1
|
Kandolf L, Peris K, Malvehy J, Mosterd K, Heppt MV, Fargnoli MC, Berking C, Arenberger P, Bylaite-Bučinskiene M, Del Marmol V, Dirschka T, Dreno B, Forsea AM, Harwood CA, Hauschild A, Heerfordt IM, Kauffman R, Kelleners-Smeets N, Lallas A, Lebbe C, Leiter U, Longo C, Mijušković Ž, Pellacani G, Puig S, Saiag P, Šitum M, Stockfleth E, Salavastru C, Stratigos A, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes). J Eur Acad Dermatol Venereol 2024; 38:1024-1047. [PMID: 38451047 DOI: 10.1111/jdv.19897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.
Collapse
Affiliation(s)
- Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endrocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - Matilda Bylaite-Bučinskiene
- Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Witten, Germany
- CentroDerm Clinic, Wuppertal, Germany
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Ana-Maria Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Ida Marie Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Roland Kauffman
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Dermato-oncology, Cancer institute APHP, Nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Caterina Longo
- Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Željko Mijušković
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Susana Puig
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mirna Šitum
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| |
Collapse
|
2
|
Longo C, Guida S, Mirra M, Pampena R, Ciardo S, Bassoli S, Casari A, Rongioletti F, Spadafora M, Chester J, Kaleci S, Lai M, Magi S, Mazzoni L, Farnetani F, Stanganelli I, Pellacani G. Dermatoscopy and reflectance confocal microscopy for basal cell carcinoma diagnosis and diagnosis prediction score: A prospective and multicenter study on 1005 lesions. J Am Acad Dermatol 2024; 90:994-1001. [PMID: 38296197 DOI: 10.1016/j.jaad.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/25/2023] [Accepted: 01/05/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is usually diagnosed by clinical and dermatoscopy examination, but diagnostic accuracy may be suboptimal. Reflectance confocal microscopy (RCM) imaging increases skin cancer diagnostic accuracy. OBJECTIVE To evaluate additional benefit in diagnostic accuracy of handheld RCM in a prospective controlled clinical setting. METHODS A prospective, multicenter study in 3 skin cancer reference centers in Italy enrolling consecutive lesions with clinical-dermatoscopic suspicion of BCC (ClinicalTrials.gov: NCT04789421). RESULTS A total of 1005 lesions were included, of which 474 histopathologically confirmed versus 531 diagnosed by clinical-dermatoscopic-RCM correlation, confirmed with 2 years of follow-up. Specifically, 740 were confirmed BCCs. Sensitivity and specificity for dermatoscopy alone was 93.2% (95% CI, 91.2-94.9) and 51.7% (95% CI, 45.5-57.9); positive predictive value was 84.4 (95% CI, 81.7-86.8) and negative predictive value 73.3 (95% CI, 66.3-79.5). Adjunctive RCM reported higher rates: 97.8 (95% CI, 96.5-98.8) sensitivity and 86.8 (95% CI, 82.1-90.6) specificity, with positive predictive value of 95.4 (95% CI, 93.6-96.8) and negative predictive value 93.5 (95% CI, 89.7-96.2). LIMITATIONS Study conducted in a single country. CONCLUSIONS Adjunctive handheld RCM assessment of lesions clinically suspicious for BCC permits higher diagnostic accuracy with minimal false negative lesions.
Collapse
Affiliation(s)
- Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Stefania Guida
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Dermatology Clinic, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Marica Mirra
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Riccardo Pampena
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Silvana Ciardo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara Bassoli
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alice Casari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco Rongioletti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Dermatology Clinic, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Spadafora
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Michela Lai
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Serena Magi
- Dermatology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy; Skin Cancer Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST), Meldola, Italy
| | - Laura Mazzoni
- Dermatology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy; Skin Cancer Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST), Meldola, Italy
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ignazio Stanganelli
- Dermatology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy; Skin Cancer Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST), Meldola, Italy
| | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
3
|
Dessinioti C, Liopyris K, Stratigos AJ. Diagnosis of invasive cutaneous squamous cell carcinoma, imaging and staging. Ital J Dermatol Venerol 2024; 159:118-127. [PMID: 38650493 DOI: 10.23736/s2784-8671.24.07670-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The assessment of patients with a lesion raising the suspicion of an invasive cutaneous squamous cell carcinoma (cSCC) is a frequent clinical scenario. The management of patients with cSCC is a multistep approach, starting with the correct diagnosis. The two main diagnostic goals are to differentiate from other possible diagnoses and correctly recognize the lesion as cSCC, and then to determine the tumor spread (perform staging), that is if the patient has a common primary cSCC or a locally advanced cSCC, or a metastatic cSCC (with in-transit, regional lymph nodal, or rarely distant metastasis). The multistep diagnostic approach begins with the clinical characteristics of the primary cSCC, it is complemented with features with dermoscopy and, if available, reflectance confocal microscopy and is confirmed with histopathology. The tumor spread is assessed by physical examination and, in some cases, ultrasound and/or computed tomography or magnetic resonance imaging, mainly to investigate for regional lymph node metastasis or for local infiltration into deeper structures. In the last step, the clinical, histologic and radiologic findings are incorporated into staging systems.
Collapse
Affiliation(s)
- Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Konstantinos Liopyris
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece -
| |
Collapse
|
4
|
Jacobsen K, Ortner VK, Wenande E, Sahu A, Paasch U, Haedersdal M. Line-field confocal optical coherence tomography in dermato-oncology: A literature review towards harmonized histopathology-integrated terminology. Exp Dermatol 2024; 33:e15057. [PMID: 38623958 DOI: 10.1111/exd.15057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 04/17/2024]
Abstract
Non-invasive diagnostics like line-field confocal optical coherence tomography (LC-OCT) are being implemented in dermato-oncology. However, unification of terminology in LC-OCT is lacking. By reviewing the LC-OCT literature in the field of dermato-oncology, this study aimed to develop a unified terminological glossary integrated with traditional histopathology. A PRISMA-guided literature-search was conducted for English-language publications on LC-OCT of actinic keratosis (AK), keratinocyte carcinoma (KC), and malignant melanoma (MM). Study characteristics and terminology were compiled. To harmonize LC-OCT terminology and integrate with histopathology, synonymous terms for image features of AK, KC, and MM were merged by two authors, organized by skin layer and lesion-type. A subset of key LC-OCT image-markers with histopathological correlates that in combination were typical of AK, squamous cell carcinoma in situ (SCCis), invasive squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and MM in traditional histopathology, were selected from the glossary by an experienced dermatopathologist. Seventeen observational studies of AK (7 studies), KC (13 studies), MM (7 studies) utilizing LC-OCT were included, with 117 terms describing either AK, KC, or MM. These were merged to produce 45 merged-terms (61.5% reduction); 5 assigned to the stratum corneum (SC), 23 to the viable epidermis, 2 to dermo-epidermal junction (DEJ) and 15 to the dermis. For each lesion, mandatory key image-markers were a well-defined DEJ and presence of mild/moderate but not severe epidermal dysplasia for AK, severe epidermal dysplasia and well-defined DEJ for SCCis, interrupted DEJ and/or dermal broad infiltrative strands for invasive SCC, dermal lobules connected and/or unconnected to the epidermis for BCC, as well as single atypical melanocytes and/or nest of atypical melanocytes in the epidermis or dermis for MM. This review compiles evidence on LC-OCT in dermato-oncology, providing a harmonized histopathology-integrated terminology and key image-markers for each lesion. Further evaluation is required to determine the clinical value of these findings.
