Skin Cancer pp 267-277 | Cite as

Reflectance Confocal Microscopy in Skin Cancer

  • Salvador GonzalezEmail author
  • Virginia Sanchez
  • Susanne Lange-Asschenfeldt
  • Martina Ulrich
Part of the Current Clinical Pathology book series (CCPATH)


Reflectance confocal microscopy (RCM) is a relatively novel, light microscopy-based, noninvasive imaging tool that permits visualizing structures in living skin in real time with resolution comparable to that of histological analysis. Apart from its benefit as a diagnosis tool, RCM also allows monitoring the evolution of the skin over time and in response to treatment, e.g., photodynamic therapy and postsurgical healing. In this chapter, we provide a brief overview of the fundamentals of RCM and then focus on its employment as a diagnosis and monitoring tool in skin cancer and other skin pathologies.


Basal Cell Carcinoma Actinic Keratosis Mycosis Fungoides Dermal Papilla Melanocytic Lesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Cobblestone pattern

is the pattern found in basal layer keratynocytes, which appears as one layer of small cuboid nucleated cells usually more brilliant due to the high content in melanin. It is the confocal pattern usually observed at the basal layer in dark phototypes.

Dark silhouettes

found in BCC refer to those areas where the stroma reflectance is higher than the tumor islands.

Dermal papillary rings

is the confocal pattern found at the dermoepidermal junction and it appears as bright circular structures made of basal cells that surround certain darker areas, which correspond to the dermal papillae.


dark linear valleys

Honeycombed pattern

is the pattern found in normal keratinocytes of the granular and spinous layers. These are cells with dark central oval-shaped nuclei and bright cytoplasm.

Nuclear polarization

refers to the elongated monomorphic nuclei along the same axis of orientation and present as a general confocal feature of BCC (Basal cell carcinoma). It often reflects as peripheral palisading.


Reflectance confocal microscopy.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Salvador Gonzalez
    • 1
    • 2
    Email author
  • Virginia Sanchez
    • 3
  • Susanne Lange-Asschenfeldt
    • 4
  • Martina Ulrich
    • 4
  1. 1.Dermatology Service, Ramon y Cajal HospitalAlcalá UniversityMadridSpain
  2. 2.Dermatology ServiceMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Dermatology ServiceCEU UniversityMadridSpain
  4. 4.Department of DermatologyCharité – UniversitätsmedizinBerlinGermany

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