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Al-Chaer RN, Bouazzi D, Jemec G, Mogensen M. Confocal microscopy and optical coherence tomography of inflammatory skin diseases in hairs and pilosebaceous units: A systematic review. Exp Dermatol 2023. [PMID: 37140216 DOI: 10.1111/exd.14830] [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: 01/22/2023] [Revised: 04/14/2023] [Accepted: 04/23/2023] [Indexed: 05/05/2023]
Abstract
Common skin disorders such as acne vulgaris, rosacea and folliculitis are bothersome prevalent inflammatory diseases of hair follicles that can easily be investigated bedside using optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) with micrometre resolution, opening a novel era for high-resolution hair follicle diagnostics and quantitative treatment evaluation. EMBASE, PubMed and Web of Science were searched until 5 January 2023 to identify all studies imaging hair follicle characteristics by RCM and OCT for diagnosis and monitoring of treatment in hair follicle-based skin disorders. This study followed PRISMA guidelines. After inclusion of articles, methodological quality was assessed using the QUADAS-2 critical appraisal checklist. Thirty-nine in vivo studies (33 RCM and 12 OCT studies) were included. The studies focused on acne vulgaris, rosacea, alopecia areata, hidradenitis suppurativa, folliculitis, folliculitis decalvans, lichen planopilaris, discoid lupus erythemasus, frontal fibrosing alopecia and keratosis pilaris. Inter- and perifollicular morphology including number of demodex mites, hyperkeratinization, inflammation and vascular morphology could be assessed by RCM and OCT in all included skin disorders. Methodological study quality was low, and interstudy outcome variability was high. Quality assessment showed high or unclear risk of bias in 36 studies. Both RCM and OCT visualize quantitative features as size, shape, content and abnormalities of hair follicles, and have potential to support clinical diagnosis and evaluate treatment effects. However, larger studies with better methodological quality are needed to implement RCM and OCT directly into clinical practice.
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Affiliation(s)
- Rami Nabil Al-Chaer
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Gregor Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Mette Mogensen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, The Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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2
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Braghiroli NF, Sugerik S, Freitas LARD, Oliviero M, Rabinovitz H. The skin through reflectance confocal microscopy - Historical background, technical principles, and its correlation with histopathology. An Bras Dermatol 2022; 97:697-703. [PMID: 36153173 PMCID: PMC9582891 DOI: 10.1016/j.abd.2021.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022] Open
Abstract
Since its first introduction into medical practice, reflectance confocal microscopy (RCM) has been a valuable non-invasive diagnostic tool for the assessment of benign and malignant neoplasms of the skin. It has also been used as an adjunct for diagnosing equivocal cutaneous neoplasms that lack characteristic clinical or dermoscopic features. The use of RCM has led to a decreased number of biopsies of benign lesions. Multiple published studies show a strong correlation between RCM and histopathology thereby creating a bridge between clinical aspects, dermoscopy, and histopathology. Dermatopathologists may potentially play an important role in the interpretation of confocal images, by their ability to correlate histopathologic findings. RCM has also been shown to be an important adjunct to delineating tumoral margins during surgery, as well as for monitoring the non-surgical treatment of skin cancers. Advanced technology with smaller probes, such as the VivaScope 3000, has allowed access to lesions in previously inaccessible anatomic locations. This review explains the technical principles of RCM and describes the most common RCM features of normal skin with their corresponding histological correlation.
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Affiliation(s)
- Naiara Fraga Braghiroli
- Dermatology Department, Miami Cancer Institute, Miami, FL, United States; Department of Human Pathology, Oswaldo Cruz Foundation, Salvador, BA, Brazil.
| | - Samantha Sugerik
- Medical School, Florida Atlantic University College of Medicine, BocaRaton, FL, United States
| | - Luiz Antônio Rodrigues de Freitas
- Department of Human Pathology, Oswaldo Cruz Foundation, Salvador, BA, Brazil; Department of Pathology, Federal University of Bahia, Salvador, BA, Brazil
| | - Margaret Oliviero
- Dermatology Department, Skin Cancer & Associates, Plantation, FL, United States
| | - Harold Rabinovitz
- Dermatology Department, Skin Cancer & Associates, Plantation, FL, United States
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3
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Ianoși SL, Batani A, Ilie MA, Tampa M, Georgescu SR, Zurac S, Boda D, Ianosi NG, Neagoe D, Calina D, Tutunaru C, Constantin C. Non-invasive imaging techniques for the in vivo diagnosis of Bowen's disease: Three case reports. Oncol Lett 2019; 17:4094-4101. [PMID: 30944602 PMCID: PMC6444281 DOI: 10.3892/ol.2019.10079] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/18/2018] [Indexed: 12/27/2022] Open
Abstract
Bowen's disease (BD) is a relatively frequent non-melanoma skin cancer occurring mostly in elderly people. Until now, the usual way to establish the diagnosis is histopathological examination of a skin biopsy. Dermoscopy and reflectance confocal microscopy (RCM) are modern alternative methods that can be used as quick and non-invasive diagnostic techniques and as follow-up instruments in cases in which a conservative treatment is chosen for the management of BD. There are no very specific dermoscopic criteria for the diagnosis of this disease, but some dermoscopic features (scaly surface, vascular structures and pigmentation) can be found more frequent and can be helpful for the diagnosis. RCM of BD shows an acanthotic epidermis with two types of targetoid cells: the first, a large cell with bright center and dark peripheral halo, the second, a cell with dark center and a bright rim surrounded by a dark hallo, related with dyskeratotic cells on histological examination. BD management could be improved by using non-invasive, in vivo imaging techniques that allow a fast and easy diagnosis and can be used as follow-up tools. However, larger studies are necessary for the validation of our observations.