Collapse
Affiliation(s)
- Kevin Jacobsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Emily Wenande
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Aditi Sahu
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Abarzua-Araya A, Bañuls J, Cabo H, Carrera C, Gamo R, González S, Jaimes N, Navarrete-Dechent C, Pérez Anker J, Roldán-Marín R, Segura S, Yélamos O, Puig S, Malvehy J. [Translated article] Reflectance Confocal Microscopy Terminology in Spanish: A Delphi Consensus Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T258-T264. [PMID: 38244840 DOI: 10.1016/j.ad.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/09/2023] [Indexed: 01/22/2024] Open
Abstract
The terminology used to describe reflectance confocal microscopy (RCM) findings in both melanocytic and nonmelanocytic lesions has been standardized in English. We convened a panel of Spanish-speaking RCM experts and used the Delphi method to seek consensus on which Spanish terms best describe RCM findings in this setting. The experts agreed on 52 terms: 28 for melanocytic lesions and 24 for nonmelanocytic lesions. The resulting terminology will facilitate homogenization, leading to a better understanding of structures, more standardized descriptions in clinical registries, and easier interpretation of clinical reports exchanged between dermatologists.
Collapse
Affiliation(s)
- A Abarzua-Araya
- Melanoma Unit, Dermatology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; Dermatology Department, Hospital General Universitario de Alicante Dr. Balmis, ISABIAL, Alicante, Spain; Universidad de Buenos Aires, Buenos Aires, Argentina; Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J Bañuls
- Dermatology Department, Hospital General Universitario de Alicante Dr. Balmis, ISABIAL, Alicante, Spain
| | - H Cabo
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - C Carrera
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Hospital Fundación Alcorcón, Madrid, Spain; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, Spain; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), Spain; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - R Gamo
- Hospital Fundación Alcorcón, Madrid, Spain
| | - S González
- Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, Spain
| | - N Jaimes
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - C Navarrete-Dechent
- Melanoma Unit, Dermatology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Pérez Anker
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - R Roldán-Marín
- Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - S Segura
- Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), Spain
| | - O Yélamos
- Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Puig
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Hospital Fundación Alcorcón, Madrid, Spain; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, Spain; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), Spain; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain.
| | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Hospital Fundación Alcorcón, Madrid, Spain; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, Spain; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), Spain; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| |
Collapse
|
6
|
Abarzua-Araya A, Bañuls J, Cabo H, Carrera C, Gamo R, González S, Jaimes N, Navarrete-Dechent C, Pérez Anker J, Roldán-Marín R, Segura S, Yélamos O, Puig S, Malvehy J. Reflectance Confocal Microscopy Terminology in Spanish: A Delphi Consensus Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:258-264. [PMID: 37890615 DOI: 10.1016/j.ad.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
The terminology used to describe reflectance confocal microscopy (RCM) findings in both melanocytic and nonmelanocytic lesions has been standardized in English. We convened a panel of Spanish-speaking RCM experts and used the Delphi method to seek consensus on which Spanish terms best describe RCM findings in this setting. The experts agreed on 52 terms: 28 for melanocytic lesions and 24 for nonmelanocytic lesions. The resulting terminology will facilitate homogenization, leading to a better understanding of structures, more standardized descriptions in clinical registries, and easier interpretation of clinical reports exchanged between dermatologists.
Collapse
Affiliation(s)
- A Abarzua-Araya
- Melanoma Unit, Dermatology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; Dermatology Department, Hospital General Universitario de Alicante Dr. Balmis, ISABIAL, Alicante, España; Universidad de Buenos Aires, Buenos Aires, Argentina; Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - J Bañuls
- Dermatology Department, Hospital General Universitario de Alicante Dr. Balmis, ISABIAL, Alicante, España
| | - H Cabo
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - C Carrera
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Hospital Fundación Alcorcón, Madrid, España; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, España; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), España; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, España
| | - R Gamo
- Hospital Fundación Alcorcón, Madrid, España
| | - S González
- Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, España
| | - N Jaimes
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos
| | - C Navarrete-Dechent
- Melanoma Unit, Dermatology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Pérez Anker
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - R Roldán-Marín
- Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - S Segura
- Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), España
| | - O Yélamos
- Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, España
| | - S Puig
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Hospital Fundación Alcorcón, Madrid, España; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, España; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), España; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, España.
| | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Hospital Fundación Alcorcón, Madrid, España; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, España; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), España; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, España
| |
Collapse
|
7
|
Braga JCT, Barcaui CB, Pinheiro AM, Sortino AMF, Abdalla CMZ, Campos-do-Carmo G, Rezze GG, Piñeiro-Maceira J, Rocha LL, Maia M, Sá BCSD. Reflectance confocal microscopy - Consensus terminology glossary in Brazilian Portuguese for normal skin, melanocytic and non-melanocytic lesions. An Bras Dermatol 2024; 99:100-110. [PMID: 37777382 DOI: 10.1016/j.abd.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Currently, there is no uniform and official terminology in Portuguese for reflectance confocal microscopy analysis, despite the increasing number of Brazilian dermatologists using this new tool. OBJECTIVE To present the terminology in Brazilian Portuguese for the description of reflectance confocal microscopy and establish the first Brazilian consensus on terms related to normal skin and cutaneous tumors. METHODS 10 Brazilian specialists from different institutions and states of Brazil were selected to evaluate the best corresponding terms in Portuguese for normal skin, melanocytic and non-melanocytic tumors. The terms used were translated from international consensuses in the English language. The modified Delphi method was used to create the consensus in 3 steps. RESULTS The terms considered the most appropriate in the Portuguese language to describe the findings of normal skin, melanocytic and non-melanocytic lesions in the reflectance confocal microscopy analysis were presented. STUDY LIMITATIONS The limitations of the present study include the number of participants and limited regional representation (only two of the five Brazilian regions were represented). CONCLUSION This Brazilian consensus represents an opportunity for dermatologists and physicians specializing in cutaneous oncology to become familiar with reflectance confocal microscopy, propagating the technique in clinical and research environments to stimulate national and international publications on this subject.
