In Vivo Reflectance Confocal Microscopy to Optimize the Spaghetti Technique for Defining Surgical Margins of Lentigo Maligna

Abstract

This procedure allows accurate definition of the surgical margins of LM, with a low rate of multiple excisions, sparing tissue in functional and aesthetic areas. These results should be confirmed on the basis of a larger series with longer follow-up.

Correlation of Handheld Reflectance Confocal Microscopy With Radial Video Mosaicing for Margin Mapping of Lentigo Maligna and Lentigo Maligna Melanoma

“…These results highlight that RCM improves LM/LMM margin evaluation 12,14,15 and confirm the need for increased surgical margins to achieve clear margins. 4,25–27 We used an imaging approach that parallels the design of staged excision with radial histopathologic sectioning, by imaging with HRCM radially from the center to the periphery.…”

“…To overcome variation in margin estimation due to wound retraction after electrocoagulation, specimen shrinkage after formalin fixation, 29 or inaccuracy in the digital margin calculation, we performed 2 methods of image calibration, margin estimation, and videomosaic quadrant size estimation, which have not been described in previous studies assessing the LM/LMM margins. 7,8,14,15 However, further studies involving multiple readers with varying levels of experience are needed to validate these results, since our study included only two confocalists who acquired data and one who analyzed the results.…”

“…14 Conversely, handheld RCM (HRCM) can acquire images and videos along ad hoc arbitrarily freeform non-rastered paths and over large areas which the user determines in real-time, allowing a “live” approach to mapping margins over large areas. Although the HRCM allows a less restrictive imaging acquisition, the data regarding its use in diagnosing and mapping LM/LMM is limited, 15,16 mainly due to the lack of orientation during image acquisition and lack of mosaicking capabilities in the HRCM software. However, with the advent of HRCM videomosaicking, it is now possible to transform dynamic videos into static videomosaics to help obtain architectural information.…”

Lentigo Maligna and Lentigo Maligna Melanoma: Contemporary Issues in Diagnosis and Management

“…This noninvasive technique allows imaging of up to 200 micrometers in depth of the epidermis/dermis with cellular resolution. The technique has been described as an adjunct to surgical treatment to delineate surgical margins [30], as well as a monitoring tool to evaluate for recurrence of LM following treatment [31][32][33][34]. Specific features that have been described as indicative of LM and LMM include cord-like rete ridges and adnexal infiltration by atypical melanocytes [35].…”

Advances in the use of Reflectance Confocal Microscopy in Melanoma

“…RCM also reduces the risk of positive margins after surgical excision [42,77]. RCM has been used successfully intraoperatively to achieve negative surgical margins in a case of standard wide excision [78], and also in combination with the staged excision spaghetti technique [79]. Margin delineation of LM and LMM with the handheld RCM (HRCM) is limited by the lack of precise orientation during imaging and the small field of view in absence of mosaics.…”