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Affiliation(s)
- Simona Laura Ianoși
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital, 200349 Craiova, Romania
| | - Alexandra Batani
- Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Mihaela Adriana Ilie
- Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Biochemistry, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mircea Tampa
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Simona-Roxana Georgescu
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Sabina Zurac
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, 'Prof. N. Paulescu' National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | | | - Daniela Neagoe
- Department of Internal Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Daniela Calina
- Department of Pharmacology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Cristina Tutunaru
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital, 200349 Craiova, Romania
| | - Caruntu Constantin
- Department of Dermatology, 'Prof. N. Paulescu' National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania.,Department of Physiology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Andersen AJB, Fuchs C, Ardigo M, Haedersdal M, Mogensen M. In vivo characterization of pustules in Malassezia Folliculitis by reflectance confocal microscopy and optical coherence tomography. A case series study. Skin Res Technol 2018; 24:535-541. [PMID: 29484711 DOI: 10.1111/srt.12463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Malassezia Folliculitis (MaF) is an inflammatory condition of hair follicles caused by Malassezia yeast. Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) are imaging technologies enabling in vivo visualization of superficial skin layers. This study explores morphology of pustules in MaF imaged by OCT and RCM. METHODS Patients with microscopically verified MaF were included in this case series. Morphology was evaluated qualitatively with RCM and OCT, focusing on shape, border and content of selected pustules. RESULTS Nine patients with MaF were included. Clinically, six patients presented monomorphic MaF with multiple superficial pustules, while three patients showed more polymorph MaF appearance. In total 13 pustules were investigated by RCM and OCT. In RCM images, pustules varied from having a well-defined border with homogenous content to ill-defined borders with heterogeneous content. A distinct black halo was occasionally observed around pustules as were dilated vessels. In OCT images, pustules appeared polymorphic, showing both well- and ill-defined structures with oval or irregular shape and more or less homogenous content. Malassezia fungi were not discernible by either RCM or OCT. Specific morphological image features in RCM and OCT did not reflect different clinical manifestations of MaF. CONCLUSION RCM and OCT images identify morphological aspects of MaF pustules, and confirm that MaF is a folliculitis with clinical as well as morphological variance.
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Affiliation(s)
- A J B Andersen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C Fuchs
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Ardigo
- Clinical Dermatology, IFO-San Gallicano Dermatological Institute, Rome, Italy
| | - M Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Mogensen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Yang J, Wang S, Dong L, An X, Li Y, Li J, Tu Y, Tao J. Skin healing and collagen changes of rats after fractional erbium:yttrium aluminum garnet laser: observation by reflectance confocal microscopy with confirmed histological evidence. Lasers Med Sci 2016; 31:1251-60. [PMID: 27272747 DOI: 10.1007/s10103-016-1983-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 06/01/2016] [Indexed: 12/01/2022]
Abstract
The fractional erbium:yttrium aluminum garnet (Er:YAG) laser is widely applied. Microstructural changes after laser treatment have been observed with histopathology. Epidermal and dermal microstructures have also been analyzed using reflectance confocal microscopy (RCM). However, no studies have compared these two types of microstructural changes in the same subject at multiple time points after irradiation, and it is unclear if these two types of changes are consistent. We use RCM to observe the effect of different laser energies on skin healing and collagen changes in the skin of Sprague-Dawley rats that had been irradiated by fractional Er:YAG lasering at different energies. RCM was used to observe skin healing and detect collagen changes at different time points. Collagen changes were observed using hematoxylin and eosin (H&E) staining and quantitatively analyzed by western blot. RCM showed that, irrespective of laser energy, microscopic treatment zones (MTZs) were larger at 1 day after irradiation. The MTZs then reduced in size from 3 to 7 days after irradiation. The higher the energy, the larger the MTZ area. The amount of collagen also increased with time from 1 day to 8 weeks. However, the increase in the collagen amount on both RCM and H&E staining was not influenced by the laser energy. Western blotting confirmed that the amount of type I and type III collagens increased over time, but there were no significant differences between the different energy groups (p > 0.05). In conclusion, RCM is a reliable technique for observing and evaluating skin healing and collagen expression after laser irradiation.
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Affiliation(s)
- Jing Yang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Sha Wang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Liyun Dong
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Xiangjie An
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Yan Li
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Jun Li
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Yating Tu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China
| | - Juan Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 JieFang Avenue, Wuhan, 430022, China.
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6
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Hoogedoorn L, Peppelman M, van de Kerkhof P, van Erp P, Gerritsen M. The value ofin vivoreflectance confocal microscopy in the diagnosis and monitoring of inflammatory and infectious skin diseases: a systematic review. Br J Dermatol 2015; 172:1222-48. [DOI: 10.1111/bjd.13499] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- L. Hoogedoorn
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - M. Peppelman
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - P.E.J. van Erp
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - M.J.P. Gerritsen
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
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7
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Noninvasive in vivo confocal laser scanning microscopy is effective in differentiating allergic from nonallergic equivocal patch test reactions. Lasers Med Sci 2015; 30:1081-7. [DOI: 10.1007/s10103-015-1714-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 01/09/2015] [Indexed: 02/03/2023]
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8
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Manfredini M, Mazzaglia G, Ciardo S, Farnetani F, Mandel VD, Longo C, Zauli S, Bettoli V, Virgili A, Pellacani G. Acne: in vivo
morphologic study of lesions and surrounding skin by means of reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2014; 29:933-9. [DOI: 10.1111/jdv.12730] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Manfredini
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - G. Mazzaglia
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Ciardo
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - F. Farnetani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - V. D. Mandel
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - C. Longo
- Skin Cancer Unit; Arcispedale Santa Maria Nuova; Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS); Reggio Emilia Italy
| | - S. Zauli
- Department of Dermatology; University of Ferrara; Ferrara Italy
| | - V. Bettoli
- Department of Dermatology; University of Ferrara; Ferrara Italy
| | - A. Virgili
- Department of Dermatology; University of Ferrara; Ferrara Italy
| | - G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
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9
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Peppelman M, Wolberink EAW, Gerritsen MJP, van de Kerkhof PCM, van Erp PEJ. Application of leukotriene B4 and reflectance confocal microscopy as a noninvasive in vivo model to study the dynamics of skin inflammation. Skin Res Technol 2014; 21:232-40. [PMID: 25156913 DOI: 10.1111/srt.12181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Application of leukotriene B4 (LTB4) is an established in vivo model that locally induces skin inflammation. Currently in this model, a biopsy is inevitable. In vivo reflectance confocal microscopy (RCM), a noninvasive imaging technique, could overcome this limitation. To find out to what extent RCM may be an in vivo investigative and diagnostic tool in neutrophilic conditions, we studied the dynamics of polymorphonuclear leukocytes (PMN) migration from dermis to stratum corneum using an established LTB4 model. METHODS Leukotriene B4 was topically applied on the skin of the lower back of seven volunteers. The skin sites were evaluated by RCM for three consecutive days with a 24 h time interval. For histological correlation, 3-mm punch biopsies were obtained. The tissue sections were hematoxylin-eosin and immunohistochemical stained. Minimal and average epidermal thickness was measured. RESULTS Reflectance confocal microscopy imaging showed highly reflective ill-defined particles with a granular content throughout the epidermis 24 h after application of LTB4. Over time, the appearance of these cells changed throughout the epidermis. Epidermal thickness increased over time, and the measurements based on the RCM images corresponded very well with the histological images. CONCLUSIONS Reflectance confocal microscopy was able to visualize PMN migration, accumulation, and degeneration over time in the used LTB4 model. The noninvasive character and the possibility to obtain multiple in vivo images from the same location over time make that RCM in combination with this model a useful tool to study the dynamics and function of PMN in inflammatory processes in the skin.