Collapse
Affiliation(s)
| | - Carlos B Barcaui
- Service of Dermatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ana Maria Pinheiro
- Department of Dermatology, Universidade de Brasília, Brasília, DF, Brazil
| | | | | | - Gabriella Campos-do-Carmo
- Department of Dermatology, Instituto Nacional de Câncer, Gávea Medical Center, Rio de Janeiro, RJ, Brazil
| | - Gisele Gargantini Rezze
- Department of Dermatology, Hospital Clínic I Provincial da Universidade de Barcelona, Barcelona, Spain
| | - Juan Piñeiro-Maceira
- Service of Dermatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lilian Licarião Rocha
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcus Maia
- Dermatology Clinic, Santa Casa de Misericórdia São Paulo, São Paulo, SP, Brazil
| | - Bianca Costa Soares de Sá
- Department of Dermatology, Núcleo de Câncer de Pele, A.C. Camargo Câncer Center, São Paulo, SP, Brazil
| |
Collapse
|
8
|
Cretu S, Papachatzopoulou E, Dascalu M, Salavastru CM. The role of in vivo reflectance confocal microscopy for the management of acne: A systematic review. J Eur Acad Dermatol Venereol 2023; 37:2428-2439. [PMID: 37423202 DOI: 10.1111/jdv.19327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
Acne diagnosis, severity assessment and treatment follow-up rely primarily on clinical examination. In vivo reflectance confocal microscopy (RCM) provides non-invasively, real-time images of skin lesions with a level of detail close to histopathology. This systematic literature review aims to provide an overview of RCM utility in acne and a summary of specific features with clinical application that may increase objectivity in evaluating this condition. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting our results. We systematically searched three databases: PubMed, Clarivate and Google Scholar (January 2022). All included studies used RCM to investigate acne in human patients and reported the investigated skin area and type (acne lesions or clinically uninvolved skin), the substance used in the case of treatment. Our search identified 2184 records in the three databases investigated. After duplicate removal, 1608 records were screened, 35 were selected for full-text assessment, and 14 were included in this review. We used the QUADAS-2 tool to evaluate the risk of bias and applicability concerns. RCM was selected as the index test and clinical examination as the reference standard. The total number of patients from all studies was 291, with 216 acne patients and 60 healthy participants aged between 13 and 45 years. The 14 considered studies analysed 456 follicles from healthy participants, 1445 follicles from uninvolved skin in acne patients and 1472 acne lesions. Consistent RCM findings concerning follicles of acne patients reported across studies were increased follicular infundibulum size, thick, bright border, intrafollicular content and inflammation. Our analysis indicates that RCM is a promising tool for acne evaluation. Nevertheless, standardization, a unified terminology, consistent research methods and unitary reporting of RCM findings are necessary. PROSPERO registration number CRD42021266547.
Collapse
Affiliation(s)
- S Cretu
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- Dermatology Research Unit, Colentina Clinical Hospital, Bucharest, Romania
| | - E Papachatzopoulou
- Anaesthesiology Department, 'Agios Pavlos' General Hospital of Thessaloniki, Thessaloniki, Greece
| | - M Dascalu
- Department of Computer Science, Polytechnic University of Bucharest, Bucharest, Romania
| | - C M Salavastru
- 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
- Paediatric Dermatology Department, Colentina Clinical Hospital, Bucharest, Romania
| |
Collapse
|
9
|
Chen L, Wang Y, Qin B, Fang H, Li Q. Reflectance confocal microscopy features of vulvar lichen sclerosus in Chinese juvenile girls. J Dermatol 2023; 50:1497-1500. [PMID: 37533335 DOI: 10.1111/1346-8138.16884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/01/2023] [Accepted: 06/19/2023] [Indexed: 08/04/2023]
Abstract
Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis of unknown pathogenesis, characterized by porcelain-white atrophic plaques around the vulvar and anal areas in girls. With this communication, we performed the study on 16 female girls with clinically and histologically confirmed VLS, described the main identifying characteristics of the lesions in reflectance confocal microscopy (RCM) and elucidated the corresponding relationship between RCM findings and histology. We recommend RCM, a noninvasive technique, as a complementary diagnostic tool for VLS.
Collapse
Affiliation(s)
- Lixin Chen
- Department of Dermatology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Ying Wang
- Department of Dermatology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Bei Qin
- Department of Dermatology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Hongwei Fang
- Department of Otolaryngology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Qinfeng Li
- Department of Dermatology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| |
Collapse
|
10
|
Cinotti E, Bertello M, Dragotto M, Cartocci A, Tognetti L, Cappilli S, Peris K, Perrot JL, Del Marmol V, Rubegni P, Suppa M. Comparison of reflectance confocal microscopy and line-field optical coherence tomography for the identification of basal cell carcinoma. J Eur Acad Dermatol Venereol 2023; 37:e1147-e1150. [PMID: 37165928 DOI: 10.1111/jdv.19155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Affiliation(s)
- E Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
- Société Française de Dermatologie, Groupe d'Imagerie Non Invasive de la Société Française de Dermatologie, Paris, France
| | - M Bertello
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - M Dragotto
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - A Cartocci
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - L Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - S Cappilli
- Dermatology Unit, Department of Medical and Surgical Sciences, A. Gemelli University Hospital Foundation - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - K Peris
- Dermatology Unit, Department of Medical and Surgical Sciences, A. Gemelli University Hospital Foundation - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - J L Perrot
- Société Française de Dermatologie, Groupe d'Imagerie Non Invasive de la Société Française de Dermatologie, Paris, France
- Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - P Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - M Suppa
- Société Française de Dermatologie, Groupe d'Imagerie Non Invasive de la Société Française de Dermatologie, Paris, France
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Department of Dermatology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
11
|
Mazur E, Reich A. Photodynamic Therapy is an Effective Treatment of Facial Pigmented Actinic Keratosis. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00924-0. [PMID: 37162710 DOI: 10.1007/s13555-023-00924-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Actinic keratosis (AK), or solar keratosis, is a precancerous condition of the skin, mainly caused by excessive and chronic exposure to ultraviolet radiation. Pigmented AK (pAK) is a rare variant of AK. Photodynamic therapy (PDT) is widely used to treat the classical variant of AK, but very limited data are available on the use of PDT in patients with pAK. The objective of this study was to assess the usefulness of PDT in the treatment of pAK. METHODS The study included 16 patients with 20 pAK lesions treated with PDT. All skin lesions were clinically and dermatoscopically assessed for typical features characteristic of pAK. Reflectance confocal microscopy (RCM) was also used to assess keratinocyte atypia, confirm pAK diagnosis, and rule out other disease entities. RESULTS After three PDT sessions, the complete resolution of all clinical features of pAK was observed in 80% of the studied lesions. Dermatoscopically, 65% of the lesions achieved 100% response and no cellular atypia was seen in the follow-up RCM images of 85% of lesions. CONCLUSIONS Photodynamic therapy is an effective treatment modality for pAK in fair-skinned individuals.
