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. 2012 Dec;38(12):1945-50.
doi: 10.1111/j.1524-4725.2012.02587.x. Epub 2012 Oct 5.

In vivo reflectance confocal microscopy of Basal cell carcinoma: feasibility of preoperative mapping of cancer margins

Zhan-Yan Pan  1 , Jing-Ran Lin, Ting-Ting Cheng, Jia-Qiang Wu, Wen-Yu Wu
Affiliations

In vivo reflectance confocal microscopy of Basal cell carcinoma: feasibility of preoperative mapping of cancer margins

Zhan-Yan Pan et al. Dermatol Surg. 2012 Dec.

Abstract

Background: Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in vivo. It has the potential to define lesion margins before surgical therapy.

Objectives: To investigate the feasibility of RCM in defining the margins of basal cell carcinoma before surgery.

Methods: The margins of 10 lesions were evaluated using RCM. Biopsies of the margins were used to confirm the results. A protocol was constructed to define margins. RCM was used to delineate preoperative surgical margins in 13 patients. Intraoperative frozen biopsy was used to confirm the margins.

Results: In seven of 10 (70.0%) cases, the margins of the cancer were identified suing RCM. The tumor island was the critical feature in identifying the margins. In 12 of 13 (92.3%) cases, frozen biopsy corroborated that the surgical margins delineated by RCM were clear.

Conclusion: RCM imaging of the margins is feasible and demonstrates the possibility of preoperative mapping of cancer margins.

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Figures

Figure 1
Figure 1
Reflectance confocal microscopy imaging protocol and surgical excision. (A) Foci for reflectance confocal microscopy (RCM) examination were selected. (B) The lesion's border was refined (blue cross). (C) An extra 5-mm margin of normal skin was excised (dotted line). (D) The gross skin specimen was further sectioned along the boundaries inscribed using RCM. (E) RCM mosaic image of the margin. The upper half part of the image showed the normal reticulated meshwork pattern, while the lower part showed the tumor islands of elongated strands.
Figure 2
Figure 2
Reflectance confocal microscopy (RCM) images of the margin of a lesion. (A) Clinical image of a superficial basal cell carcinoma on the cheek of a 52-year-old woman. (B) RCM images of nonlesional skin showed the normal ring structures. (C) RCM images of lesional skin showed the tumor island. (D) RCM mosaic image of the margin. The left side of the image showed the tumor island, and the right side showed the normal ring structures. (E) Biopsies of the margins detected using RCM confirmed the result.
See this image and copyright information in PMC

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