Reflectance confocal microscopy of blue nevus

Puig, Susana; Giacomo, Thais Bello Di; Serra, David; Cabrini, Florencia; Alós, Llúcia; Palou, Josep; Malvehy, Josep

doi:10.1684/ejd.2012.1746

Cited by 13 publications

(6 citation statements)

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“…RCM has been applied in the clinical arena for the diagnosis of nodular tumours such as NM, 9 BCCs 7,10 and others although these studies comprised a limited number of cases or heterogeneous populations (mix of flat, palpable and nodular lesions). 34,35 Furthermore, few invasive SCCs have been subjected to RCM analysis so far. 29 The aim of our study was to analyse clinically nodular tumours of different origin.…”

Section: Discussionmentioning

confidence: 99%

Is confocal microscopy a valuable tool in diagnosing nodular lesions? A study of 140 cases

et al. 2013

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SummaryBackground Nodular lesions pose diagnostic challenges because nodular melanoma may simulate all kinds of melanocytic and nonmelanocytic lesions. Reflectance confocal microscopy (RCM) is a novel technique that allows visualization of the skin at nearly histological resolution although limited laser depth penetration hampers visualization of the deep dermis. Objectives We sought to assess whether the diagnostic accuracy of RCM was comparable to histopathology for the diagnosis of nodular lesions, and to identify possible limitations of this technique. Methods We retrospectively evaluated 140 nodules by means of RCM while blinded from the histopathological diagnosis. At the end of the study the patient codes were broken and the evaluations were matched with histopathological diagnosis before performing statistical analysis. Results The study consisted of 140 nodular lesions (23 'pure' nodular melanomas, nine melanoma metastases, 28 BCCs, six invasive SCCs, 32 naevi, 14 seborrhoeic keratoses, 17 dermatofibromas, five vascular lesions and six other lesions). RCM correctly diagnosed 121 of 140 lesions (86Á4%); eight of 140 (5Á7%) lesions revealed discordance between histopathology and confocal microscopy. Eight of the 140 (5Á7%) cases were not evaluable by means of RCM due to the presence of ulceration or hyperkeratosis and three cases showed a nonspecific pattern. Interestingly, confocal microscopy reached a 96Á5% sensitivity and 94Á1% specificity (area under curve 0Á970) (95% CI 0Á924-1Á015) (P < 0Á001) for the diagnosis of melanoma. Conclusions The study is retrospective and lesions were not included on the basis of their diagnostic difficulty. Despite the limited laser depth penetration of RCM, this imaging tool represents an effective instrument in diagnosing nodular lesions; however, for fully ulcerated lesions or when a marked hyperkeratosis is present, biopsy should always be performed. Prospective studies on difficult-todiagnose nodules should be performed to analyse further the pros and cons of RCM in skin cancer diagnosis.

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Section: Discussionmentioning

confidence: 99%

Is confocal microscopy a valuable tool in diagnosing nodular lesions? A study of 140 cases

et al. 2013

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“…However, because RCM allows the visualization of microscopic structures in vivo at a cellular level resolution, a combination of two nevus cell population can be detected. One limit in the confocal evaluation can be the case of a deep dermal or blue nevus not detectable because of the limits in depth penetration of RCM . Moreover, in case of a differential diagnosis with melanoma, RCM can reveal the presence or absence of specific melanoma features (Fig.…”

Section: Melanoma Simulatorsmentioning

confidence: 99%

“…One limit in the confocal evaluation can be the case of a deep dermal or blue nevus not detectable because of the limits in depth penetration of RCM. [14][15][16] Moreover, in case of a differential diagnosis with melanoma, RCM can reveal the presence or absence of specific melanoma features ( Fig. 1).…”

Section: Combined Nevimentioning

confidence: 99%

Melanocytic nevi with special features: clinical‐dermoscopic and reflectance confocal microscopic‐findings

Borges

Zalaudek

Longo³

et al. 2013

Acad Dermatol Venereol

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Histopathology is considered the 'gold' standard for the diagnosis and classification of melanocytic nevi, but the widespread use of in vivo diagnostic technologies such as dermoscopy and reflectance confocal microscopy (RCM), has enriched profoundly the knowledge regarding the morphological variability in nevi. This is because most morphological observations made via these in vivo tools are closely correlated with features seen in histopathology. Dermoscopy has allowed for a more detailed classification of nevi. As such, dermoscopy identifies four main morphologic groups (i.e. globular, reticular, starburst and structureless blue nevi), one group of nevi located at special body sites (i.e. face, acral, nail) and one group of nevi with special features. This latter category consists of nevi of the former categories, which are typified by peculiar clinical-histopathological findings. They can be subdivided into 'melanoma simulators' including combined nevi, recurrent nevi and sclerosing nevus with pseudomelanomatous features, 'targetoid' nevi (i.e. halo, cockade, irritated targetoid haemosiderotic and eczematous nevus) and uncommon histopathological variants such as desmoplastic, white dysplastic or ballon cell nevus. While the dermoscopic and RCM patterns of the former categories have been studied in detail, little is currently known about the clinical morphology of the heterogeneous group of 'special' nevi. In this article, we describe the clinical, dermoscopic and RCM features of 'special' nevi and review the current literature on this group of melanocytic proliferations.

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“…RCM findings of blue naevus have been described recently, showing as a main feature the presence of hyperrefractile dendritic cells arranged in nests or in sheets and surrounded by bright collagen fibres. 12 The observed granular bright structures can also be easily differentiated from melanophages found in melanocytic tumours and in lesions with incontinence of pigment due to a different size and shape.…”

Section: Discussionmentioning

confidence: 93%

In vivoreflectance confocal microscopy characterization of silver deposits in localized cutaneous argyria

et al. 2016

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Summary Localized cutaneous argyria is a rare condition secondary to skin deposition of silver following exposure to substances containing this metal. The clinical appearance and dermoscopy findings require deep melanocytic lesions and particularly melanoma metastasis to be ruled out. Silver deposits are usually confirmed by scanning electron microscopy and/or energy‐dispersive X‐ray spectroscopy. Herein we describe the in vivo reflectance confocal microscopy (RCM) features observed in one case of localized cutaneous argyria. These features include the presence of a hyperrefractile network in the papillary dermis and a periadnexal dotted bright pattern. In vivo RCM might be a useful tool for an early diagnosis of this uncommon entity.

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Reflectance confocal microscopy of blue nevus

Cited by 13 publications

References 0 publications

Is confocal microscopy a valuable tool in diagnosing nodular lesions? A study of 140 cases

Is confocal microscopy a valuable tool in diagnosing nodular lesions? A study of 140 cases

Melanocytic nevi with special features: clinical‐dermoscopic and reflectance confocal microscopic‐findings

In vivoreflectance confocal microscopy characterization of silver deposits in localized cutaneous argyria

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