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Affiliation(s)
- M Peppelman
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Miyamoto K, Kudoh H. Quantification and visualization of cellular NAD(P)H in young and aged female facial skin with in vivo two-photon tomography. Br J Dermatol 2014; 169 Suppl 2:25-31. [PMID: 23786617 DOI: 10.1111/bjd.12370] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND In vivo two-photon tomography is a novel noninvasive three-dimensional optical skin imaging technology with subcellular resolution which enables the sensitive detection of endogenous fluorophores. One of these fluorophores, NAD(P)H (a coenzyme which plays an important role in the release of free energy during glycolysis, and influences filaggrin and lipid synthesis), can be selectively detected in keratinocytes (granular cells) with two-photon tomography. OBJECTIVES To quantify NAD(P)H levels in subsurface human facial skin in vivo as a measure to determine if there are changes with age. METHODS A total of 80 healthy Asian females were enrolled in this study, aged 21-68 years. Measurements were performed on facial skin using in vivo two-photon tomography (DermaInspect/MPTflex™, JenLab GmbH, Jena, Germany). The laser beam scans a skin field of interest in pulses, focused at a depth to reach the granular layer. The near-infrared laser pulses excite the endogenous fluorophores NAD(P)H. Image processing was performed to obtain high-resolution autofluorescence images (optical biopsies) and to quantify the fluorescent grey scale to determine NAD(P)H levels. Additional skin surface measures taken were hydration (corneometer), elasticity (cutometer) and wrinkles (image capture and analysis). RESULTS Statistically significant changes in all measured parameters as a function of age were observed. Most importantly, the mean fluorescent grey scale values for NAD(P)H in the youngest group studied (women in their 20s) was 38.8 (SD ± 12.39), while that of the oldest group studied (women in their 60s) was 32.7 (SD ± 12.47). These NAD(P)H levels are statistically significantly different (P = 0.0078). CONCLUSIONS The level of NAD(P)H in the epidermis is significantly greater in younger vs. older skin in vivo. This likely reflects decreased production and/or increased degradation of NAD(P)H in older skin, possibly as a result of chronological ageing and environmental damage (e.g. photodamage). NAD(P)H levels in epidermal skin may be a useful biomarker of skin ageing in vivo. It is also likely that maintaining NAD(P)H production is a useful approach to maintaining good skin condition and caring for ageing skin.
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Affiliation(s)
- K Miyamoto
- R&D Prestige, P&G Innovation GK, 1-17 Koyo-cho Naka, Higashinada-ku, Kobe 658-0035, Japan.
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11
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Agozzino M, Berardesca E, Donadio C, Franceschini C, de Felice CM, Cavallotti C, Sperduti I, Ardigò M. Reflectance Confocal Microscopy Features of Seborrheic Dermatitis for Plaque Psoriasis Differentiation. Dermatology 2014; 229:215-21. [DOI: 10.1159/000363289] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/28/2014] [Indexed: 11/19/2022] Open
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Abstract
Traditional diagnostic testing for dermatophyte infection currently requires skin scraping for light microscopy and/or fungal culture or skin biopsy. Immunofluorescent microscopy can also be used with calcofluor stain. All of these tests can be time-consuming to perform, require a waiting period for results and are invasive. This study aimed to define the in vivo reflectance confocal microscopy (RCM) features of superficial cutaneous fungal infections and to analyse concordance with microscopic examination. Totally, 45 patients, who were diagnosed with superficial cutaneous fungal infections according to the positive result of microscopic examination, were enrolled in this study. We selected three typical lesions examined by RCM, and then recorded the results. In the patients with the tinea manus and pedis, mycelium in stratum corneum was found by the RCM in 14 of 22 patients (14/22; 63.64%). In the patients with the tinea cruris, mycelium in stratum corneum was found by the RCM in 19 of 23 patients (19/23; 82.61%). RCM seems to be useful for microscopic evaluation of mycelium features and may have a scientific value in study of superficial cutaneous fungal infections.
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Affiliation(s)
- Dai Hui
- Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang, China
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13
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Debarbieux S, Depaepe L, Poulalhon N, Dalle S, Balme B, Thomas L. Reflectance confocal microscopy characteristics of eight cases of pustular eruptions and histopathological correlations. Skin Res Technol 2012; 19:e444-52. [PMID: 22934633 DOI: 10.1111/j.1600-0846.2012.00662.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM)'s interest has been well established for the non-invasive diagnosis of skin cancers, especially melanocytic, and in the differential diagnosis between benign and malignant cutaneous lesions. However, its diagnostic interest in inflammatory skin diseases still needs to be demonstrated. Our purpose was to evaluate the correlation between RCM and conventional histopathology in a series of pustular eruptions of different pathogeny. METHODS Reflectance confocal microscopy analysis was performed in eight consecutive unselected patients in whom the diagnoses of pustular psoriasis, bacterial sur-infection, herpes-type virus skin sur-infection, Sneddon-Wilkinson subcorneal putulosis and Hailey-Hailey disease have been made and images were compared to conventional histopathology. RESULTS Neutrophils within the epidermis exhibited never reported earlier specific features, with either a shiny granular sludge or polylobated particules with a bright granular content. Moreover, some specific etiologies could be identified, such as acantholysis and herpes-type virus-infected keratinocytes. CONCLUSION Our studies show a good correlation between RCM and conventional histopathology in pustular eruptions. Reflectance confocal microscopy may play an important role in the differential diagnosis of pustular eruptions; as most of the pathologic clues are epidermal, narrow thickness of the field of imaging, its main technical limitation, is indeed of lesser importance.
