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Coco V, Cappilli S, Di Stefani A, Ricci C, Perino F, Di Nardo L, Longo C, Peris K. Confocal Assessment of Pigmented-Mucosal Lesions: A Monocentric, Retrospective Evaluation of Lip and Genital Area. Dermatol Pract Concept 2024; 14:dpc.1401a28. [PMID: 38364417 PMCID: PMC10868824 DOI: 10.5826/dpc.1401a28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Pigmentation of lip and/or genitalia is mainly due to the development of benign melanotic macules, with a less occurrence of melanocytic and other non-melanocytic lesions. Mucosal melanoma has worse prognosis compared with cutaneous counterpart, hence identification of atypical features for an early diagnosis is crucial. OBJECTIVES The aim of this study was to report further data of confocal features characterizing pigmented mucosal lesions of genital area and of the lips and test the diagnostic role of the reflectance confocal microscopy (RCM)lip score. METHODS Clinical, dermoscopic and RCM images of histologically proven pigmented lesions, involving the genital area (vulva or glans penis) and lip, were retrospectively reviewed. RCM images were evaluated for malignant criteria, and statistical analysis was conducted for categorical variables. RESULTS Seventy pigmented lesions were included in the study and divided into two groups based on the body area location: lip (17) and genital area (53). Architectural disarray (P = 0.002), dendritic (P = 0.031) and roundish cells in epidermis (P < 0.0001), interpapillary dendritic cells (P = 0.039) and junctional atypical cells (P = 0.002) were associated to genital melanoma. Melanoma involving the lip was characterized by roundish cells in epidermis, a criterion found in one labial benign lesion, only (P = 0.005). Main limitations of the study are the inclusion of low melanomas and the presence of epidermal dendritic cells in melanosis and melanoma, as a confusing factor in imaging. CONCLUSIONS Dermatologists should consider confocal microscopy as an adjunctive tool to dermoscopy in the differential diagnosis of pigmented mucosal lesions, especially in presence of clinical and dermoscopic findings suspicious for malignancy.
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Affiliation(s)
- Valeria Coco
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
| | - Simone Cappilli
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Di Stefani
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Costantino Ricci
- Pathology Unit, Maggiore Hospital, AUSL Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesca Perino
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
| | - Lucia Di Nardo
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
| | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
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Menditti D, Santagata M, Imola G, Staglianò S, Vitagliano R, Boschetti CE, Inchingolo AM. Personalized Medicine in Oral Oncology: Imaging Methods and Biological Markers to Support Diagnosis of Oral Squamous Cell Carcinoma (OSCC): A Narrative Literature Review. J Pers Med 2023; 13:1397. [PMID: 37763165 PMCID: PMC10532745 DOI: 10.3390/jpm13091397] [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: 06/29/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
For decades, oral squamous cell carcinoma (OSCC) has been one of the most prevalent and mortal cancers worldwide. The gold standard for OSCC diagnosis is still histopathology but this narrative multidisciplinary review has the aim to explore the literature about conventional OSCC prognostic indicators related to the pTNM stage at the diagnosis such as the depth of invasion and the lymphovascular invasion associated with distant metastasis as indicators of poor life expectancy. Despite its multifactorial nature and recognizable precursors, its diagnosis at the early stages is still challenging. We wanted to highlight the importance of the screening as a primary weapon that a stomatologist should consider, intercepting all at-risk conditions and lesions associated with OSCC and its early stages. This narrative review also overviews the most promising imaging techniques, such as CT, MRI, and US-echography, and their application related to clinical and surgical practice, but also the most-investigated prognostic and diagnostic tissue and salivary biomarkers helpful in OSCC diagnosis and prognostic assessment. Our work highlighted remarkable potential biomarkers that could have a leading role in the future. However, we are still far from defining an appropriate and concrete protocol to apply in clinical practice. The hope is that the present and future research will overcome these limitations to benefit patients, clinicians, and welfare.
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Affiliation(s)
- Dardo Menditti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | - Mario Santagata
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | - Gianmaria Imola
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | - Samuel Staglianò
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | - Rita Vitagliano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
| | - Ciro Emiliano Boschetti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (D.M.); (M.S.); (G.I.); (S.S.); (C.E.B.)
