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Confocal microscopy is an optimal device that offers a nearly histologic view of skin tissue.
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In vivo confocal microscopy helps to outline lateral basal cell carcinoma margins with accuracy, although it has been tested on a limited set of patients.
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Ex vivo confocal microscopy is a valid alternative to conventional frozen section pathology for BCC margin assessment.
In Vivo and Ex Vivo Confocal Microscopy for Dermatologic and Mohs Surgeons
Section snippets
Key points
In vivo applications of reflectance confocal microscopy
In vivo RCM has been applied at the patient’s bedside for lateral margin detection in BCC and lentigo maligna (LM), because of its capability of exploring the skin at the cellular level, enabling the identification of tumor characteristics.
Ex vivo applications of fluorescence confocal microscopy
Ex vivo FCM is used on freshly excised tumors in the operating room. Different fluorophores, such as fluorescein, Nile blue, patent blue, methylene blue, and acridine orange, can be used at different wavelengths. However, acridine orange is one of the most commonly used because of its capability to provide an excellent contrast. Confocal mosaics are acquired using an ex vivo fluorescence confocal microscope (Vivascope 2500, Mavig). The laser illumination wavelength is 488 nm. The depth is
Other tumors
FCM has been used to assess the margins during micrographic mohs surgery (MMS) of eccrine syringomatous carcinoma.32 On FCM the tumor appears highly fluorescent. Epidermis is spared of any neoplastic proliferation, whereas neoplastic cords of monomorphous fluorescent cells can be seen in the dermis. Those structures are similar to eccrine gland tubular structure.
Summary
The need of defining skin cancer margins for a more accurate surgical excision has fueled the exploration of confocal microscopy in this special setting. In vivo and ex vivo confocal microscopy has been used with the great advantage of saving time and providing good diagnostic accuracy. For both techniques intense and dedicated training is required to learn how to use the device and even more relevant, how to interpret the images. For the near future we envision the routine application of
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The authors have no conflicts of interest to disclose.
Funding: Dr C. Longo and Prof G. Pellacani were partially funded by Research Project NET-2011-02347213, Italian Ministry of Health.