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14
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Laser skin rejuvenation: epidermal changes and collagen remodeling evaluated by in vivo confocal microscopy. Lasers Med Sci 2012; 28:769-76. [DOI: 10.1007/s10103-012-1145-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
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15
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Peng T, Xie H, Ding Y, Wang W, Li Z, Jin D, Tang Y, Ren Q, Xi P. CRAFT: Multimodality confocal skin imaging for early cancer diagnosis. JOURNAL OF BIOPHOTONICS 2012; 5:469-476. [PMID: 22232081 DOI: 10.1002/jbio.201100124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 12/08/2011] [Accepted: 12/12/2011] [Indexed: 05/31/2023]
Abstract
Although histological analysis serves as a gold standard to cancer diagnosis, its application on skin cancer detection is largely prohibited due to its invasive nature. To obtain both the structural and pathological information in situ, a Confocal Reflectance/Auto-Fluorescence Tomography (CRAFT) system was established to examine the skin sites in vivo with both reflectance and autofluorescence modes simultaneously. Nude mice skin with cancerous sites and normal skin sites were imaged and compared with the system. The cellular density and reflective intensity in cancerous sites reflects the structural change of the tissue. With the decay coefficient analysis, the corresponding NAD(P)H decay index for cancerous sites is 1.65-fold that of normal sites, leading to a 97.8% of sensitivity and specificity for early cancer diagnosis. The results are verified by the followed histological analysis. Therefore, CRAFT may provide a novel method for the in vivo, non-invasive diagnosis of early cancer.
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Affiliation(s)
- Tong Peng
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
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16
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Hui D, Ai-E X. The vascular features of psoriatic skin: imaging using in vivo confocal laser scanning microscopy. Skin Res Technol 2012; 19:e545-8. [PMID: 22356590 DOI: 10.1111/j.1600-0846.2011.00606.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2011] [Indexed: 01/31/2023]
Affiliation(s)
- Dai Hui
- Department of Dermatology; Third People's Hospital of Hangzhou; Hangzhou Institute of Dermatology and Venereology; Hangzhou; China
| | - Xu Ai-E
- Department of Dermatology; Third People's Hospital of Hangzhou; Hangzhou Institute of Dermatology and Venereology; Hangzhou; China
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Rudnicka L, Olszewska M, Rakowska A. In vivo reflectance confocal microscopy: usefulness for diagnosing hair diseases. J Dermatol Case Rep 2011; 2:55-9. [PMID: 21886715 DOI: 10.3315/jdcr.2008.1017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 10/16/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND Reflectance confocal laser scanning microscopy (R-CSLM) is a new diagnostic technique which allows visualization of "optical intersections" within the epidermis and superficial layers of the dermis. Outlines of cells and their architecture are imaged and may be analyzed both horizontally and vertically to the skin surface. The method proved useful in early melanoma detection. We evaluated the potential usefulness of this method in a short series of patients with hair diseases. MAIN OBSERVATIONS Two healthy persons and 6 patients with hair diseases (1 with alopecia areata, 1 with androgenic alopecia and 4 with genetic hair shaft abnormalities) were examined with the use of Vivascope 1500. In all patients one scalp location and one location in the mid forearm were evaluated. R-CSLM examination gave in all cases high quality images of the hair shaft intersections, at 1µm intervals, which allowed detailed analysis of the hair structure. Hair follicles could be partly visualized at a depth of up to 200µm, which allowed analysis of only superficial parts of the hair follicles. An additional hurdle was bright reflection within the follicular ostia, which decreased the perception of details in these images. Hair could be best visualized, when analyzed on flat surfaces. Receiving good quality images from convex surfaces on the scalp required additional effort from the patient (to not move) and from the physician (to obtain best possible fit of the "optic window" to the scalp). CONCLUSIONS These preliminary data show that R-CSLM may develop into a valuable tool in evaluation of hair shaft diseases. Further development is needed to apply this technique in abnormalities of the hair follicle and the perifollicular area.
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Shtirshnayder YY, Michenko AV, Katunina OR, Zubarev AR, SHTIRSHNEIDER YUYU, MICHENKO AV, KATUNINA OR, ZUBAREV AR. Up-to-date non-invasive visualization technologies in dermatology. VESTNIK DERMATOLOGII I VENEROLOGII 2011. [DOI: 10.25208/vdv1062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The authors present a review of up-to-date non-invasive visualization methods used in diagnostics of diseases of skin
and its appendages. They describe physical principles forming the basis for non-invasive visualization methods such
as dermatoscopy, confocal laser scanning microscopy, optical video monitoring, optical topometry, optical coherent
tomography, ultrasound scanning, 3D-modeling. They also describe the potential of practical application of these diagnostics
methods at the current stage of their development. The authors have demonstrated that it is possible to reduce the clinicians
need in biopsy diagnostics due to the high information value of non-invasive visual diagnostics methods.
