Reflectance confocal microscopy of cutaneous melanoma. Correlation with dermoscopy and histopathology

Abstract

In vivo Confocal Microscopy is a method for non-invasive, real-time visualization of microscopic structures and cellular details of the epidermis and dermis, which has a degree of resolution similar to that obtained with histology. We present a case of cutaneous melanoma in which diagnosis was aided by confocal microscopy examination. We also correlate the observed features with the dermoscopic and histopathological findings. Confocal microscopy proved to be an useful adjunct to dermoscopy, playing an important role as a method 'between clinical evaluation and histopathology'.

FIGURE 1

Brownish, hyperchromic, asymmetrical, 6-mm macule with irregular edges and variable colors in the right deltoid region

FIGURE 2

Dermatoscopy of the lesion. Global pattern: asymmetrical structure and varied colors and structures (multi-components). Specific features: blurs and atypical pigment network with peripheral projections (pseudopods). Pigmented cells irregularly distributed in the periphery of the lesion. Blue-gray irregularly distributed pigmentation

FIGURE 3

In vivo Confocal Microscopy: Atypical “honeycomb” pattern. Round cells with bright cytoplasm and dark nucleus (yellow arrow), and dendritic cells (red arrow) in the epidermis (pagetoid cells)

FIGURE 4

In vivo Confocal Microscopy: Presence of nests with heterogeneous brightness at the dermo-epidermal junction and papillary dermis (red arrow)

FIGURE 5

In vivo Confocal Microscopy: Bright cells dispersed in the dermis, corresponding to melanophages (red arrow)

FIGURE 6

The heterogeneous nests of clear cells seen in ICM (red arrow) are seen in histopathology as a proliferation of atypical melanocytes arranged in irregular nests along the DEJ and papillary dermis (blue arrow) In dermoscopy, they are seen as heterogeneous globules (orange arrow)

FIGURE 7

In ICM, round cells with clear cytoplasm and dark nucleus located in the epidermis (red arrow) correspond to atypical pagetoid melanocytes (blue arrow) in histopathology. In dermoscopy they may be seen as blurs (orange arrow)

FIGURE 8

In ICM, the large clear nucleated cells infliltrating the papillary dermis (red arrow) correspond to the melanophages in the papillary dermis (blue arrow) seen in histopathology. and to the blue-gray veil seen in dermoscopy (orange arrow)