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The Role of Reflectance Confocal Microscopy in the Evaluation of Pigmented Oral Lesions and Their Relationship With Histopathological Aspects. Am J Dermatopathol 2022; 44:658-663. [PMID: 35503878 DOI: 10.1097/dad.0000000000002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Oral pigmentations are a heterogeneous group and can be the result of physiological activity of oral mucosal melanocytes, secondary to exogenous causes, associated with systemic or local diseases, or due to proliferative activity of melanocytes. Their diagnosis is critical because these lesions can be markers of internal diseases or, in the case of melanocytic proliferative processes, they may represent a malignant neoplasm. In the past decade, the use of reflectance confocal microscopy, a noninvasive imaging tool, has aided the analysis of such lesions, but the establishment of firm criteria in their evaluation is still lacking. This study evaluated a series of 19 cases of pigmented oral lesions and correlated the reflectance confocal microscopy findings with histopathological classical criteria. We found 13 cases of melanotic macule, 1 of them associated with Peutz-Jeghers syndrome and 2 with Laugier-Hunzinker syndrome; 1 melanocytic nevus; 2 lentigo maligna; 2 pigmented actinic cheilitis; and 1 case of postinflammatory pigmentation secondary to a lupus erythematosus oral discoid lesion. The main difference between benign and malignant lesions was the presence of atypical proliferation in lentigo maligna. Langerhans cells with thick dendritic processes, which may be present in other benign and inflammatory pigmentations is one of the main reasons for diagnostic pitfalls.
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Romano A, Di Stasio D, Petruzzi M, Fiori F, Lajolo C, Santarelli A, Lucchese A, Serpico R, Contaldo M. Noninvasive Imaging Methods to Improve the Diagnosis of Oral Carcinoma and Its Precursors: State of the Art and Proposal of a Three-Step Diagnostic Process. Cancers (Basel) 2021; 13:cancers13122864. [PMID: 34201237 PMCID: PMC8228647 DOI: 10.3390/cancers13122864] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Oral squamous cell carcinoma (OSCC) accounts for 90–95% of malignant tumors of the lip and oral cavity and is associated with high mortality in the advanced stages. Early diagnosis is a challenge for oral pathologists and dentists, due to the ambiguous appearance of early OSCC, which is often misdiagnosed, mistreated, and associated with diagnostic delay. The gold standards for OSCC diagnosis are biopsy and histopathological assessment, but these procedures are invasive and time-consuming. Adjunctive noninvasive techniques allow the definition of the malignant features of a suspicious lesion in real time and noninvasively, thus improving the diagnostic procedure. The present review aimed to focus on some of the main promising noninvasive imaging techniques, to highlight their perspective adoption in a three-step diagnosis, which is idealistically faster and better, as well as enables the patient’s compliance. Abstract Oral squamous cell carcinoma (OSCC) is the most prevalent form of cancer of lips and oral cavity, and its diagnostic delay, caused by misdiagnosis at the early stages, is responsible for high mortality ratios. Biopsy and histopathological assessment are the gold standards for OSCC diagnosis, but they are time-consuming, invasive, and do not always enable the patient’s compliance, mainly in cases of follow-up with the need for more biopsies. The use of adjunctive noninvasive imaging techniques improves the diagnostic approach, making it faster and better accepted by patients. The present review aims to focus on the most consolidated diagnostic techniques, such as vital staining and tissue autofluorescence, and to report the potential role of some of the most promising innovative techniques, such as narrow-band imaging, high-frequency ultrasounds, optical coherence tomography, and in vivo confocal microscopy. According to their contribution to OSCC diagnosis, an ideal three-step diagnostic procedure is proposed, to make the diagnostic path faster, better, and more accurate.