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Agozzino M, Tosti A, Barbieri L, Moscarella E, Cota C, Berardesca E, Ardigò M. Confocal microscopic features of scarring alopecia: preliminary report. Br J Dermatol 2011; 165:534-40. [PMID: 21605108 DOI: 10.1111/j.1365-2133.2011.10424.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are the most common causes of lymphocytic primary cicatricial alopecia. The management of scarring alopecia can be difficult. The combination of clinical, dermoscopy and reflectance confocal microscopy (RCM), a noninvasive, high-resolution imaging technique, examinations have already been demonstrated to be useful for choosing the correct biopsy site in patients with inflammatory skin disease and obtaining microscopic diagnostic criteria. OBJECTIVES We evaluated the usefulness in practice of RCM for the identification of criteria for LPP and DLE involving the scalp and their management during therapeutic follow-up. METHODS Seven white patients with a previously established histological diagnosis of DLE (three) and LPP (four), were included in the study. RCM criteria for primary scarring alopecia were selected: epidermal disarray, spongiosis, exocytosis of inflammatory cells in the epidermis, interface dermatitis, peri- and intra-adnexal infiltration of inflammatory cells, dilated vessels in the dermis, dermal infiltration of inflammatory cells and melanophages and dermal sclerosis. All patients were followed up using RCM during the treatment. During follow-up the RCM evolution of the epidermal, junctional and dermal inflammation were evaluated. RESULTS A series of RCM features of scalp LPP and DLE were identified that show correlation with the histopathological evaluation. During the treatment follow-up of the cases RCM was shown to be sensitive for the identification of therapeutic response. CONCLUSION In our preliminary study the effective usefulness of RCM for the diagnosis of scarring alopecia and follow-up seemed to be evident. Moreover, RCM seems to be also promising for differential diagnosis between the different entities.
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Affiliation(s)
- M Agozzino
- San Gallicano Dermatological Institute-IRCCS, Via Chianesi, 53, 00144, Rome, Italy
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Noninvasive visualization of intraepidermal and subepidermal blisters in vesiculobullous skin disorders by in vivo reflectance confocal microscopy. Lasers Med Sci 2011; 27:261-6. [DOI: 10.1007/s10103-011-0943-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 06/01/2011] [Indexed: 10/18/2022]
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Anuthama K, Sherlin HJ, Anuja N, Ramani P, Premkumar P, Chandrasekar T. Characterization of different tissue changes in normal, betel chewers, potentially malignant lesions, conditions and oral squamous cell carcinoma using reflectance confocal microscopy: Correlation with routine histopathology. Oral Oncol 2010; 46:232-48. [DOI: 10.1016/j.oraloncology.2009.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 12/20/2009] [Accepted: 12/21/2009] [Indexed: 11/30/2022]
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Ardigo M, Cota C, Berardesca E, González S. Concordance betweenin vivoreflectance confocal microscopy and histology in the evaluation of plaque psoriasis. J Eur Acad Dermatol Venereol 2009; 23:660-7. [DOI: 10.1111/j.1468-3083.2009.03134.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gerger A, Hofmann-Wellenhof R, Samonigg H, Smolle J. In vivoconfocal laser scanning microscopy in the diagnosis of melanocytic skin tumours. Br J Dermatol 2009; 160:475-81. [DOI: 10.1111/j.1365-2133.2008.08995.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Angelova-Fischer I, Pfeuti T, Zillikens D, Rose C. In vivoconfocal laser scanning microscopy for non-invasive diagnosis of pemphigus foliaceus. Skin Res Technol 2009; 15:40-4. [DOI: 10.1111/j.1600-0846.2008.00332.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Burmeister M, von Schwanewede H, Stave J, Guthoff RF. Intraorale Diagnostik mittels konfokaler Laser-Scanning-Mikroskopie / Intraoral diagnostics using confocal laser scanning microscopy. ACTA ACUST UNITED AC 2009; 54:23-8. [DOI: 10.1515/bmt.2009.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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González S, Gilaberte-Calzada Y. In vivo reflectance-mode confocal microscopy in clinical dermatology and cosmetology. Int J Cosmet Sci 2008; 30:1-17. [PMID: 18377626 DOI: 10.1111/j.1468-2494.2008.00406.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging tool that allows real-time visualization of cells and structures in living skin with near histological resolution. RCM has been used for the assessment of benign and malignant lesions, showing great potential for applications in basic skin research and clinical dermatology. RCM also reveals dynamic changes in the skin over time and in response to specific stimuli, like ultraviolet exposure, which makes it a promising tool in cosmetology, as it allows repetitive sampling without biopsy collection, causing no further damage to the areas under investigation. This review summarizes the latest advances in RCM, and its applications in the characterization of both normal and pathological skin.
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Affiliation(s)
- S González
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA.
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Lieber CA, Majumder SK, Billheimer D, Ellis DL, Mahadevan-Jansen A. Raman microspectroscopy for skin cancer detection in vitro. JOURNAL OF BIOMEDICAL OPTICS 2008; 13:024013. [PMID: 18465976 DOI: 10.1117/1.2899155] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We investigate the potential of near-infrared Raman microspectroscopy to differentiate between normal and malignant skin lesions. Thirty-nine skin tissue samples consisting of normal, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma from 39 patients were investigated. Raman spectra were recorded at the surface and at 20-microm intervals below the surface for each sample, down to a depth of at least 100 microm. Data reduction algorithms based on the nonlinear maximum representation and discrimination feature (MRDF) and discriminant algorithms using sparse multinomial logistic regression (SMLR) were developed for classification of the Raman spectra relative to histopathology. The tissue Raman spectra were classified into pathological states with a maximal overall sensitivity and specificity for disease of 100%. These results indicate the potential of using Raman microspectroscopy for skin cancer detection and provide a clear rationale for future clinical studies.
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Affiliation(s)
- Chad A Lieber
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee 37235, USA.
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Sokolov K, Nida D, Descour M, Lacy A, Levy M, Hall B, Dharmawardhane S, Ellington A, Korgel B, Richards-Kortum R. Molecular optical imaging of therapeutic targets of cancer. Adv Cancer Res 2007; 96:299-344. [PMID: 17161684 DOI: 10.1016/s0065-230x(06)96011-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Recent progress in discerning the molecular events that accompany carcinogenesis has led to development of new cancer therapies directly targeted against the molecular changes of neoplasia. Molecular-targeted therapeutics have shown significant improvements in response rates and decreased toxicity as compared to conventional cytotoxic therapies which lack specificity for tumor cells. In order to fully explore the potential of molecular-targeted therapy, a new set of tools is required to dynamically and quantitatively image and monitor the heterogeneous molecular profiles of tumors in vivo. Currently, molecular markers can only be visualized in vitro using complex immunohistochemical staining protocols. In this chapter, we discuss emerging optical tools to image in vivo a molecular profile of risk-based hallmarks of cancer for selecting and monitoring therapy. We present the combination of optically active, targeted nanoparticles for molecular imaging with advances in minimally invasive optical imaging systems, which can be used to dynamically image both a molecular and phenotypic profile of risk and to monitor changes in this profile during therapy.
