the lip for which the cause was uncertain clinically, whose differential diagnosis included melanoma, and who had undergone both invivo RCM and subsequent biopsy. The outcome measures were RCM features, dermoscopy features, and histopathological diagnosis. Results were reported by descriptive analysis and correlations made between RCM features and histopathology. Eight patients were recruited for the study. Invivo RCM facilitated the targeting of small biopsies to identify two in situ oral melanoma recurrences and successfully mapped an in situ oral melanoma before wide excision. Suprabasal dendritic pagetoid cells and epidermal disarray on RCM were useful indicators for in situ melanoma of the lip. Previously described dermoscopy features for mucosal melanoma were not very helpful in diagnosing melanoma in our series. Challenges included evaluating inflamed lesions with pigment incontinence. RCM can assist in the diagnosis and management of pigmented lip lesions, but additional studies are required to further evaluate these initial observations.

In-Vivo Reflectance Confocal Microscopy of Meissner’s Corpuscles as an Objective Measure of Diabetic Polyneuropathy (P5.046)

In-Vivo Reflectance Confocal Microscopy of Meissner’s Corpuscles as an Objective Measure of Diabetic Polyneuropathy (P5.046)

Improving the overall diagnosis of eyelid margin tumours with in vivo reflectance confocal microscopy

PurposeThe clinical diagnosis of eyelid margin tumours is often challenging and surgical excision in this area may have both functional and aesthetic consequences. Aim: to assess the role of handheld in vivo reflectance confocal microscopy (IVCM) in the diagnosis of eyelid margin tumours.MethodsWe prospectively evaluated and characterized 130 eyelid margin lesions using a handheld dermatology IVCM (Vivascope 3000, Mavig/Lcid, NY). Patients were referred to our multidisciplinary consultation from may 2013 to april 2015. All lesions were first clinically characterized as benign or malignant and then evaluated under IVCM by 3 skilled Dermatologists. Surgical excision was decided for 79 of them, based on both clinical and IVCM features. The 51 remaining lesions with no signs of malignancy were under followed up for at least 6 months. Clinical, IVCM, and histopathology diagnoses were compared.ResultsConsidering the 79 excised lesions: IVCM showed a sensitivity (Se) of 90% and a specificity (Sp) of 57% for malignant tumours (basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma) as compared to the histopathology. Clinical evaluation had Se of 81% and Sp of 50%. IVCM showed Se and Sp of respectively 89% and 62% for BCC; 60% and 100% for SCC; 100% and 45% for melanoma. None of the non‐excised lesions had clinical progression at 6 months and all these lesions were considered as benign.ConclusionsIVCM is an important tool in the management of eyelid margin tumours by improving the global sensitivity and specificity of the clinical diagnosis GRANT: AP jeune chercheur GIRCI RAA.

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

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.

The role of in vivo confocal microscopy in the diagnosis of eyelid margin tumors: 47 cases

Handheld invivo reflectance confocal microscopy (IVCM) is a new imaging method that allows noninvasive diagnosis of cutaneous tumors but to date it has not been used in the study of eyelid tumors. We sought to evaluate the suitability of IVCM for eyelid margin tumors. We prospectively evaluated the IVCM features of 47 eyelid margin lesions, clinically suspicious of malignancy; 35 of these were excised whereas the other 12, with no IVCM malignant features, were followed up for at least 1 year. Clinical, IVCM, and histologic diagnoses were compared. IVCM showed sensitivity and specificity of 100% and 69.2%, respectively, for malignancy (basal cell carcinoma, squamous cell carcinoma, and melanoma). The follow-up of the 12 nonexcised lesions did not show any clinical progression. The lesions showing neither clinical nor IVCM features for malignancies were not biopsied in view of the potential functional and aesthetic consequences of eyelid margin surgery. Used with a handheld dermatology-specific microscope, IVCM can play a role in the noninvasive diagnosis of eyelid margin lesions. Further studies are needed to better define diagnostic criteria of eyelid tumors and improve the specificity of this technique.