Collapse
Affiliation(s)
- Ewelina Mazur
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
- Doctoral School of the University of Rzeszow, University of Rzeszow, Rzeszow, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland.
| |
Collapse
|
12
|
Shahriari N, Grant-Kels JM, Rabinovitz H, Oliviero M, Scope A. Reflectance confocal microscopy of facial neoplasms: Follicular involvement as a clue to diagnosis. J Cutan Pathol 2023; 50:178-184. [PMID: 36321579 DOI: 10.1111/cup.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Facial skin is characterized by high density of follicles. Facial neoplasms may present overlapping clinical and dermoscopic findings. Our goal was to evaluate and compare, via reflectance confocal microscopy (RCM), follicular involvement in facial neoplasms. METHODS We retrospectively searched our image database, between January 2008 and December 2020, for all facial lesions with (1) a standardized set of clinical, dermoscopic, and RCM images, and (2) a biopsy-proven diagnosis of lentigo maligna/lentigo maligna melanoma (LM/LMM, n = 39), basal cell carcinoma (BCC, n = 51), squamous cell carcinoma in situ (SCCIS, n = 5), actinic keratosis (AK, n = 11), and lichen-planus-like keratosis (LPLK, n = 18). Two readers jointly evaluated the RCM images for a set of predefined features of follicular involvement. RESULTS Diffuse obliteration of follicles was frequent in BCC (88%), while follicular infiltration by refractile dendritic cells and/or by bright round nucleated cells was common in melanoma (90% and 44%, respectively). Extension of atypical keratinocytes down follicles was more prominent among SCCIS than AK (80% vs. 45%, p = 0.01). In most LPLK (89%), there was follicular sparing. CONCLUSIONS Evaluation of RCM criteria centering on the follicles can be useful in the differential diagnosis between common facial neoplasms.
Collapse
Affiliation(s)
- Neda Shahriari
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA.,Department of Dermatology, University of Florida, Gainesville, Florida, USA
| | - Harold Rabinovitz
- Skin and Cancer Associates, Plantation, Florida, USA.,Dermatology Department, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | | | - Alon Scope
- The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Dermatology Service, Memorial Sloan Kettering Center, New York, New York, USA
| |
Collapse
|
13
|
Cinotti E, Bertello M, Cartocci A, Fiorani D, Tognetti L, Solmi V, Cappilli S, Peris K, Perrot JL, Suppa M, Del Marmol V, Rubegni P. Comparison of reflectance confocal microscopy and line-field optical coherence tomography for the identification of keratinocyte skin tumours. Skin Res Technol 2023; 29:e13215. [PMID: 36424847 PMCID: PMC9838760 DOI: 10.1111/srt.13215] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT) are non-invasive imaging devices that can help in the clinical diagnosis of actinic keratosis (AK) and cutaneous squamous cell carcinoma (SCC). No studies are available on the comparison between these two technologies for the identification of the different features of keratinocyte skin tumours. OBJECTIVES To compare RCM and LC-OCT findings in AK and SCC. METHODS A retrospective multicenter study was conducted. Tumours were imaged with RCM and LC-OCT devices before surgery, and the diagnosis was confirmed by histological examinations. LC-OCT and RCM criteria for AK/SCC were identified, and their presence/absence was evaluated in all study lesions. Gwet AC1 concordance index was calculated to compare RCM and LC-OCT. RESULTS We included 52 patients with 33 AKs and 19 SCCs. Irregular epidermis was visible in most tumours and with a good degree of agreement between RCM and LC-OCT (Gwet's AC1 0.74). Parakeratosis, dyskeratotic keratinocytes and both linear dilated and glomerular vessels were better visible at LC-OCT than RCM (p < 0.001). Erosion/ulceration was identified with both methods in more than half of the cases with a good degree of agreement (Gwet AC1 0.62). CONCLUSIONS Our results suggest that both LC-OCT and hand-held RCM can help clinicians in the identification of AK and SCC, providing an in vivo and non-invasive identification of an irregular epidermis. LC-OCT proved to be more effective in identifying parakeratosis, dyskeratotic keratinocytes and vessels in this series.
Collapse
Affiliation(s)
- Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, Università degli Studi di Siena, Siena, Italy.,Groupe d'Imagerie non invasive de la Société Française de Dermatologie, Paris, France
| | - Martina Bertello
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, Università degli Studi di Siena, Siena, Italy
| | | | - Diletta Fiorani
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, Università degli Studi di Siena, Siena, Italy
| | - Linda Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, Università degli Studi di Siena, Siena, Italy
| | - Valentina Solmi
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, Università degli Studi di Siena, Siena, Italy
| | - Simone Cappilli
- Dermatology Unit, Department of Medicine and Traslational Surgery, Catholic University of Sacred Heart, Rome, Italy.,Dermatology Unit, Department of Medical and Surgical Sciences, A. Gemelli University Hospital Foundation - IRCCS, Rome, Italy
| | - Ketty Peris
- Dermatology Unit, Department of Medicine and Traslational Surgery, Catholic University of Sacred Heart, Rome, Italy.,Dermatology Unit, Department of Medical and Surgical Sciences, A. Gemelli University Hospital Foundation - IRCCS, Rome, Italy
| | - Jean Luc Perrot
- Groupe d'Imagerie non invasive de la Société Française de Dermatologie, Paris, France.,Department of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Mariano Suppa
- Groupe d'Imagerie non invasive de la Société Française de Dermatologie, Paris, France.,Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Veronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, Università degli Studi di Siena, Siena, Italy
| |
Collapse
|
14
|
Francesca DT, Mandel VD, Ignazio S, Cinotti E, Kaleci S, Ciardo S, Peccerillo F, Longo C, Farnetani F, Pellacani G. The role of reflectance confocal microscopy in the diagnosis of eccrine poroma: a retrospective case‐control study. Exp Dermatol 2022; 31:1779-1790. [DOI: 10.1111/exd.14658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/18/2022] [Accepted: 07/30/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Di Tullio Francesca
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Victor Desmond Mandel
- Porphyria and Rare Diseases Unit San Gallicano Dermatological Institute ‐ IRCCS Rome Italy
| | - Stanganelli Ignazio
- Skin Cancer Unit, Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori” ‐ IRST S.r.l. Istituto di Ricovero e Cura a Carattere Scientifico, Meldola Italy
- Medicine and Surgery Department University of Parma Parma Italy
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section University of Siena Siena Italy
| | - Shaniko Kaleci
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Silvana Ciardo
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Francesca Peccerillo
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Caterina Longo
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale ‐ IRCCS Reggio Emilia Italy
| | - Francesca Farnetani
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Giovanni Pellacani
- Dermatologic Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences La Sapienza University of Rome Rome Italy
| |
Collapse
|
15
|
Li J, Garfinkel J, Zhang X, Wu D, Zhang Y, de Haan K, Wang H, Liu T, Bai B, Rivenson Y, Rubinstein G, Scumpia PO, Ozcan A. Biopsy-free in vivo virtual histology of skin using deep learning. LIGHT, SCIENCE & APPLICATIONS 2021; 10:233. [PMID: 34795202 PMCID: PMC8602311 DOI: 10.1038/s41377-021-00674-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 05/09/2023]
Abstract
An invasive biopsy followed by histological staining is the benchmark for pathological diagnosis of skin tumors. The process is cumbersome and time-consuming, often leading to unnecessary biopsies and scars. Emerging noninvasive optical technologies such as reflectance confocal microscopy (RCM) can provide label-free, cellular-level resolution, in vivo images of skin without performing a biopsy. Although RCM is a useful diagnostic tool, it requires specialized training because the acquired images are grayscale, lack nuclear features, and are difficult to correlate with tissue pathology. Here, we present a deep learning-based framework that uses a convolutional neural network to rapidly transform in vivo RCM images of unstained skin into virtually-stained hematoxylin and eosin-like images with microscopic resolution, enabling visualization of the epidermis, dermal-epidermal junction, and superficial dermis layers. The network was trained under an adversarial learning scheme, which takes ex vivo RCM images of excised unstained/label-free tissue as inputs and uses the microscopic images of the same tissue labeled with acetic acid nuclear contrast staining as the ground truth. We show that this trained neural network can be used to rapidly perform virtual histology of in vivo, label-free RCM images of normal skin structure, basal cell carcinoma, and melanocytic nevi with pigmented melanocytes, demonstrating similar histological features to traditional histology from the same excised tissue. This application of deep learning-based virtual staining to noninvasive imaging technologies may permit more rapid diagnoses of malignant skin neoplasms and reduce invasive skin biopsies.