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Affiliation(s)
- Konstantin Sokolov
- Department of Imaging Physics, MD Anderson Cancer Center, Houston, Texas 77030, USA
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Branzan AL, Landthaler M, Szeimies RM. In vivo confocal scanning laser microscopy in dermatology. Lasers Med Sci 2006; 22:73-82. [PMID: 17115235 DOI: 10.1007/s10103-006-0416-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 08/04/2006] [Indexed: 10/23/2022]
Abstract
The need to improve the diagnostic accuracy and sensitivity for skin tumours has led to the development of new non-invasive, in vivo techniques including ultrasound, dermoscopy, digital photography, confocal scanning laser microscopy, magnetic resonance imaging and optical coherence tomography. Of all these in vivo techniques, only confocal scanning laser microscopy allows for the examination of the epidermis and papillary dermis at a resolution approaching histological detail. This review article looks at some of the most important applications of this new technology, highlighting its qualities and limitations.
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Affiliation(s)
- Anca L Branzan
- Department of Dermatology, Regensburg University Hospital, Regensburg, Germany
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Nakano K, Kiyokane K, Benvenuto-Andrade C, González S. Real-TimeReflectance Confocal Microscopy, a Noninvasive Tool for in vivo Quantitative Evaluation of Comedolysis in the Rhino Mouse Model. Skin Pharmacol Physiol 2006; 20:29-36. [PMID: 17035719 DOI: 10.1159/000096169] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Accepted: 04/21/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Near-infrared reflectance confocal microscopy (RCM) is a noninvasive tool that provides real-time images of thin virtual horizontal tissue sections. AIMS/METHODS We have used a rhino mouse model in combination with topical application of all-trans-retinoic acid and all-trans-retinol to investigate the usefulness of RCM as a noninvasive imaging tool to evaluate comedolysis in vivo and over time. Optical images were correlated with routine histology. RESULTS Our results demonstrate that RCM in vivo can visualize the process of transformation of utriculi (pseudocomedones) towards a normal-appearing follicular structure during retinoid treatment. The retinoic acid intervention group showed a dose-related response, while the vehicle-treated group did not show utricular changes. CONCLUSIONS RCM represents a useful tool for in vivo morphological and quantitative evaluation of skin utriculi over time and could be used as an adjunct tool to histopathological techniques for comedolysis studies.
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Affiliation(s)
- K Nakano
- Wellman Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Cutaneous melanoma is responsible for the majority of skin cancer deaths. Early and accurate detection are the most important means to improve patient survival. This article reviews the common clinical presentations of head and neck cutaneous melanoma, and discusses lesions that might be clinically mistaken for melanoma.
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Gilaberte Y, Serra-Guillén C, de las Heras ME, Ruiz-Rodríguez R, Fernández-Lorente M, Benvenuto-Andrade C, González-Rodríguez S, Guillén-Barona C. Terapia fotodinámica en dermatología. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:83-102. [PMID: 16595110 DOI: 10.1016/s0001-7310(06)73359-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Photodynamic therapy (PDT) is a therapeutic modality based on the photooxidation of biological materials induced by a photosensitizer, which selectively locates itself in certain tumorous cells or tissues, so that when illuminated by a light of the right length and at a sufficient dose, these cells are destroyed. In dermatology, PDT with topical 5-aminolevulinic acid or 5-methyl aminolevulinate is very effective in the treatment of actinic keratoses, basal cell carcinomas and Bowen's disease. In addition, very promising results have been obtained in inflammatory pathologies like morphea or sarcoidosis, infections like warts, and cosmetic processes such as photoaging, among others. This article reviews the most significant aspects of PDT in dermatology. First of all, we will review the basic fundamentals of photodynamic treatment. Next, we will outline its clinical applications in dermatology, both in oncological applications and all those dermatological processes in which PDT may play a role in their management. We will also discuss its promising cosmetic application in the treatment of photoaging. We will complete the review with photodiagnosis and the different non-invasive ways to monitor the effectiveness of PDT.
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Just T, Stave J, Pau HW, Guthoff R. In vivo observation of papillae of the human tongue using confocal laser scanning microscopy. ORL J Otorhinolaryngol Relat Spec 2005; 67:207-12. [PMID: 16088248 DOI: 10.1159/000087320] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Accepted: 01/20/2005] [Indexed: 11/19/2022]
Abstract
The aim of this investigation was to visualize the epithelial structures of the tongue using confocal laser scanning microscopy (LSM). The human tongue epithelium of 28 healthy subjects, aged 21-67 years, mean age 38 years, 14 women and 14 men, was examined in vivo by LSM. Using LSM, a combination of the Heidelberg Retina Tomograph HRT II and the Rostock Cornea Module, up to 800-fold magnifications were obtained. On the tongue surface both filiform and fungiform papillae and their taste pores were easily identified. The epithelium of the tongue with its subcellular structures could be observed up to a depth of 50 microm, cellular structures up to 150 microm and subepithelial vessels up to 300 microm. Additionally the papillary crests and blood flow were visible. Confocal LSM seems suitable for noninvasive in vivo examination of the tongue. The hydraulic z scan, the manual start setting and the measurement of the depth allow a clear classification of the observed structures.
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Affiliation(s)
- Tino Just
- Department of Otorhinolaryngology, University of Rostock, Rostock, Germany.
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Gerger A, Koller S, Kern T, Massone C, Steiger K, Richtig E, Kerl H, Smolle J. Diagnostic Applicability of In Vivo Confocal Laser Scanning Microscopy in Melanocytic Skin Tumors. J Invest Dermatol 2005; 124:493-8. [PMID: 15737188 DOI: 10.1111/j.0022-202x.2004.23569.x] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In vivo confocal laser scanning microscopy (CLSM) represents a novel imaging tool that allows the examination of skin morphology in real time at a resolution equal to that of conventional microscopes. The aim of the study was to test the applicability of CLSM to the diagnostic discrimination of benign nevi and melanoma. five independent observers without previous experience in CLSM received a standardized instruction about diagnostic CLSM features. Subsequently, 117 melanocytic skin tumors (90 benign nevi and 27 melanoma), imaged using a commercially available, near-infrared, reflectance confocal laser scanning microscope, were evaluated by each observer. Overall, sensitivity of 88.15% and specificity of 97.60% was achieved by the five observers. Logistic regression analysis revealed that mainly cytomorphology, architecture and keratinocyte cell borders should be taken into account for diagnostic decisions. Remarkably, using the presence or absence of monomorphic melanocytes as a single diagnostic criterion, the classification results with a sensitivity of 98.15% and a specificity of 98.89% were superior to the intuitive, integrative judgement of the observers. This first sensitivity and specificity study with CLSM has yielded promising results. CLSM provides new and useful information to the clinician diagnosing melanocytic skin tumors.
