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OVERVIEW

image SUMMARY

  • Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that enables the in vivo evaluation of skin with near-to-histology resolution.

  • RCM improves diagnostic accuracy and reduces the number needed to excise (NNE) compared with dermoscopy alone.

  • RCM is beneficial not only for diagnosing skin cancers but also for obtaining appropriate presurgical margins and monitoring the efficacy and treatment response of topical therapies.

image DON’T FORGET

  • Different diagnostic accuracies have been described for experienced and novice RCM users. Experienced RCM users showed higher diagnostic sensitivity compared with novice RCM users.

  • Four main features have been identified to help the dissemination of RCM to beginner users. “Atypical cells” and “dermal-epidermal junction disarray” are the two melanoma-specific key features; “tumor islands” are basal cell carcinoma (BCC)-specific key features; and “keratinocyte disarray” are squamous cell carcinoma (SCC)-specific key features.

image CLINICAL PEARLS

  • Histopathology remains the gold standard for diagnosing skin cancer. RCM provides clues for the diagnosis and contributes in cases of suspicious lesions and when a dermoscopic diagnosis is difficult.

image PATIENT EDUCATION POINTS

  • Melanoma and SCC have the potential to metastasize, whereas BCC is usually confined to the skin but progressively infiltrates and damages the surrounding tissue. Therefore, adequate diagnosis and prompt treatment are essential.

  • The increasing incidence of skin cancers has led to the development of noninvasive imaging techniques such as RCM to improve skin cancer diagnosis and, consequently, morbidity and survival rates.

INTRODUCTION

The increasing incidence of skin cancer has led to the development of noninvasive imaging techniques to improve skin cancer diagnosis and, consequently, morbidity and survival rates.

Melanoma and squamous cell carcinoma (SCC) have the potential to metastasize and consequently have significant lethality rates. Basal cell carcinoma (BCC) is usually confined to the skin, but it progressively infiltrates and damages the surrounding skin.

Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that enables the in vivo evaluation of the skin with near-to-histology resolution up to the depth of 250 μm, which corresponds to the upper dermis.1,2 RCM can be performed with the wide-probe Vivascope 1500® (Caliber ID), which allows a broad, noninvasive examination at cellular-level resolution with a maximum size of 8- × 8-mm mosaics (Vivablock®) at three different levels: the epidermis, the dermal-epidermal junction (DEJ), and the upper dermis. The wide probe device guarantees an overlap of RCM images with dermoscopy through the Vivacam®.3 The device received U.S. Food and Drug Administration clearance to visualize cellular structures within the skin noninvasively, and current procedural terminology (CPT) codes are used for Medicare reimbursement in the United States.

A handheld device, Vivascope 3000® (Caliber ID), enables clinicians to examine anatomic areas that are difficult to access, such as the eyelids, ears, nasal region, scalp, and mucosae.4 In both tools (Vivascope 3000 and Vivascope 1500), horizontal images of the skin result ...

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