Collapse
Affiliation(s)
- Jingxi Li
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | | | - Xiaoran Zhang
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
| | - Di Wu
- Computer Science Department, University of California, Los Angeles, CA, 90095, USA
| | - Yijie Zhang
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Kevin de Haan
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Hongda Wang
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Tairan Liu
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Bijie Bai
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Yair Rivenson
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | | | - Philip O Scumpia
- Division of Dermatology, University of California, Los Angeles, CA, 90095, USA.
- Department of Dermatology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, 90073, USA.
| | - Aydogan Ozcan
- Electrical and Computer Engineering Department, University of California, Los Angeles, CA, 90095, USA.
- Bioengineering Department, University of California, Los Angeles, CA, 90095, USA.
- California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA.
- Department of Surgery, University of California, Los Angeles, CA, 90095, USA.
| |
Collapse
|
16
|
Ruini C, Schuh S, Gust C, Kendziora B, Frommherz L, French LE, Hartmann D, Welzel J, Sattler EC. Line-field confocal optical coherence tomography for the in vivo real-time diagnosis of different stages of keratinocyte skin cancer: a preliminary study. J Eur Acad Dermatol Venereol 2021; 35:2388-2397. [PMID: 34415646 DOI: 10.1111/jdv.17603] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The treatment of keratinocyte cancers (KC) strictly depends on their differentiation and invasiveness. Non-invasive diagnostic techniques can support the diagnosis in real time, avoiding unnecessary biopsies. This study aimed to preliminarily define main imaging criteria and histological correlations of actinic keratosis (AK), Bowen's disease (BD) and squamous cell carcinoma (SCC) using the novel device line-field confocal optical coherence tomography (LC-OCT). METHODS Dermoscopy and LC-OCT images of 73 histopathologically confirmed lesions (46 AKs, 11 BD and 16 SCCs) were included in the study. Exemplary lesions (10 AKs, 5 BD and 5 SCCs) were additionally investigated with optical coherence tomography and reflectance confocal microscopy. RESULTS Most common LC-OCT findings of KC in the descriptive statistics were hyperkeratosis/parakeratosis, disruption of stratum corneum, broadened epidermis, basal and suprabasal keratinocyte atypia, dilated vessels/neoangiogenesis and elastosis/collagen alterations. In the univariate multinomial logistic regression, a preserved DEJ was less common in SCC compared with AK and BD, BD displayed marked keratinocyte atypia involving all epidermal layers (bowenoid pattern), while SCC showed ulceration, increased epidermal thickness, keratin plugs, acantholysis, not visible/interrupted DEJ and epidermal bright particles. LC-OCT increased the diagnostic confidence by 24.7% compared with dermoscopy alone. CONCLUSIONS Our study describes for the first time specific LC-OCT features of different stages of KC and their histopathological correlates, focusing on keratinocyte morphology and architecture of the epidermis and DEJ. LC-OCT may open new scenarios in the bedside diagnosis, treatment planning and follow-up of KC.
Collapse
Affiliation(s)
- C Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.,PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Schuh
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - C Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - B Kendziora
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L Frommherz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - D Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - J Welzel
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - E C Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| |
Collapse
|
17
|
Sun MD, Halpern AC. Advances in the Etiology, Detection, and Clinical Management of Seborrheic Keratoses. Dermatology 2021; 238:205-217. [PMID: 34311463 DOI: 10.1159/000517070] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022] Open
Abstract
Seborrheic keratoses (SKs) are ubiquitous, generally benign skin tumors that exhibit high clinical variability. While age is a known risk factor, the precise roles of UV exposure and immune abnormalities are currently unclear. The underlying mechanisms of this benign disorder are paradoxically driven by oncogenic mutations and may have profound implications for our understanding of the malignant state. Advances in molecular pathogenesis suggest that inhibition of Akt and APP, as well as existing treatments for skin cancer, may have therapeutic potential in SK. Dermoscopic criteria have also become increasingly important to the accurate detection of SK, and other noninvasive diagnostic methods, such as reflectance confocal microscopy and optical coherence tomography, are rapidly developing. Given their ability to mimic malignant tumors, SK cases are often used to train artificial intelligence-based algorithms in the computerized detection of skin disease. These technologies are becoming increasingly accurate and have the potential to significantly augment clinical practice. Current treatment options for SK cause discomfort and can lead to adverse post-treatment effects, especially in skin of color. In light of the discontinuation of ESKATA in late 2019, promising alternatives, such as nitric-zinc and trichloroacetic acid topicals, should be further developed. There is also a need for larger, head-to-head trials of emerging laser therapies to ensure that future treatment standards address diverse patient needs.
Collapse
Affiliation(s)
- Mary D Sun
- Icahn School of Medicine at Mount Sinai, New York, New York, USA,
| | - Allan C Halpern
- Dermatology Service, Memorial Sloan Kettering, New York, New York, USA
| |
Collapse
|
18
|
Farnetani F, Pedroni G, Lippolis N, Giovani M, Ciardo S, Chester J, Kaleci S, Pezzini C, Cantisani C, Dattola A, Manfredini M, Dika E, Patrizi A, Pellacani G. Facial seborrheic keratosis with unusual dermoscopic patterns can be differentiated from other skin malignancies by in vivo reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2021; 35:e784-e787. [PMID: 34161654 DOI: 10.1111/jdv.17470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 12/14/2022]
Affiliation(s)
- F Farnetani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - G Pedroni
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - N Lippolis
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - M Giovani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Ciardo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - J Chester
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Kaleci
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - C Pezzini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - C Cantisani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - A Dattola
- Department of Dermatology, University of Rome 'Tor Vergata', Rome, Italy
| | - M Manfredini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - E Dika
- Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - A Patrizi
- Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - G Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
19
|
Guida S, Pellacani G, Ciardo S, Longo C. Reflectance Confocal Microscopy of Aging Skin and Skin Cancer. Dermatol Pract Concept 2021; 11:e2021068. [PMID: 34123564 DOI: 10.5826/dpc.1103a68] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
Skin aging is a complex process that causes morphologic variations. Some of these variations have been hypothesized to be involved in skin cancer development. This paper reviews current knowledge of the features of aged skin as seen with reflectance confocal microscopy (RCM). Basic principles of the technique are described, and the RCM features of healthy skin and skin cancer are briefly discussed. Moreover, the RCM features at different layers of young and elderly skin are described, as are the variations that occur with passing years and in relation to sun exposure that contribute to photoaging and the development of skin cancer. RCM enables the noninvasive evaluation, at quasi-histologic resolution, of aging-related skin changes, some of which are shared with skin cancer; this ability helps avoid skin biopsy. Further research is needed to understand the relation between skin aging and skin cancer development.
Collapse
Affiliation(s)
- Stefania Guida
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvana Ciardo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Caterina Longo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
20
|
Clinical Applications of In Vivo and Ex Vivo Confocal Microscopy. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11051979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Confocal laser scanning microscopy (CLSM) has been introduced in clinical settings as a tool enabling a quasi-histologic view of a given tissue, without performing a biopsy. It has been applied to many fields of medicine mainly to the skin and to the analysis of skin cancers for both in vivo and ex vivo CLSM. In vivo CLSM involves reflectance mode, which is based on refractive index of cell structures serving as endogenous chromophores, reaching a depth of exploration of 200 μm. It has been proven to increase the diagnostic accuracy of skin cancers, both melanoma and non-melanoma. While histopathologic examination is the gold standard for diagnosis, in vivo CLSM alone and in addition to dermoscopy, contributes to the reduction of the number of excised lesions to exclude a melanoma, and to improve margin recognition in lentigo maligna, enabling tissue sparing for excisions. Ex vivo CLSM can be performed in reflectance and fluorescent mode. Fluorescence confocal microscopy is applied for “real-time” pathological examination of freshly excised specimens for diagnostic purposes and for the evaluation of margin clearance after excision in Mohs surgery. Further prospective interventional studies using CLSM might contribute to increase the knowledge about its application, reproducing real-life settings.
Collapse
|
21
|
Navarrete-Dechent C, Liopyris K, Rishpon A, Marghoob NG, Cordova M, Dusza SW, Sahu A, Kose K, Oliviero M, Rabinovitz H, Busam KJ, Marchetti MA, Chen CCJ, Marghoob AA. Association of Multiple Aggregated Yellow-White Globules With Nonpigmented Basal Cell Carcinoma. JAMA Dermatol 2021; 156:882-890. [PMID: 32459294 DOI: 10.1001/jamadermatol.2020.1450] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Basal cell carcinoma (BCC) is the most common skin cancer. Dermoscopic imaging has improved diagnostic accuracy; however, diagnosis of nonpigmented BCC remains limited to arborizing vessels, ulceration, and shiny white structures. Objective To assess multiple aggregated yellow-white (MAY) globules as a diagnostic feature for BCC. Design, Setting, and Participants In this retrospective, single-center, case-control study, nonpigmented skin tumors, determined clinically, were identified from a database of lesions consecutively biopsied during a 7-year period (January 1, 2009, to December 31, 2015). A subset of tumors was prospectively diagnosed, and reflectance confocal microscopy, optical coherence tomography, and histopathologic correlation were performed. Data analysis was conducted from July 1 to September 31, 2019. Exposures Investigators evaluated for the presence or absence of known dermoscopic criteria. MAY globules were defined as aggregated, white-yellow structures visualized in polarized and nonpolarized light. Main Outcomes and Measures The primary outcome was the diagnostic accuracy of MAY globules for the diagnosis of BCC. Secondary objectives included the association with BCC location and subtype. Interrater agreement was estimated. Results A total of 656 nonpigmented lesions from 643 patients (mean [SD] age, 63.1 [14.9] years; 381 [58.1%] male) were included. In all, 194 lesions (29.6%) were located on the head and neck. A total of 291 (44.4%) were BCCs. MAY globules were seen in 61 of 291 BCC cases (21.0%) and in 3 of 365 other diagnoses (0.8%) (P < .001). The odds ratio for diagnosis of BCC was 32.0 (96% CI, 9.9-103.2). The presence of MAY globules was associated with a diagnosis of histologic high-risk BCC (odds ratio, 6.5; 95% CI, 3.1-14.3). The structure was never seen in cases of superficial BCCs. Conclusions and Relevance The findings suggest that MAY globules may have utility as a new BCC dermoscopic criterion with a high specificity. MAY globules were negatively associated with superficial BCC and positively associated with deeper-seated, histologic, higher-grade tumor subtypes.
Collapse
Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Konstantinos Liopyris
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ayelet Rishpon
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nadeem G Marghoob
- New York Institute of Technology College of Osteopathic Medicine, New York
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aditi Sahu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kivanc Kose
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chih-Chan J Chen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
22
|
Navarrete-Dechent C, Aleissa S, Connolly K, Hibler BP, Dusza SW, Rossi AM, Lee E, Nehal KS. Clinical size is a poor predictor of invasion in melanoma of the lentigo maligna type. J Am Acad Dermatol 2020; 84:1295-1301. [PMID: 33096134 DOI: 10.1016/j.jaad.2020.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/28/2020] [Accepted: 10/15/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND There are no well-defined clinical factors to predict the risk of occult invasion in melanoma of the lentigo maligna type (LM) before complete histopathologic analysis. OBJECTIVE To evaluate whether clinical size was a predictor of invasion in LM and subclinical extension. METHODS Consecutive cases of LM were recorded in a prospectively maintained database from 2006 to 2019. Patient and tumor data were recorded during initial evaluation. The LM clinical area was calculated in square millimeters (length × width). All patients were treated with staged excision. RESULTS We included 600 patients. The mean age was 65.9 years (standard deviation, 12.3; range, 27-95 years); 62.8% (n = 377) were men. The mean LM clinical area was 128.32 mm2 for in situ lesions versus 200.14 mm for invasive lesions (P = .1). Based on quantile regression, the median margin required for complete removal increased with LM clinical area. LIMITATIONS The study was performed in a tertiary cancer center with possible referral bias and more complex cases. CONCLUSIONS LM can present with variable clinical size, which may correlate with subclinical extension; however, the presence of invasion is not well estimated by LM clinical area.
Collapse
Affiliation(s)
- Cristian Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Saud Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen Connolly
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian P Hibler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Erica Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| |
Collapse
|
23
|
Diagnosis of congenital pigmented macules in infants with reflectance confocal microscopy and machine learning. J Am Acad Dermatol 2020; 85:1308-1309. [PMID: 32926972 DOI: 10.1016/j.jaad.2020.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022]
|
24
|
In vivo imaging characterization of basal cell carcinoma and cutaneous response to high-dose ionizing radiation therapy: A prospective study of reflectance confocal microscopy, dermoscopy, and ultrasonography. J Am Acad Dermatol 2020; 84:1575-1584. [PMID: 32827607 DOI: 10.1016/j.jaad.2020.07.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 05/28/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Radiation therapy (RT) is a treatment option for select skin cancers. The histologic effects of RT on normal skin or skin cancers are not well characterized. Dermoscopy, high-frequency ultrasonography (HFUS), and reflectance confocal microscopy (RCM) are noninvasive imaging modalities that may help characterize RT response. OBJECTIVES To describe changes in the tumor and surrounding skin of patients with basal cell carcinoma (BCC) treated with RT. METHODS The study was conducted between 2014 and 2018. Patients with biopsy-proven BCCs were treated with 42 Gy in 6 fractions using a commercially available brachytherapy device. Dermoscopy, HFUS, and RCM were performed before treatment and at 6 weeks, 3 months, and 12 months after RT. RESULTS A total of 137 imaging assessments (RCM + dermoscopy + HFUS) were performed in 12 patients. BCC-specific features were present in 81.8%, 91%, and 17% of patients imaged with dermoscopy, RCM, and HFUS at baseline, respectively, before treatment. After treatment, the resolution of these features was noted in 33.4%, 91.7%, and 100% of patients imaged with the respective modalities. No recurrences were seen after a mean of 31.7 months of follow-up. LIMITATIONS Small sample size and no histopathologic correlation. CONCLUSION Dermoscopy and HFUS were not as reliable as RCM at characterizing BCC RT response.
Collapse
|
25
|
Liu N, Chen Z, Xing D. Integrated photoacoustic and hyperspectral dual-modality microscopy for co-imaging of melanoma and cutaneous squamous cell carcinoma in vivo. JOURNAL OF BIOPHOTONICS 2020; 13:e202000105. [PMID: 32406187 DOI: 10.1002/jbio.202000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 05/09/2023]
Abstract
Skin carcinoma such as melanoma (MM) and cutaneous squamous cell carcinoma (cSCC) are considered as the highest mortality and the most aggressive skin cancers in dermatology. In view that early diagnosis and treatment can greatly improve the survival rate and life quality of the patients, developing noninvasive and effective evaluation methods is of great significance for the detection and identification of early stage cutaneous cancers. In this article, we propose a hybrid photoacoustic and hyperspectral dual-modality microscopy to evaluate and differentiate skin carcinoma by structural and multiphysiological parameters. The proposed system's imaging abilities are verified by mimic phantoms and normal mice experiments. Furthermore, in vivo characterization and evaluation results of MM and cSCC mice are obtained successfully, which prove this novel method could be used as a reliable and useful method for skin cancer detection in early stages.
Collapse
Affiliation(s)
- Ning Liu
- MOE Key Laboratory of Laser Life Science, Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
| | - Zhongjiang Chen
- MOE Key Laboratory of Laser Life Science, Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
| | - Da Xing
- MOE Key Laboratory of Laser Life Science, Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
| |
Collapse
|
26
|
Navarrete-Dechent C, Liopyris K, Monnier J, Aleissa S, Boyce LM, Longo C, Oliviero M, Rabinovitz H, Marghoob AA, Halpern AC, Pellacani G, Scope A, Jain M. Reflectance confocal microscopy terminology glossary for melanocytic skin lesions: A systematic review. J Am Acad Dermatol 2020; 84:102-119. [PMID: 32454102 DOI: 10.1016/j.jaad.2020.05.097] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is lack of uniformity in the reflectance confocal microscopy (RCM) terminology for melanocytic lesions. OBJECTIVE To review published RCM terms for melanocytic lesions and identify redundant, synonymous terms. METHODS A systematic review of original research articles adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted until August 15, 2018. Two investigators gathered all published RCM terms used to describe melanoma and melanocytic nevi. Synonymous terms were grouped based on similarity in definition and in histopathologic correlation. RESULTS Out of 156 full-text screened articles, 59 studies met the inclusion criteria. We identified 209 terms; 191 (91.4%) corresponding to high-magnification/cellular-level terms and 18 (8.6%) corresponding to low-magnification/architectural patterns terms. The overall average use frequency of RCM terms was 3.1 times (range, 1-31). By grouping of individual RCM terms based on likely synonymous definitions and by eliminating terms lacking clear definition, the total number of RCM terms could be potentially reduced from 209 to 40 terms (80.8% reduction). LIMITATIONS Non-English and non-peer-reviewed articles were excluded. CONCLUSIONS This systematic review of published RCM terms identified significant terminology redundancy. It provides the basis for subsequent terminology consensus on melanocytic neoplasms.
Collapse
Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Konstantinos Liopyris
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, University of Athens, Andreas Syggros Hospital of Skin and Venereal Diseases, Athens, Greece
| | - Jilliana Monnier
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Saud Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lindsay M Boyce
- Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Azienda Unità Sanitaria Locale-Istituo di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | | | | | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alon Scope
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Manu Jain
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| |
Collapse
|
27
|
Navarrete-Dechent C, Aleissa S, Cordova M, Liopyris K, Sahu A, Rossi AM, Lee EH, Nehal KS. Management of complex head-and-neck basal cell carcinomas using a combined reflectance confocal microscopy/optical coherence tomography: a descriptive study. Arch Dermatol Res 2020; 313:193-200. [PMID: 32020324 DOI: 10.1007/s00403-020-02037-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/13/2019] [Accepted: 01/18/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recently, a combined reflectance confocal microscopy (RCM)-optical coherence tomography (OCT) has been tested for the diagnosis of basal cell carcinoma (BCC). Evaluating the role of RCM-OCT in management of complex BCCs has not been studied. The objective of the study was to investigate the utility of a new combined RCM-OCT device in the evaluation and management of complex BCCs in a descriptive study. METHODS Prospective study of consecutive cases (July 2018-June 2019) of biopsy-proven 'complex' BCC defined as BCC in the head-and-neck area with multiple high-risk criteria such as large size in the mask area, multiple recurrences, and high-risk subtype. All cases were evaluated with a combined RCM-OCT device that provided simultaneous image viewing on a screen. Lesions were evaluated bedside with RCM-OCT according to previously described criteria. RESULTS Ten patients with complex head-and-neck BCCs had mean age of 73.1 ± 13.0 years. Six (60%) patients were males. Mean BCC clinical size was 1.9 ± 1.2 cm (range 0.6-4.0 cm). RCM detected residual BCC in 8 out of 10 cases (80%) and OCT detected residual BCC in all 10 cases (100%). Six BCCs (60%) had a depth estimate of > 1000 µm under OCT. In five cases, (50%) RCM-OCT imaging results led to a change/modification in BCC management. CONCLUSION The use of a combined RCM-OCT device may help in the evaluation of complex head-and-neck BCCs by guiding treatment selection and defining the extent of surgery.
Collapse
Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th Street, New York, NY, USA
| | - Saud Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th Street, New York, NY, USA
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th Street, New York, NY, USA
| | - Konstantinos Liopyris
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th Street, New York, NY, USA
- University of Athens, Athens, Greece
| | - Aditi Sahu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th Street, New York, NY, USA
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th Street, New York, NY, USA
| | - Erica H Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th Street, New York, NY, USA
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E 60th Street, New York, NY, USA.
| |
Collapse
|
28
|
Hanlon K, Grichnik J, Correa-Selm L. Epidermal streaming seen in a seborrheic keratosis using reflectance confocal microscopy and histopathology correlation. JAAD Case Rep 2019; 5:1065-1067. [PMID: 31799353 PMCID: PMC6881612 DOI: 10.1016/j.jdcr.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Katharine Hanlon
- Department of Cutaneous Oncology, Cleveland Clinic Indian River Hospital, Scully Welsh Cancer Center, Vero Beach, Florida
| | - James Grichnik
- Department of Cutaneous Oncology, Cleveland Clinic Indian River Hospital, Scully Welsh Cancer Center, Vero Beach, Florida
| | - Lilia Correa-Selm
- Department of Cutaneous Oncology, Cleveland Clinic Indian River Hospital, Scully Welsh Cancer Center, Vero Beach, Florida
| |
Collapse
|
29
|
Navarrete-Dechent C, Cordova M, Aleissa S, Liopyris K, Dusza SW, Phillips W, Rossi AM, Lee EH, Marghoob AA, Nehal KS. Reflectance confocal microscopy confirms residual basal cell carcinoma on clinically negative biopsy sites before Mohs micrographic surgery: A prospective study. J Am Acad Dermatol 2019; 81:417-426. [PMID: 31227277 DOI: 10.1016/j.jaad.2019.02.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Biopsy specimens from patients with basal cell carcinoma (BCC) can present to surgery with no clinically residual tumor, complicating treatment decisions. OBJECTIVE To evaluate reflectance confocal microscopy (RCM) for the assessment of residual BCC following biopsy. METHODS Consecutive patients with biopsy-proven BCC and no clinical evidence of residual tumor who had been referred for Mohs micrographic surgery were included. Biopsy sites were imaged with a handheld RCM device. On the basis of RCM evaluation, cases were labeled RCM positive or RCM negative. Mohs micrographic surgery was performed in all cases; margins and 15-μm serial vertical sectioning were evaluated. RESULTS A total of 61 patients were included (mean age, 61.7 years [standard deviation, 12.2 years]; range, 37-87 years); 60.7% were women. The mean lesion size was 5.1 mm (range, 3-12 mm); 73.8% of patients were positive on RCM, and 68.9% had residual BCC on histopathologic examination. The rates of RCM sensitivity, specificity, positive predictive value, and negative predictive value were 92.8%, 68.4%, 86.6%, and 81.2%, respectively. Three cases of BCC (high-risk, infiltrative, and basosquamous) were missed with use of RCM. When high-risk subtypes were excluded (n = 5), sensitivity and negative predictive value were both 100%. LIMITATIONS RCM can miss deep-seated residual tumor. CONCLUSION RCM is a valuable tool for the evaluation of residual BCC following biopsy, with the potential to reduce unnecessary surgical procedures.
Collapse
Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Saud Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Konstantinos Liopyris
- Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William Phillips
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erica H Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| |
Collapse
|
30
|
Navarrete-Dechent C, Cordova M, Liopyris K, Yélamos O, Aleissa S, Hibler B, Sierra H, Sahu A, Blank N, Rajadhyaksha M, Rossi A. Reflectance confocal microscopy-guided carbon dioxide laser ablation of low-risk basal cell carcinomas: A prospective study. J Am Acad Dermatol 2019; 81:984-988. [PMID: 31202871 DOI: 10.1016/j.jaad.2019.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/13/2019] [Accepted: 06/08/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) treatment modalities can be stratified by tumor subtype and recurrence risk. The main limitation of nonsurgical treatment modalities is the lack of histopathologic confirmation. Reflectance confocal microscopy (RCM) is a noninvasive imaging device that provides quasihistologic images. OBJECTIVE To evaluate the feasibility and efficacy of RCM-guided carbon dioxide (CO2) laser ablation of low-risk BCCs. METHODS Prospective study with biopsy specimen-proven low-risk BCCs imaged with RCM. RCM was performed on these sites before and after ablation. If residual tumor was found, a new series of laser passes were performed. The patients were then monitored for recurrence clinically and with RCM. RESULTS Twenty-two tumor sites in 9 patients (5 men, 4 women) were imaged and treated. Median age was 59 ± 12.9 years (range, 30-74 years). Mean tumor size was 7.7 mm (range, 5-10 mm). Residual tumor was identified in 5 of 22 cases (22.7%) under RCM on immediate first-pass postablation sites, prompting additional laser passes. Median follow-up was 28.5 months (range, 22-32 months) with no recurrences found. CONCLUSIONS Addition of RCM to laser ablation workflow can detect subclinical persistent tumor after initial ablation and may serve as an aid to increase the efficacy of laser ablation.
Collapse
Affiliation(s)
- Cristian Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Konstantinos Liopyris
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Oriol Yélamos
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Saud Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Brian Hibler
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Heidy Sierra
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Computer Science and Engineering, University of Puerto Rico Mayaguez, Mayaguez, Puerto Rico
| | - Aditi Sahu
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Nina Blank
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Milind Rajadhyaksha
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Anthony Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Weill Cornell Medical College, New York, New York.
| |
Collapse
|