Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jul 31;4(3):67-71.
doi: 10.5826/dpc.0403a13. eCollection 2014 Jul.

Recognizing the benefits and pitfalls of reflectance confocal microscopy in melanoma diagnosis

Alon Scope  1 , Caterina Longo  2
Affiliations

Recognizing the benefits and pitfalls of reflectance confocal microscopy in melanoma diagnosis

Alon Scope et al. Dermatol Pract Concept. .
No abstract available

Keywords: dermatoscopy; melanoma; reflectance confocal microscopy.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
(A) Dermatoscopic image of a nevus showing an irregular network with thickened dark brown lines. (B) RCM mosaic (3.5 × 3.5 mm) acquired at dermo-epidermal junction level reveals a regular Ringed and Meshwork pattern. (C) Higher magnification RCM image (1.5 × 1 mm) depicts well-outlined dermal papillae in the absence of atypical cells, features compatible with the diagnosis of a nevus. [Copyright: ©2014 Scope et al.]
Figure 2.
Figure 2.
(A) Dermatoscopy image of a nevus typified by complex pattern with central bluish clods, structureless areas and peripheral network. (B) RCM overview image (5 × 6 mm mosaic) acquired at dermo-epidermal junction level reveals a regular Meshwork pattern. (C) Higher magnification RCM image (1.5 × 1 mm) shows junctional thickening and junctional nests in the absence of atypical cells, features compatible with the diagnosis of a nevus. [Copyright: ©2014 Scope et al.]
Figure 3.
Figure 3.
(A) Clinical image of a 10 mm asymmetric brown patch on the right leg. The patient is a 64-year-old female with prior history of melanoma, and the lesion has been present for several years without notable change. (B) Dermatoscopic image showing an irregular reticular pattern. The differential diagnosis was between solar lentigo and melanoma on sun-damaged skin. (C) RCM mosaic image (1.5 × 1.5 mm) acquired at dermo-epidermal junction level reveals a Ringed pattern. The initial RCM diagnosis was that of a nevus. However, more exhaustive imaging (akin to “step sectioning” on histopathology) was done as clinically and dermatoscopically, the lesion did not fit well with a nevus. (D) RCM image (0.5 × 0.5 mm) at the level of the basal layer of the epidermis showed foci with irregular infiltration of bright dendritic cells as solitary units (arrowhead) and as aggregates (arrow). The final RCM diagnosis was melanoma. (E) On histopathology (hematoxylin & eosin, 10x), there is a broad asymmetric junctional proliferation of melanocytes, compatible with a melanoma in situ. (F) Higher magnification histopathology (hematoxylin & eosin, 20x) shows the tissue correlates of the RCM findings; atypical dendritic melanocytes are seen as crowded solitary units (arrowhead) and as aggregates (arrow). [Copyright: ©2014 Scope et al.]
Figure 4.
Figure 4.
(A) Baseline back images of a 69-year-old male patient with a history of melanoma. (B) Repeat back image, at 3-year follow-up, reveals a new pigmented macule on the left upper back (red arrow). Of note, the arrows in (A) and (B) correspond to the same anatomic locations. (C) Clinically (inset) the lesion is a symmetric 5 mm macule with 2 shades of brown. Dermatoscopically, the lesion displays a homogenous pattern, with brown-gray dots. The suspicion for melanoma was very low at this juncture, but the patient was referred to RCM because the lesion was new. (D) RCM mosaic (2.5 × 2 mm) acquired at the level of the basal layer of the epidermis shows an irregular Ringed (yellow arrow) and non-specific pattern (white asterisk). (E) On higher magnification RCM image (0.5 × 0.5 mm) at the spinous layer of the epidermis, dendritic cells in pagetoid pattern can be seen. The RCM diagnosis is melanoma. (F) On histopathlogy (hematoxylin and eosin, 20X), there are irregularly crowded nests of atypical melanocytes at the DEJ, lack of dermal maturation, and atypical melanocytes in pagetoid pattern (arrows). The diagnosis is melanoma 0.6 mm in Breslow thickness. [Copyright: ©2014 Scope et al.]
Figure 5.
Figure 5.
(A) Dermatoscopy image of a 3 mm pigmented lesion. Dermatoscopy reveals a structureless brown-gray pigmentation with few dots. (B) RCM mosaic (3.5 × 2.5 mm) acquired at the level of the spinous-granular layers of the epidermis displays a disarrayed pattern of the epidermis with bright cells in pagetoid distribution at the periphery of the lesion (blue square). (C) On higher magnification RCM image (1.25 × 0.75 mm), large and bright nucleated cells in pagetoid pattern (arrows) can be easily detected. The RCM diagnosis for this lesion is melanoma. (D) On histopathology (hematoxylin and eosin, 20X), there is a junctional proliferation of atypical melanocytes as confluents nests and as solitary units, as well as melanocytes in pagetoid pattern. The diagnosis is melanoma 0.3 mm in Breslow thickness. [Copyright: ©2014 Scope et al.]
See this image and copyright information in PMC

References

    1. Rigel DS. Epidemiology of melanoma. Semin Cutan Med Surg. 2010;29:204–9. - PubMed
    1. Stevenson AD, Mickan S, Mallett S, et al. Systematic review of diagnostic accuracy of reflectance confocal microscopy for melanoma diagnosis in patients with clinically equivocal skin lesions. Dermatol Pract Concept. 2013;3:19–27. - PMC - PubMed
    1. Carli P, De Giorgi V, Crocetti E, et al. Improvement of malignant/benign ratio in excised melanocytic lesions in the ‘dermoscopy era’: a retrospective study 1997–2001. Br J Dermatol. 2004;150:687–92. - PubMed
    1. Bassoli S, Rabinovitz HS, Pellacani G, et al. Reflectance confocal microscopy criteria of lichen planus-like keratosis. J Eur Acad Dermatol Venereol. 2012;26:578–90. - PubMed
    1. Longo C, Moscarella E, Pepe P. Confocal microscopy of recurrent naevi and recurrent melanomas: a retrospective morphological study. Br J Dermatol. 2011;165:61–8. - PubMed

LinkOut - more resources