Reflectance confocal microscopy of skin in vivo: From bench to bedside

Abstract

Following more than two decades of effort, reflectance confocal microscopy (RCM) imaging of skin was granted codes for reimbursement by the US Centers for Medicare and Medicaid Services. Dermatologists in the USA have started billing and receiving reimbursement for the imaging procedure and for the reading and interpretation of images. RCM imaging combined with dermoscopic examination is guiding the triage of lesions into those that appear benign, which are being spared from biopsy, against those that appear suspicious, which are then biopsied. Thus far, a few thousand patients have been spared from biopsy of benign lesions. The journey of RCM imaging from bench to bedside is certainly a success story, but still much more work lies ahead toward wider dissemination, acceptance, and adoption. We present a brief review of RCM imaging and highlight key challenges and opportunities. The success of RCM imaging paves the way for other emerging optical technologies, as well—and our bet for the future is on multimodal approaches.

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.…”

The fractional laser‐induced coagulation zone characterized over time by laser scanning confocal microscopy—A proof of concept study

“…Fluorescence confocal microscopy (FCM) enables imaging of specific endogenous and exogenous fluorescent molecules for example fluorescein with an excitation wavelength of 488 nm. RCM has successfully been used to image skin morphology of superficial skin diseases, in particular non-melanoma skin cancer, actinic keratosis (AKs), and melanocytic lesions [12][13][14][15][16]. Further, FCM and RCM imaging have been combined with fluorescent molecules and nonfluorescent compounds in explorative contrast agent and drug delivery studies [17][18][19][20][21][22].…”

Fluorescence detection, enumeration and characterization of single circulating cellsin vivo: technology, applications and future prospects

“…Likewise, reflectance confocal microscopy with intrinsic contrast is already widely studied in humans in dermatological applications, e.g. (Rajadhyaksha et al , 1995; Rajadhyaksha et al , 2017; Stevenson et al , 2013; Longo et al , 2013). Other candidate anatomical locations include the capillary bed in the earlobe or retina of a human.…”