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Affiliation(s)
- Armin Gerger
- Department of Dermatology, Medical University of Graz, Graz, Austria.
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González S, Swindells K, Rajadhyaksha M, Torres A. Changing paradigms in dermatology: confocal microscopy in clinical and surgical dermatology. Clin Dermatol 2004; 21:359-69. [PMID: 14678715 DOI: 10.1016/j.clindermatol.2003.08.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The current practice of pathology and dermatopathology depends upon the evaluation of tissue in some manner extirpated from the patient and then processed and stained. While high resolution of detail can be accomplished by this method, there are certain risks and disadvantages. Recent imaging techniques now allow for a potential of achieving noninvasive high-resolution analysis of lesions in situ in the patient. Of these, Reflectance mode confocal microscopy offers the highest resolution imaging comparable to routine histology. Being entirely non invasive, skin can be observed in its native, dynamic state. This chapter will review the fundamentals of in vivo confocal imaging and the clinical applications in general and surgical dermatology.
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Affiliation(s)
- Salvador González
- Department of Dermatology, Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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37
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Sokolov K, Aaron J, Hsu B, Nida D, Gillenwater A, Follen M, MacAulay C, Adler-Storthz K, Korgel B, Descour M, Pasqualini R, Arap W, Lam W, Richards-Kortum R. Optical systems for in vivo molecular imaging of cancer. Technol Cancer Res Treat 2004; 2:491-504. [PMID: 14640761 DOI: 10.1177/153303460300200602] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Progress toward a molecular characterization of cancer would have important clinical benefits; thus, there is an important need to image the molecular features of cancer in vivo. In this paper, we describe a comprehensive strategy to develop inexpensive, rugged and portable optical imaging systems for molecular imaging of cancer, which couples the development of optically active contrast agents with advances in functional genomics of cancer. We describe initial results obtained using optically active contrast agents to image the expression of three well known molecular signatures of neoplasia: including over expression of the epidermal growth factor receptor (EGFR), matrix metallo-proteases (MMPs), and oncoproteins associated with human papillomavirus (HPV) infection. At the same time, we are developing inexpensive, portable optical systems to image the morphologic and molecular signatures of neoplasia noninvasively in real time. These real-time, portable, inexpensive systems can provide tools to characterize the molecular features of cancer in vivo.
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Affiliation(s)
- K Sokolov
- Department of Imaging Physics, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
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Noninvasive Imaging of Skin Tumors. Dermatol Surg 2004. [DOI: 10.1097/00042728-200402002-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
In this article, the authors review different approaches to the diagnosis of skin tumors using noninvasive diagnostic tools, which are becoming increasingly reliable and, as a consequence, increasingly popular among physicians and patients. Especially in the realm of pigmented skin lesions, dermoscopy and sonography may add useful information to the clinical constellation, improving the diagnostic performance for early diagnosis of melanoma and for differentiating various melanocytic and nonmelanocytic pigmented lesions. More recently, confocal scanning laser microscopy was introduced as a novel technique that enables the in vivo study of the skin at a nearly histologic resolution, being of diagnostic value in various skin disorders, including basal cell carcinoma and pigmented skin lesions. These modalities have various other potential applications besides diagnosis, including lesion's selection for biopsy, determination of appropriate therapeutic modalities, verification of treatment efficacy, and decision of surgical margins. Finally, a hint to the use of cytodiagnosis for basal cell carcinoma is provided.
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Affiliation(s)
- Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples Department of Dermatology, University of Modena, Modena, Italy
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40
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Swindle LD, Thomas SG, Freeman M, Delaney PM. View of Normal Human Skin In Vivo as Observed Using Fluorescent Fiber-Optic Confocal Microscopic Imaging. J Invest Dermatol 2003; 121:706-12. [PMID: 14632185 DOI: 10.1046/j.1523-1747.2003.12477.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fluorescence confocal scanning laser microscopy, using a miniaturized handheld scanner, was performed to visualize the microscopic architecture of normal human epidermis in vivo. Fluorescein sodium (approximately 20 microL of 0.2% wt/vol) was administered via intradermal injection to normal skin on the volar forearm of 22 patients. The skin was imaged continuously from 1 to 15 min after injection. Fluorescein was excited at 488 nm and the fluorescent emission was detected at > 505 nm. In each subject, a series of images was collected at increasing depth, from superficial stratum corneum to papillary dermis. Features observed in confocal images were compared to those seen in hematoxylin- and eosin-stained sections of skin. The confocal images demonstrated the architecture of superficial skin in the horizontal plane. There was a transition in keratinocyte size, shape, and morphology with progressive imaging into the deeper epidermal layers. Superficial dermis and microscopic capillaries with blood flow were easily observed. The morphologic patterns associated with the major cell types of the epidermis were consistent with those known from conventional histology. We report the ability of in vivo fluorescence point scanning laser confocal microscopy to produce real-time, high-resolution images of the microscopic architecture of normal human epidermis using a noninvasive imaging technology.
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Estudio morfométrico in vivo con microscopía confocal en tiempo real de las alteraciones epidérmicas de la piel tras dosis bajas y repetitivas de radiación ultravioleta A (UVA). ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)79230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abramovits W, Stevenson LC. Changing paradigms in dermatology: new ways to examine the skin using noninvasive imaging methods. Clin Dermatol 2003; 21:353-8. [PMID: 14678714 DOI: 10.1016/j.clindermatol.2003.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Detailed visualization of the skin in the practice of dermatology is key to a comprehensive examination and accurate diagnosis. Advancements in digital dermoscopy, microscopy, imaging and photography have formed an impressive arsenal with which dermatologists can offer state-of-the-art patient care while streamlining their clinical practice and improving their academic and research capacities. Many types of advanced imaging are used in the biologic sciences at the bench; however, our paper reviews the clinical, noninvasive in vivo human applications of these emerging technologies. Our experiences with these instruments reinforce such reviews.
