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Confocal microscopy

Pellacani, G.

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doi: 10.1097/01.cmr.0000382763.16366.d1
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Reflectance-mode confocal scanning laser microscopy is a new tool for the non invasive study of the skin at quasi-histopathologic resolution, giving rise to images corresponding to horizontal sections of the epidermis and superficial dermis. In confocal microscopy, contrast is provided by differences in refraction index of organelles and other microstructures, that appear bright, contrasting with the background. Since in-vivo confocal microscopy provides high-resolution and instantaneous imaging of cellular and architectural details in human skin, it has been explored for the characterization of different neoplastic skin diseases. The employment of dermoscopy in combination with confocal microscopy for the study of the most characteristic dermoscopic structures of pigmented skin lesions enabled the exact correlation of single dermoscopic patterns with their cytological and architectural substrate. Different aspects of the pigment network, pigment globules and blue areas, and the degree of architectural and cytological atypia were evidenced by confocal microscopy, enabling the distinction of benign and malignant melanocytic lesions with a specificity far superior than dermoscopy, while showing no difference in sensitivity. In particular, the diagnosis of light coloured lesions was dramatically improved by confocal microscopy compared to dermoscopy. Besides the value of this technique in skin cancer and melanoma diagnosis, it is evident the capability to catch different morphologic aspects that can be correlated with different types melanoma subtypes. In fact, at least three main different cell morphology are observed in melanomas corresponding to predominance of dendritic cells, roundish cells and/or small cells aggregated in dermal clusters. This classification in different melanoma subtypes seems to be correlated with different phenotypes, epidemiological characteristics, and biomarkers, making confocal an useful device to segregate melanomas with mild sign of malignancy that could have an indolent behaviour from the ones with more aggressive features. In conclusion, confocal microscopy, permitting the in vivo visualisation of skin architecture and cytology, represents the missing link between the Clinicians and the Pathologists. Moreover, an integration of new in vivo confocal aspects coupled with molecular biology techniques, can significantly accelerate the translation of biomarker discovery to clinical benefit.

© 2010 Lippincott Williams & Wilkins, Inc.