Skip to main content

In Vivo Reflectance Confocal Microscopy for Non-Melanocytic Malignant Skin Tumours

  • Chapter
  • First Online:

Abstract

Non-melanoma skin cancer (NMSC) is a major health problem because of its high incidence in the Caucasian population, as well as its related potential morbidity and mortality. Reflectance confocal microscopy is a non-invasive technique that allows the visualization of the skin at a nearly histological resolution, improving significantly the early diagnosis of NMSC. This tool is also important in the management of NMSC therapy and in the post-treatment follow-up. In this chapter, we provide a review of the reflectance confocal microscopy criteria for the diagnosis of NMSC.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Ridky TW. Nonmelanoma skin cancer. J Am Acad Dermatol. 2007;57:484–501.

    Article  PubMed  Google Scholar 

  2. Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166:1069–80.

    Article  CAS  PubMed  Google Scholar 

  3. Malvehy J, Pellacani G. Dermoscopy, confocal microscopy and other non-invasive tools for the diagnosis of non-melanoma skin cancers and other skin conditions. Acta Derm Venereol. 2017;(Suppl 218):22–30.

    Google Scholar 

  4. Giavedoni P, Puig S, Carrera C. Non invasive imaging for nonmelanoma skin cancer. Semin Cutan Med Surg. 2016;35:31–41.

    Google Scholar 

  5. Ferrari B, et al. Non-melanoma skin cancer of the head and neck: the aid of reflectance confocal microscopy for the accurate diagnosis and management. G Ital Dermatol E Venereol. 2017;152:169–77.

    Google Scholar 

  6. Ulrich M, et al. Peritumoural clefting in basal cell carcinoma: correlation of in vivo reflectance confocal microscopy and routine histology. J Cutan Pathol. 2011;38:190–5.

    Article  PubMed  Google Scholar 

  7. Casari A, et al. Pigmented nodular basal cell carcinomas in differential diagnosis with nodular melanomas: confocal microscopy as a reliable tool for in vivo histologic diagnosis. J Skin Cancer. 2011;2011:406859.

    Article  PubMed  Google Scholar 

  8. Langley RGB, Burton E, Walsh N, Propperova I, Murray SJ. In vivo confocal scanning laser microscopy of benign lentigines: comparison to conventional histology and in vivo characteristics of lentigo maligna. J Am Acad Dermatol. 2006;55:88–97.

    Article  PubMed  Google Scholar 

  9. Shahriari N, Grant-Kels JM, Rabinovitz H, Oliviero M, Scope A. In vivo reflectance confocal microscopy image interpretation for the dermatopathologist. J Cutan Pathol. 2018;45:187–97.

    Article  PubMed  Google Scholar 

  10. Guitera P, et al. In vivo confocal microscopy for diagnosis of melanoma and basal cell carcinoma using a two-step method: analysis of 710 consecutive clinically equivocal cases. J Invest Dermatol. 2012;132:2386–94.

    Article  CAS  PubMed  Google Scholar 

  11. Cinotti E, et al. Sensitivity of handheld reflectance confocal microscopy for the diagnosis of basal cell carcinoma: a series of 344 histologically proven lesions. J Am Acad Dermatol. 2015;73:319–20.

    Article  PubMed  Google Scholar 

  12. Agero ALC, et al. Reflectance confocal microscopy of pigmented basal cell carcinoma. J Am Acad Dermatol. 2006;54:638–43.

    Article  PubMed  Google Scholar 

  13. Ruini C, et al. The invisible basal cell carcinoma: how reflectance confocal microscopy improves the diagnostic accuracy of clinically unclear facial macules and papules. Lasers Med Sci. 2016;31:1727–32.

    Article  CAS  PubMed  Google Scholar 

  14. Rishpon A, et al. Reflectance confocal microscopy criteria for squamous cell carcinomas and actinic keratoses. Arch Dermatol. 2009;145:766–72.

    Article  PubMed  Google Scholar 

  15. Ulrich M, Lange-Asschenfeldt S, Gonzalez S. The use of reflectance confocal microscopy for monitoring response to therapy of skin malignancies. Dermatol Pract Concept. 2012;2:202a10.

    Article  PubMed  Google Scholar 

  16. Venturini M, Sala R, Gonzàlez S, Calzavara-Pinton PG. Reflectance confocal microscopy allows in vivo real-time noninvasive assessment of the outcome of methyl aminolaevulinate photodynamic therapy of basal cell carcinoma. Br J Dermatol. 2013;168:99–105.

    Article  CAS  PubMed  Google Scholar 

  17. Couzan C, et al. Reflectance confocal microscopy identification of subclinical basal cell carcinomas during and after vismodegib treatment. J Eur Acad Dermatol Venereol. 2018;32:763–7.

    Article  CAS  PubMed  Google Scholar 

  18. Lear JT, Smith AG. Basal cell carcinoma. Postgrad Med J. 1997;73:538–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Roewert-Huber J, Lange-Asschenfeldt B, Stockfleth E, Kerl H. Epidemiology and aetiology of basal cell carcinoma. Br J Dermatol. 2007;157(Suppl 2):47–51.