In vivo reflectance confocal microscopy to monitor the response of lentigo maligna to imiquimod

Imiquimod has been used for treating lentigo maligna (LM) in selected cases when surgery is not an appropriate option because of functional or aesthetic impairment. Reflectance confocal microscopy (RCM) is a noninvasive method that has not been validated for monitoring the treatment of LM with imiquimod. We sought to evaluate the use of invivo RCM to accurately monitor the response of LM to nonsurgical treatment with topical imiquimod. Twenty patients with confirmed facial LM, not amenable to surgical treatment or radiation therapy, were included prospectively. Clinical evaluation was performed by dermoscopy, RCM, and histopathology. Patients applied imiquimod 5% for 8 weeks. The affected area was assessed using the previously described LM score on RCM, and target sample biopsies were performed to confirm or discard RCM findings. Fifteen of the 20 patients (75%) presented histologic tumor clearance. Confocal microscopy identified 70% of these responders with no false-negative results, and when compared with histopathology, there was no significant difference in evaluating the response to imiquimod. The impossibility of examining the entire lesion by means of histopathology is a limitation. Invivo RCM evaluation was useful in accurately monitoring the response of LM to nonsurgical treatment with topical imiquimod in patients when surgery is contraindicated.

Quantification of capillary blood cell flow using reflectance confocal microscopy

In vivo reflectance confocal microscopy (IVCM) is a new tool for skin microcirculation. However, the measure of quantitative blood cell flow (QBCF) has not been standardized. We studied the inter-investigator and the intra-capillary reproducibility of the manual measure of QBCF on IVCM videos and investigated if a software program might help measure QBCF and be sensitive to vascular occlusion tests. The inter-investigator reproducibility of the manual QBCF was evaluated on 107 videos. The intra-capillary reproducibility of QBCF measured manually and by 2 semi-automatic procedures based on Image J software analysis was evaluated on 19 capillaries. One of the semi-automatic methods (peaks of luminous intensity) was also used to measure the QBCF during vascular occlusion tests. The manual measure did not show a good inter-investigator reproducibility (Pearson's coefficient <0.5). The 'peaks of luminous intensity' method was found to have a good intra-capillary reproducibility and to be sensitive to vascular occlusion. Differently from the manual count, the count of peaks of luminous intensity by Image J software seems to be promising to measure QBCF. The future is to create software allowing for real-time measure of the QBCF based on the peaks of luminous intensity inside the capillaries recorded by IVCM.

Optical diagnosis of a metabolic disease: cystinosis

Nephropathic cystinosis (NC) is a rare autosomal recessive storage disease characterized by the lysosomal accumulation of cystine crystals throughout the body, particularly in blood cells, the cornea, skin, kidneys, the central nervous system, and the muscles. The skin and the cornea are the most accessible sites to explore, and in vivo reflectance confocal microscopy (IVCM) helps identify crystals in both but does not provide any information to help define their composition. Raman spectroscopy (RS) allows cystine to be easily recognized thanks to its characteristic signature with a band at 499 cm⁻¹. Two dermatology confocal microscopes were used to visualize crystals in both the skin and the ocular surface of a cystinosis patient, and an ex vivo Raman examination of a skin biopsy and of the cornea was performed and removed during a corneal graft to confirm the cystine composition of the crystals. Recently, RS has been performed in vivo and coupled with IVCM. In the future, it is suggested that crystals in NC and other deposits in storage diseases could be identified with this noninvasive in vivo technique that combines IVCM to recognize the deposits and RS to confirm their chemical nature.

Hidradénome nodulaire

Handheld in vivo reflectance confocal microscopy (IVCM) is a new imaging method that allows noninvasive diagnosis of cutaneous tumors but to date it has not been used in the study of eyelid tumors.We sought to evaluate the suitability of IVCM for eyelid margin tumors.We prospectively evaluated the IVCM features of 47 eyelid margin lesions, clinically suspicious of malignancy; 35 of these were excised whereas the other 12, with no IVCM malignant features, were followed up for at least 1 year. Clinical, IVCM, and histologic diagnoses were compared.IVCM showed sensitivity and specificity of 100% and 69.2%, respectively, for malignancy (basal cell carcinoma, squamous cell carcinoma, and melanoma). The follow-up of the 12 nonexcised lesions did not show any clinical progression.The lesions showing neither clinical nor IVCM features for malignancies were not biopsied in view of the potential functional and aesthetic consequences of eyelid margin surgery.Used with a handheld dermatology-specific microscope, IVCM can play a role in the noninvasive diagnosis of eyelid margin lesions. Further studies are needed to better define diagnostic criteria of eyelid tumors and improve the specificity of this technique.