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Affiliation(s)
- William Abramovits
- Department of Dermatology and Medicine, Baylor University Medical Center, Dallas, Texas 75230, USA.
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Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. J Am Acad Dermatol 2003; 49:1-31; quiz 31-4. [PMID: 12833005 DOI: 10.1067/mjd.2003.582] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.
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Affiliation(s)
- Elizabeth L Tanzi
- Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037, USA
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Ammirati CT, Hruza GJ. Clinical presentations of cutaneous melanoma. Facial Plast Surg Clin North Am 2003; 11:9-22. [PMID: 15062283 DOI: 10.1016/s1064-7406(02)00051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christie Travelute Ammirati
- Department of Dermatology, PennState, Milton S. Hershey Medical Center, 500 University Drive, PO Box 850, Hershey, PA 17033, USA.
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Boixeda P, Pérez-Rodríguez A, Fernández-Lorente M, Arrazola JM. Novedades en láser cutáneo. ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76675-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Affiliation(s)
- Ralph Weissleder
- Center for Molecular Imaging Research, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
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Busam KJ, Charles C, Lohmann CM, Marghoob A, Goldgeier M, Halpern AC. Detection of intraepidermal malignant melanoma in vivo by confocal scanning laser microscopy. Melanoma Res 2002; 12:349-55. [PMID: 12170184 DOI: 10.1097/00008390-200208000-00007] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The early detection of malignant melanoma remains challenging for physicians. New techniques are being explored in order to improve diagnostic accuracy. Confocal scanning laser microscopy (CSLM) represents one such novel imaging modality. It allows in vivo microscopic analysis of skin lesions at a level of resolution approaching histological detail. Therefore, interpretation of optical sections represents in principle a histopathological analysis. Pigmented lesions are particularly amenable to examination by CSLM, since melanin pigment provides endogenous contrast, facilitating the recognition of melanocytes and their distribution within the epidermis. As a first step to explore the use of CSLM in the detection of melanoma, we sought to determine whether images obtained by CSLM are suitable for analysis by established histopathological criteria for the diagnosis of melanoma. We examined five pigmented lesions clinically suspicious for melanoma from five individual patients. Following imaging by CSLM, the clinical lesions were excised for examination by conventional histology. The melanocytes in the confocal images were recognized within the epidermis by their bright cytoplasmic signal intensity. They were round to oval in shape and frequently showed dendritic processes of various lengths. Confocal images of melanoma showed an increased number of intraepidermal melanocytes in solitary units at all layers of the epidermis, including the upper spinous and granular cell layers. Our results demonstrate that intraepidermal melanoma can be recognized by CSLM through analysis of the intraepidermal growth patterns of melanocytes using the same criteria as established for conventional histology. Thus, the application of CSLM represents a new tool for non-invasive screening of intraepidermal pigmented lesions in vivo and offers the opportunity to bring histopathological analysis to the bedside.
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Affiliation(s)
- K J Busam
- Departments of Pathology, Dermatology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, NY 10021, USA.
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Goldgeier M, Alessi C, Muhlbauer JE. Immediate noninvasive diagnosis of herpesvirus by confocal scanning laser microscopy. J Am Acad Dermatol 2002; 46:783-5. [PMID: 12004325 DOI: 10.1067/mjd.2002.120616] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In an immunocompromised host, cutaneous herpesvirus infections may be atypical and severe. Bedside microscopic imaging allows rapid diagnosis and prompt therapy. We report the case of an immunocompromised woman whose clinical differential diagnosis included herpesvirus infection. We used confocal scanning laser microscopy (CSLM) for immediate noninvasive bedside detection of histologic patterns diagnostic of cutaneous herpesvirus infection. We found that CLSM revealed the presence of pleomorphic ballooned keratinocytes and multinucleated giant cells in a loose aggregate of keratinocytes, inflammatory cells, and debris. Findings on CSLM were identical to those of conventional histologic examination. Prompt treatment of the immunocompromised patient produced clearing of cutaneous lesions. We conclude that CLSM may be a useful tool in the diagnosis of cutaneous herpesvirus infections.
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Busam KJ, Charles C, Lee G, Halpern AC. Morphologic features of melanocytes, pigmented keratinocytes, and melanophages by in vivo confocal scanning laser microscopy. Mod Pathol 2001; 14:862-8. [PMID: 11557781 DOI: 10.1038/modpathol.3880402] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Confocal scanning laser microscopy (CSLM) represents a novel imaging technique for in vivo microscopic analysis of skin lesions at a level of resolution that allows morphologic analysis of microanatomic structures. We investigated the feasibility of recognizing the cellular constituents of pigmented skin lesions, such as pigmented keratinocytes, melanocytes, and melanophages, by CSLM. Fifteen pigmented lesions (five pigmented seborrheic keratoses, and 10 compound melanocytic nevi) from 15 patients were studied, as well as normal skin. After the clinical lesions were imaged by CSLM, they were biopsied or excised for examination by conventional histology for comparison of the morphologic features. In images obtained by CSLM, pigmented keratinocytes were seen as polygonal cohesive cells with variably bright granular cytoplasm. Melanocytes appeared as bright round, oval, fusiform, or dendritic cells. The architectural growth pattern of melanocytes could be analyzed. Melanocytes were identified by their nested growth pattern as aggregates of bright round to oval structures at the dermoepidermal junction or in the superficial dermis. Melanocytes were also recognizable as single cells along the dermoepidermal junction, usually separated from each other by a variable number of keratinocytes. Melanophages appeared as large bright plump cells with ill-defined cytoplasmic borders, usually located around or near vessels of the superficial dermis. Our results demonstrate that the cellular constituents of pigmented lesions can be recognized by CSLM. This technique sets a new paradigm for noninvasive quasihistologic examination of pigmented lesions in vivo and merits further evaluation for diagnostic use.
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Affiliation(s)
- K J Busam
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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