    Article  CAS  PubMed  Google Scholar 

  20. Rubin AI, Chen EH, Ratner D. Basal-cell carcinoma. N Engl J Med. 2005;353:2262–9.

    Article  CAS  PubMed  Google Scholar 

  21. Scope A, Mecca PS, Marghoob AA. skINsight lessons in reflectance confocal microscopy: rapid diagnosis of pigmented basal cell carcinoma. Arch Dermatol. 2009;145:106–7.

    Article  PubMed  Google Scholar 

  22. Nori S, et al. Sensitivity and specificity of reflectance-mode confocal microscopy for in vivo diagnosis of basal cell carcinoma: a multicenter study. J Am Acad Dermatol. 2004;51:923–30.

    Article  PubMed  Google Scholar 

  23. Castro RP, et al. Accuracy of in vivo confocal microscopy for diagnosis of basal cell carcinoma: a comparative study between handheld and wide-probe confocal imaging. J Eur Acad Dermatol Venereol. 2015;29:1164–9.

    Article  CAS  PubMed  Google Scholar 

  24. Que SKT, Grant-Kels JM, Rabinovitz HS, Oliviero M, Scope A. Application of handheld confocal microscopy for skin Cancer diagnosis: advantages and limitations compared with the wide-probe confocal. Dermatol Clin. 2016;34:469–75.

    Article  CAS  PubMed  Google Scholar 

  25. González S, Tannous Z. Real-time, in vivo confocal reflectance microscopy of basal cell carcinoma. J Am Acad Dermatol. 2002;47:869–74.

    Article  PubMed  Google Scholar 

  26. Zalaudek I, et al. How to diagnose nonpigmented skin tumours: a review of vascular structures seen with dermoscopy: part II. Nonmelanocytic skin tumours. J Am Acad Dermatol. 2010;63:377–86; quiz 387–388.

    Article  PubMed  Google Scholar 

  27. Segura S, Puig S, Carrera C, Palou J, Malvehy J. Development of a two-step method for the diagnosis of melanoma by reflectance confocal microscopy. J Am Acad Dermatol. 2009;61:216–29.

    Article  PubMed  Google Scholar 

  28. Segura S, Puig S, Carrera C, Palou J, Malvehy J. Dendritic cells in pigmented basal cell carcinoma: a relevant finding by reflectance-mode confocal microscopy. Arch Dermatol. 2007;143:883–6.

    Article  PubMed  Google Scholar 

  29. Braga JCT, et al. The significance of reflectance confocal microscopy in the assessment of solitary pink skin lesions. J Am Acad Dermatol. 2009;61:230–41.

    Article  PubMed  Google Scholar 

  30. Guida S, et al. Update on the use of confocal microscopy in melanoma and non-melanoma skin cancer. G Ital Dermatol E Venereol. 2015;150:547–63.

    CAS  Google Scholar 

  31. Longo C, et al. Classifying distinct basal cell carcinoma subtype by means of dermatoscopy and reflectance confocal microscopy. J Am Acad Dermatol. 2014;71:716–724.e1.

    Article  PubMed  Google Scholar 

  32. Peppelman M, et al. In vivo diagnosis of basal cell carcinoma subtype by reflectance confocal microscopy. Dermatol Basel Switz. 2013;227:255–62.

    Article  Google Scholar 

  33. Reggiani C, et al. Fibroepithelioma of Pinkus: case reports and review of the literature. Dermatol Basel Switz. 2013;226:207–11.

    Article  Google Scholar 

  34. Perrot JL, et al. Contribution of reflectance confocal microscopy to the diagnosis of fibroepithelioma of Pinkus. Ann Dermatol Venereol. 2014;141:643–5.

    Article  CAS  PubMed  Google Scholar 

  35. Longo C, et al. In vivo confocal microscopic pattern of fibroepithelioma of pinkus. Arch Dermatol. 2012;148:556.

    Article  PubMed  Google Scholar 

  36. Venturini M, et al. A new approach for presurgical margin assessment by reflectance confocal microscopy of basal cell carcinoma. Br J Dermatol. 2016;174:380–5.

    Article  CAS  PubMed  Google Scholar 

  37. Gualdi G, Venturini M, Zanca A, Calzavara-Pinton PG, Pellacani G. Pre-surgical basal cell carcinoma margin definition: the SMART approach. J Eur Acad Dermatol Venereol. 2016;30:474–6.

    Article  CAS  PubMed  Google Scholar 

  38. Ackerman AB, Mones JM. Solar (actinic) keratosis is squamous cell carcinoma. Br J Dermatol. 2006;155:9–22.

    Article  CAS  PubMed  Google Scholar 

  39. Basset-Seguin N. The real face of actinic keratosis: field of cancerisation and squamous cell carcinoma. Eur J Dermatol. 2012;22(Suppl 1):5–9.

