A case of recurrent lentigo maligna diagnosed with precise reflectance confocal microscopy–guided biopsy technique

Abstract

An 87-year-old woman presented for a 12-month follow-up examination after radiation therapy for management of a 20 3 25-mm lentigo maligna on her left cheek (Fig 1, A).

Response to: A case of recurrent lentigo maligna diagnosed with precise reflectance confocal microscopy-guided biopsy technique

“…The surgical ink is a sterile dye traditionally used to optimize intraoperative tissue orientation and margin marking. 5 The ink securely adheres to tissue and brightly stains the area for easy recognition by 1 We have successfully Q4 utilized this technique on several cases of RCM-identified suspicious pigmented and nonpigmented lesions, including a case of LM recurring in a scar. This highlights how the use of the described RCM-guided biopsy technique can be used to improve localization for biopsies for challenging cases and increase diagnostic accuracy in an efficient and time-sensitive manner that may have more widespread appeal compared to previously described techniques.…”

“…To the Editor: We would like to commend Robinson et al 1 for the introduction and successful application of a new reflectance confocal microscopy (RCM)-guided biopsy technique in the diagnosis of lentigo maligna (LM). LM is a common form of melanoma in situ that often shares many clinical features of benign pigmented lesions, making it diagnostically challenging for clinicians and pathologists.…”

“… 2 Currently, guidelines recommend biopsies for LM be taken from the area with the highest concentration of pigment in order to minimize sampling error. 3 Robinson et al 1 proposed a clever solution by utilizing adhesive paper tape to delineate the area of the lesion with suspicious findings on RCM to guide biopsy. By creating a window for visualization in the tape, the lesion is evaluated through the window by handheld RCM (Vivascope 3000; CaliberID), constantly repositioning the tape until concerning RCM features are identified.…”

“…By creating a window for visualization in the tape, the lesion is evaluated through the window by handheld RCM (Vivascope 3000; CaliberID), constantly repositioning the tape until concerning RCM features are identified. 1 The authors successfully implemented this tape technique to perform a precise RCM-guided biopsy in order to minimize sampling errors and improve diagnostic accuracy.…”

“…When evaluating large skin lesions, such as those typically seen in LM, the handheld RCM is often preferred over traditional RCM (Vivascope 1500, CaliberID) due to its rapid imaging and evaluation. 4 The method by Robinson et al 1 requires constant repositioning of the tape and limited visualization through a small window, which may be time consuming and pose a barrier to the widespread adoption of this technique, especially when evaluating large lesions. We propose an alternative method for performing RCM-guided biopsies that does not significantly increase the time needed for complete lesional assessment.…”