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Affiliation(s)
- Antonio Romano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Dario Di Stasio
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Fausto Fiori
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli–IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy;
| | - Andrea Santarelli
- Department of Clinical Specialist and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy;
| | - Alberta Lucchese
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Rosario Serpico
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
- Correspondence: ; Tel.: +39-3204876058
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De Pascalis A, Perrot JL, Tognetti L, Rubegni P, Cinotti E. Review of Dermoscopy and Reflectance Confocal Microscopy Features of the Mucosal Melanoma. Diagnostics (Basel) 2021; 11:diagnostics11010091. [PMID: 33429900 PMCID: PMC7827612 DOI: 10.3390/diagnostics11010091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 02/03/2023] Open
Abstract
Mucosal melanoma is a rare tumor with aggressive biological behavior and poor prognosis. Diagnosis is often performed at an advanced stage when the lesions become symptomatic. Although dermoscopy and reflectance confocal microscopy (RCM) are widely used techniques for the diagnosis of cutaneous tumors, their use for mucosal lesions is not well established, probably because the latter are rarer. The objective of this study was to evaluate current literature on these imaging techniques for mucosal melanoma. We searched in PubMed and Cochrane databases all studies up to October 2020 dealing with dermoscopy, RCM, and mucosal melanoma. We found that the most relevant dermoscopic features were structureless pattern and/or the presence of multiple colors. RCM examination mainly showed numerous basal hyper-reflective dendritic cells and loss of normal architecture of the papillae of the lamina propria. Although diagnostic algorithms have been proposed for both techniques, the limit of these methods is the absence of large studies and of standardized and shared diagnostic criteria.
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Affiliation(s)
- Andrea De Pascalis
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy; (L.T.); (P.R.); (E.C.)
- Correspondence: ; Tel.: +39-0577-585428; Fax: +39-0577-585484
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, 42000 Saint-Etienne, France;
| | - Linda Tognetti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy; (L.T.); (P.R.); (E.C.)
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy; (L.T.); (P.R.); (E.C.)
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy; (L.T.); (P.R.); (E.C.)
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6
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Gómez-Martín I, Collgros H, Ferguson PM, Barreiro A, Guitera P, Andrades-López E, Puig S, Pujol RM, Barranco C, Alòs L, Segura S. Diagnostic accuracy of pigmented labial macules by in vivo reflectance confocal microscopy and correlation among techniques. J Am Acad Dermatol 2020; 85:1151-1160. [PMID: 32147389 DOI: 10.1016/j.jaad.2020.02.067] [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: 10/22/2019] [Revised: 12/28/2019] [Accepted: 02/22/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pigmented labial macules (PLMs) are clinical, dermoscopic, and histopathologic challenges. OBJECTIVE To describe and evaluate the utility of reflectance confocal microscopy (RCM) in PLMs and to establish a correlation between dermoscopy, RCM, histopathology, and immunohistochemistry. METHODS Prospective study of PLMs from 4 tertiary referral dermatology centers. The study included 51 biopsy specimen-proven PLMs. Dermoscopic, RCM images, and histopathologic preparations were evaluated for malignant criteria. Diagnostic accuracy of RCM for melanoma diagnosis, RCM Lip Score previously reported, and κ values between techniques were calculated. RESULTS Included were 5 melanomas and 46 benign PLMs. Dermoscopically, melanomas exhibited more frequently ≥3 colors and ≥3 structures. With RCM, pagetoid spreading, epithelial disarray, continuous proliferation of atypical cells around papillae, nonhomogeneously distributed papillae, marked cellular atypia, and a higher number of dendritic cells per papillae were more frequent in melanomas. The RCM Lip Score was significantly higher in malignant lesions. Good κ values were observed in most of the evaluated features. A perfect sensitivity and specificity was obtained combining dermoscopy and RCM. LIMITATIONS A low number of melanomas were obtained. CONCLUSIONS RCM improves lip melanoma diagnosis, and the RCM Lip Score represents a useful tool for the evaluation of a PLM.
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Affiliation(s)
- Ignacio Gómez-Martín
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Departament de Medicina de la UAB, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Helena Collgros
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Peter M Ferguson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Alicia Barreiro
- Department of Dermatology, Hospital Clínic-Instituto de Investigaciones Biomédicas August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Pascale Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Melanoma Institute Australia and Central Clinical School, Sydney University, New South Wales, Australia
| | | | - Susana Puig
- Department of Dermatology, Hospital Clínic-Instituto de Investigaciones Biomédicas August Pi i Sunyer, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Departament de Medicina de la UAB, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Carlos Barranco
- Department of Pathology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Llúcia Alòs
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sonia Segura
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Departament de Medicina de la UAB, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
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Cho SI, Sun S, Mun JH, Kim C, Kim SY, Cho S, Youn SW, Kim HC, Chung JH. Dermatologist-level classification of malignant lip diseases using a deep convolutional neural network. Br J Dermatol 2019; 182:1388-1394. [PMID: 31449661 DOI: 10.1111/bjd.18459] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Deep convolutional neural networks (DCNNs) can classify skin diseases at a level equivalent to a dermatologist, but their performance in specific areas requires further research. OBJECTIVE To evaluate the performance of a trained DCNN-based algorithm in classifying benign and malignant lip diseases. METHODS A training set of 1629 images (743 malignant, 886 benign) was used with Inception-Resnet-V2. Performance was evaluated using another set of 344 images and 281 images from other hospitals. Classifications by 44 participants (six board-certified dermatologists, 12 dermatology residents, nine medical doctors not specialized in dermatology and 17 medical students) were used for comparison. RESULTS The outcomes based on the area under curve, sensitivity and specificity were 0·827 [95% confidence interval (CI) 0·782-0·873], 0·755 (95% CI 0·673-0·827) and 0·803 (95% CI 0·752-0·855), respectively, for the set of 344 images; and 0·774 (95% CI 0·699-0·849), 0·702 (95% CI 0·579-0·808) and 0·759 (95% CI 0·701-0·813), respectively, for the set of 281 images. The DCNN was equivalent to the dermatologists and superior to the nondermatologists in classifying malignancy. After referencing the DCNN result, the mean ± SD Youden index increased significantly for nondermatologists, from 0·201 ± 0·156 to 0·322 ± 0·141 (P < 0·001). CONCLUSIONS DCNNs can classify lip diseases at a level similar to dermatologists. This will help unskilled physicians discriminate between benign and malignant lip diseases. What's already known about this topic? Deep convolutional neural networks (DCNNs) can classify malignant and benign skin diseases at a level equivalent to dermatologists. The lips are a unique feature in terms of histology and morphology. Previous studies of DCNNs have not investigated tumours on specific locations. What does this study add? This study shows that DCNNs can distinguish rare malignant and benign lip disorders at the same rate as dermatologists. DCNNs can help nondermatologists to distinguish malignant lip diseases. What are the clinical implications of this work? DCNNs can distinguish malignant and benign skin diseases even at specific locations such as the lips, as well as board-certified dermatologists. Malignant lip diseases are rare and difficult for less trained doctors to differentiate them from benign lesions. This study shows that in dermatology, DCNN can help improve decision-making processes for rare skin diseases in specific areas of the body.
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Affiliation(s)
- S I Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - S Sun
- Interdisciplinary Program, Bioengineering Major, Graduate School, Seoul National University, Seoul, Korea
| | - J-H Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - C Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - S Y Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - S Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - S W Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - H C Kim
- Interdisciplinary Program, Bioengineering Major, Graduate School, Seoul National University, Seoul, Korea.,Department of Biomedical Engineering, and Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - J H Chung
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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8
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Porto AC, Fraga-Braghiroli N, Blumetti TP, Petaccia de Macedo M, Rabinovitz H, Scope A, Tavoloni Braga JC. Reflectance confocal microscopy features of labial melanotic macule: Report of three cases. JAAD Case Rep 2018; 4:1000-1003. [PMID: 30417063 PMCID: PMC6216092 DOI: 10.1016/j.jdcr.2018.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ana Carolina Porto
- Cutaneous Oncology Department, AC Camargo Cancer Center, Sao Paulo
- Correspondence to: Ana Carolina Porto, MD, Rua Prof. Antônio Prudente, 211, Sao Paulo, Sao Paulo 01509-010, Brazil.
| | | | | | | | | | - Alon Scope
- Sheba Medical Center, Dermatology Tel Hashomer, Ramat-Gan, Israel
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9
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Waddell A, Star P, Guitera P. Advances in the use of reflectance confocal microscopy in melanoma. Melanoma Manag 2018; 5:MMT04. [PMID: 30190930 PMCID: PMC6122529 DOI: 10.2217/mmt-2018-0001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/12/2018] [Indexed: 12/15/2022] Open
Abstract
In vivo reflectance confocal microscopy (RCM) is a noninvasive high-resolution skin imaging tool that has become an important adjunct to clinical exam, dermoscopy and histopathology assessment, in the diagnosis and management of melanoma. RCM generates a horizontal view of the skin, whereby cellular and subcellular (e.g., nuclei, melanophages, collagen) structures, to the level of the upper dermis, are projected onto a screen at near-histological resolution. Morphologic descriptors, standardized terminology, and diagnostic algorithms are well established for the RCM assessment of melanoma, melanocytic, and nonmelanocytic lesions. Clinical applications of RCM in melanoma are broad and include diagnosis, assessment of large lesions on cosmetically sensitive areas, directing areas to biopsy, delineating margins prior to surgery, detecting response to treatment and assessing recurrence. This review will provide an overview of RCM technology, findings by melanoma subtype, clinical applications, as well as explore the accuracy of RCM for melanoma diagnosis, pitfalls and emerging uses of this technology ex vivo.