    PubMed  Google Scholar 

  40. Lebwohl M. Actinic keratosis: epidemiology and progression to squamous cell carcinoma. Br J Dermatol. 2003;149(Suppl 66):31–3.

    Article  PubMed  Google Scholar 

  41. Ulrich M, et al. Reflectance confocal microscopy for noninvasive monitoring of therapy and detection of subclinical actinic keratoses. Dermatol Basel Switz. 2010;220:15–24.

    Article  CAS  Google Scholar 

  42. Salasche SJ. Epidemiology of actinic keratoses and squamous cell carcinoma. J Am Acad Dermatol. 2000;42:4–7.

    Google Scholar 

  43. Ulrich M, Zalaudek I, Welzel J. Shining into the white: the Spectrum of epithelial tumours from actinic keratosis to squamous cell carcinoma. Dermatol Clin. 2016;34:459–67.

    Article  CAS  PubMed  Google Scholar 

  44. Actinic Keratosis and Non-Invasive Diagnostic Techniques: Biomedicines. 2018;6:8.

    Google Scholar 

  45. Ulrich M, et al. Clinical applicability of in vivo reflectance confocal microscopy for the diagnosis of actinic keratoses. Dermatol Surg. 2008;34:610–9.

    CAS  PubMed  Google Scholar 

  46. Aghassi D, Anderson RR, González S. Confocal laser microscopic imaging of actinic keratoses in vivo: a preliminary report. J Am Acad Dermatol. 2000;43:42–8.

    Article  CAS  PubMed  Google Scholar 

  47. Pellacani G, et al. Grading keratinocyte atypia in actinic keratosis: a correlation of reflectance confocal microscopy and histopathology. J Eur Acad Dermatol Venereol. 2015;29:2216–21.

    Article  CAS  PubMed  Google Scholar 

  48. Zalaudek I, et al. Pitfalls in the clinical and dermoscopic diagnosis of pigmented actinic keratosis. J Am Acad Dermatol. 2005;53:1071–4.

    Article  PubMed  Google Scholar 

  49. Pock L, Drlík L, Hercogová J. Dermatoscopy of pigmented actinic keratosis—a striking similarity to lentigo maligna. Int J Dermatol. 2007;46:414–6.

    Article  PubMed  Google Scholar 

  50. Cinotti E, et al. Dermoscopy vs. reflectance confocal microscopy for the diagnosis of lentigo maligna. J Eur Acad Dermatol Venereol. 2018;32:1284–91.

    Google Scholar 

  51. Guitera P, et al. The impact of in vivo reflectance confocal microscopy on the diagnostic accuracy of lentigo maligna and equivocal pigmented and nonpigmented macules of the face. J Invest Dermatol. 2010;130:2080–91.

    Article  CAS  PubMed  Google Scholar 

  52. de Carvalho N, et al. Reflectance confocal microscopy correlates of dermoscopic patterns of facial lesions help to discriminate lentigo maligna from pigmented nonmelanocytic macules. Br J Dermatol. 2015;173:128–33.

    Article  PubMed  Google Scholar 

  53. Moscarella E, et al. Dermoscopy and reflectance confocal microscopy of pigmented actinic keratoses: a morphological study. J Eur Acad Dermatol Venereol. 2015;29:307–14.

    Article  CAS  PubMed  Google Scholar 

  54. Wurm EMT, et al. Confocal features of equivocal facial lesions on severely sun-damaged skin: four case studies with dermatoscopic, confocal, and histopathologic correlation. J Am Acad Dermatol. 2012;66:463–73.

    Article  PubMed  Google Scholar 

  55. Ulrich M, et al. Non-invasive diagnosis and monitoring of actinic cheilitis with reflectance confocal microscopy. J Eur Acad Dermatol Venereol. 2011;25:276–84.

    Article  CAS  PubMed  Google Scholar 

  56. Ulrich M, et al. Evaluation of Bowen disease by in vivo reflectance confocal microscopy. Br J Dermatol. 2012;166:451–3.

    Article  CAS  PubMed  Google Scholar 

  57. Shahriari N, Grant-Kels JM, Rabinovitz HS, Oliviero M, Scope A. Reflectance confocal microscopy criteria of pigmented squamous cell carcinoma in situ. Am J Dermatopathol. 2018;40:173–9.

    Article  PubMed  Google Scholar 

  58. Debarbieux S, et al. Reflectance confocal microscopy of pigmented Bowen’s disease: misleading dendritic cells. Skin Res Technol. 2017;23:126–8.

    Article  CAS  PubMed  Google Scholar 

  59. Manfredini M, et al. Dermoscopic and reflectance confocal microscopy features of cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol. 2017;31:1828–33.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fiorani, D., Cinotti, E. (2020). In Vivo Reflectance Confocal Microscopy for Non-Melanocytic Malignant Skin Tumours. In: Fimiani, M., Rubegni, P., Cinotti, E. (eds) Technology in Practical Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-030-45351-0_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-45351-0_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-45350-3

  • Online ISBN: 978-3-030-45351-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics