[Reflectance confocal microscopy in the diagnosis of cutaneous melanoma]

Assessment of skin pigmentation by confocal microscopy: Influence of solar exposure and protection habits on cutaneous hyperchromias

BACKGROUND

Cutaneous hyperchromias are disorders of skin pigmentation involving an increase of melanin production and its irregular accumulation in skin cells. It is known that the use of sunscreens helps to prevent changes in the skin pigmentation pattern, but the structural and morphological alterations that occur in the different types of hyperpigmentations need better elucidation.

OBJECTIVE

To assess the influence of solar exposure and protection habits on the pattern of skin pigmentation using reflectance confocal microscopy (RCM).

METHODS

Forty volunteers aged 18-39 years with skin hyperpigmentation participated in the study. Skin characterization was performed by imaging techniques and by assessing the habits of solar exposure and protection by applying questionnaires to the volunteers. RCM was used to record sequences of confocal sections at areas of interest and to examine cell shape and brightness in the basal cell layer of the lesion and in normal perilesional skin. Furthermore, high-resolution images were obtained for analysis of the spots.

RESULTS

Sunlight influences the number and location of spots as the face of volunteers with higher solar exposure was covered with spots, whereas volunteers with less exposure had fewer spots located in the nose and cheeks region due to greater exposure of these areas to the sun.

CONCLUSION

The data showed the importance of sun protection for preventing changes in the pattern of skin pigmentation, and RCM proved to be an important tool for skin characterization.

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

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

Melasma update

Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmented macules on the face. Its pathogenesis is complex and involves the interplay of various factors such as genetic predisposition, ultraviolet radiation, hormonal factors, and drugs. An insight into the pathogenesis is important to devise treatment modalities that accurately target the disease process and prevent relapses. Hydroquinone remains the gold standard of treatment though many newer drugs, especially plant extracts, have been developed in the last few years. In this article, we review the pathogenetic factors involved in melasma. We also describe the newer treatment options available and their efficacy. We carried out a PubMed search using the following terms “melasma, pathogenesis, etiology, diagnosis, treatment” and have included data of the last few years.

Genital warts: comparing clinical findings to dermatoscopic aspects, in vivo reflectance confocal features and histopathologic exam

Genital warts can be diagnosed through physical examination and confirmed by histopathology. Noninvasive methods are useful for ruling out other diagnoses with no harm to the patient. In this study the clinical findings were compared to dermoscopy, reflectance confocal microscopy (RCM), and to histopathology findings, in order to determine possible patterns that can aid diagnosis of the lesion. It was possible to identify structural changes on reflectance confocal microscopy that are already known by dermoscopy, in addition to cellular changes previously seen only by histopathological examination. This study shows the use of reflectance confocal microscopy in cases of genital warts, providing important information that can be used in further studies.

In vivo confocal microscopy and histopathology of the conjunctiva in trachomatous scarring and normal tissue: a systematic comparison

AIM

To compare in vivo confocal microscopy (IVCM) with the histopathological examination of tissue and cellular changes in normal and diseased conjunctiva.

METHODS

Participants underwent clinical examination and IVCM of the tarsal conjunctiva. A biopsy of the upper tarsal conjunctiva was collected and stained with tinctorial stains and by immunohistochemical staining for CD45 and CD83. Connective tissue scarring, inflammatory cell density and the presence of dendritiform cells were quantitatively assessed in a masked manner by both IVCM and histological assessments for comparative analysis.

RESULTS

Thirty-four participants with severe trachomatous conjunctival scarring and 33 participants with healthy conjunctiva were recruited. The IVCM connective tissue scarring score was strongly associated with the histological grading of scarring (p<0.001). There was limited evidence of an association between the IVCM inflammatory cell infiltrate and the histological inflammatory cell grade (p=0.05). We did not find any evidence to support the hypothesis that dendritiform cells seen with IVCM are mature, conventional dendritic cells.

CONCLUSIONS

The results show that IVCM can be used to robustly quantitate connective tissue scarring and also has a role in measuring the inflammatory cell infiltrate. The discordance between IVCM dendritiform cells and immunohistochemical dendritic cells may be a result of study limitations or may be because these dendritiform structures represent another cell type, such as fibroblasts, rather than dendritic cells.

In vivo reflectance confocal microscopy in a typical case of melasma

Melasma is a common disorder of hypermelanosis that affects mainly young and middle-aged women of Fitzpatrick's phototypes III-V. The disease significantly impacts their lives. In vivo reflectance confocal microscopy, a spreading technology for the noninvasive evaluation of the skin up to the papillary dermis, provides real-time en face images with cellular resolution. We present a case of melasma with in vivo reflectance confocal microscopy findings closely correlated to the histopathological features described in the literature.