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Affiliation(s)
- Andréanne Waddell
- Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Department of Medicine/Division of Dermatology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Department of Medicine/Division of Dermatology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Phoebe Star
- Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia.,Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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10
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Halani S, Foster FS, Breslavets M, Shear NH. Ultrasound and Infrared-Based Imaging Modalities for Diagnosis and Management of Cutaneous Diseases. Front Med (Lausanne) 2018; 5:115. [PMID: 29922650 PMCID: PMC5996893 DOI: 10.3389/fmed.2018.00115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/06/2018] [Indexed: 12/16/2022] Open
Abstract
Non-invasive bedside imaging tools are becoming more prevalent for assessing cutaneous lesions. Ultrasound used at specific frequencies allows us to assess margins of lesions to minimize the extent of the biopsy that is performed and improve cosmetic outcomes. Vascularity, seen on Doppler ultrasound and contrast-enhanced ultrasound, and stiffness, assessed on tissue elastography, can help differentiate between benign and malignant lesions for clinicians to be more judicious in deciding whether to biopsy. Moreover, research has shown the efficacy in using ultrasound in monitoring flares of hidradenitis suppurativa, a disease affecting apocrine gland-rich areas of the body, for which the current gold standard involves examining and scoring inflammatory lesions with the naked eye. Infrared-based modalities have also been on the uptrend to aid in clinical decision-making regarding suspiciousness of lesions. Reflectance confocal microscopy has lateral resolution that is comparable to histopathology and it has been shown to be an appropriate adjunctive tool to dermoscopy, specifically when evaluating melanomas. Optical coherence tomography has utility in determining lesion thickness because of its depth penetration, and spectrophotometric intracutaneous analysis is becoming more popular as a tool that can be used by general practitioners to know when to refer to dermatology regarding worrisome pigmented lesions. Strides have been made to incorporate electrical impedance spectroscopy alongside dermoscopy in decision-making regarding excision, although the evidence for its use in the clincial setting remains inconclusive. This paper reviews the efficacy and drawbacks of these techniques in the field of dermatology and suggests future directions.
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Affiliation(s)
- Sheliza Halani
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - F Stuart Foster
- Medical Biophysics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Neil H Shear
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dermatology, University of Toronto, Toronto, ON, Canada
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Yélamos O, Cordova M, Peterson G, Pulitzer MP, Singh B, Rajadhyaksha M, DeFazio JL. In vivo intraoral reflectance confocal microscopy of an amalgam tattoo. Dermatol Pract Concept 2017; 7:13-16. [PMID: 29214103 PMCID: PMC5718120 DOI: 10.5826/dpc.0704a04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/10/2017] [Indexed: 12/31/2022] Open
Abstract
The majority of oral pigmentations are benign lesions such as nevi, melanotic macules, melanoacanthomas or amalgam tattoos. Conversely, mucosal melanomas are rare but often lethal; therefore, excluding oral melanomas in this setting is crucial. Reflectance confocal microscopy is a non-invasive, in vivo imaging system with cellular resolution that has been used to distinguish benign from malignant pigmented lesions in the skin, and more recently in the mucosa. However, lesions located posteriorly in the oral cavity are difficult to assess visually and difficult to biopsy due to their location. Herein we present a patient with previous multiple melanomas presenting with an oral amalgam tattoo in the buccal mucosa, which was imaged using an intraoral telescopic probe attached to a commercially available handheld RCM. In this case report we describe this novel probe, the first RCM description of an amalgam tattoo and we discuss its differences with the findings described in oral melanomas.
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Affiliation(s)
- Oriol Yélamos
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Cordova
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary Peterson
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa P Pulitzer
- Pathology Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bhuvanesh Singh
- Head and Neck Cancer Center, Memorial Sloan Kettering Cancer Center, Hauppauge, NY, USA
| | - Milind Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer L DeFazio
- Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppauge, NY, USA
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