Reflectance Confocal Microscopy in Pigmentary Disorders

Chapter
Part of the Updates in Clinical Dermatology book series (UCD)

Abstract

In vivo reflectance confocal microscopy (RCM) is a non-invasive tool for imaging the superficial layers of the skin. It has been recently introduced in dermatology practice. The RCM provides real-time, dynamic horizontal images that provide cellular and subcellular details in the depth of the skin.

Melanin is one of the main refractile targets of RCM (appears bright), so this technique is an interesting method of evaluation of both hyperpigmentary and hypopigmentary disorders (acquired pigmentary skin disorders such as melasma and vitiligo or melanocytic lesions such naevi and melanoma). The interpretation of the images must be done according to the clinical history and symptoms as in histopathology.

Keywords

Reflectance Confocal microscopy Skin imaging Pigmentary disorders Melasma Vitiligo Melanoma Naevi 

References

  1. 1.
    Pellacani G, Guitera P, Longo C, Avramidis M, Seidenari S, Menzies S. The impact of in vivo reflectance confocal microscopy for the diagnostic accuracy of melanoma and equivocal melanocytic lesions. J Invest Dermatol. 2007;127(12):2759–65.CrossRefGoogle Scholar
  2. 2.
    Xiong YD, Ma S, Li X, Zhong X, Duan C, Chen Q. A meta-analysis of reflectance confocal microscopy for the diagnosis of malignant skin tumours. J Eur Acad Dermatol Venereol. 2016;30(8):1295–302.CrossRefGoogle Scholar
  3. 3.
    Guida S, Pellacani G, Cesinaro AM, Moscarella E, Argenziano G, Farnetani F, et al. Spitz naevi and melanomas with similar dermoscopic patterns: can confocal microscopy differentiate? Br J Dermatol. 2016;174(3):610–6.CrossRefGoogle Scholar
  4. 4.
    Rajadhyaksha M, Grossman M, Esterowitz D, Webb RH, Anderson RR. In vivo confocal scanning laser microscopy of human skin: melanin provides strong contrast. J Invest Dermatol. 1995;104(6):946–52.CrossRefGoogle Scholar
  5. 5.
    Busam KJ, Charles C, Lee G, Halpern AC. Morphologic features of melanocytes, pigmented keratinocytes, and melanophages by in vivo confocal scanning laser microscopy. Mod Pathol. 2001;14(9):862–8.CrossRefGoogle Scholar
  6. 6.
    Scope A, Benvenuto-Andrade C, Agero AL, Malvehy J, Puig S, Rajadhyaksha M, et al. In vivo reflectance confocal microscopy imaging of melanocytic skin lesions: consensus terminology glossary and illustrative images. J Am Acad Dermatol. 2007;57(4):644–58.CrossRefGoogle Scholar
  7. 7.
    Xiang W, Peng J, Song X, Xu A, Zhang D, Liu J, et al. In vivo visualization of honeycomb pattern, cobblestone pattern, ringed pattern, and dermal papillae by confocal laser scanning microscopy. Skin Res Technol. 2016;22(1):32–9.CrossRefGoogle Scholar
  8. 8.
    Rajadhyaksha M, Gonzalez S, Zavislan JM, Anderson RR, Webb RH. In vivo confocal scanning laser microscopy of human skin II: advances in instrumentation and comparison with histology. J Invest Dermatol. 1999;113(3):293–303.CrossRefGoogle Scholar
  9. 9.
    Segura S, Pellacani G, Puig S, Longo C, Bassoli S, Guitera P, et al. In vivo microscopic features of nodular melanomas: dermoscopy, confocal microscopy, and histopathologic correlates. Arch Dermatol. 2008;144(10):1311–20.CrossRefGoogle Scholar
  10. 10.
    Pan ZY, Liang J, Zhang QA, Lin JR, Zheng ZZ. In vivo reflectance confocal microscopy of extramammary Paget disease: diagnostic evaluation and surgical management. J Am Acad Dermatol. 2012;66(2):e47–53.CrossRefGoogle Scholar
  11. 11.
    Pellacani G, Cesinaro AM, Seidenari S. Reflectance-mode confocal microscopy for the in vivo characterization of pagetoid melanocytosis in melanomas and nevi. J Invest Dermatol. 2005;125(3):532–7.CrossRefGoogle Scholar
  12. 12.
    Hoogedoorn L, Peppelman M, van de Kerkhof PC, van Erp PE, Gerritsen MJ. The value of in vivo reflectance confocal microscopy in the diagnosis and monitoring of inflammatory and infectious skin diseases: a systematic review. Br J Dermatol. 2015;172(5):1222–48.CrossRefGoogle Scholar
  13. 13.
    Ardigo M, Cameli N, Berardesca E, Gonzalez S. Characterization and evaluation of pigment distribution and response to therapy in melasma using in vivo reflectance confocal microscopy: a preliminary study. J Eur Acad Dermatol Venereol. 2010;24(11):1296–303.CrossRefGoogle Scholar
  14. 14.
    Kang HY, Bahadoran P, Suzuki I, Zugaj D, Khemis A, Passeron T, et al. In vivo reflectance confocal microscopy detects pigmentary changes in melasma at a cellular level resolution. Exp Dermatol. 2010;19(8):e228–33.CrossRefGoogle Scholar
  15. 15.
    Pan ZY, Yan F, Zhang ZH, Zhang QA, Xiang LH, Zheng ZZ. In vivo reflectance confocal microscopy for the differential diagnosis between vitiligo and nevus depigmentosus. Int J Dermatol. 2011;50(6):740–5.CrossRefGoogle Scholar
  16. 16.
    Lai LG, Xu AE. In vivo reflectance confocal microscopy imaging of vitiligo, nevus depigmentosus and nevus anemicus. Skin Res Technol. 2011;17(4):404–10.CrossRefGoogle Scholar
  17. 17.
    Xiang W, Xu A, Xu J, Bi Z, Shang Y, Ren Q. In vivo confocal laser scanning microscopy of hypopigmented macules: a preliminary comparison of confocal images in vitiligo, nevus depigmentosus and postinflammatory hypopigmentation. Lasers Med Sci. 2010;25(4):551–8.CrossRefGoogle Scholar
  18. 18.
    Sehgal VN, Srivastava G. Hereditary hypo/de-pigmented dermatoses: an overview. Int J Dermatol. 2008;47(10):1041–50.CrossRefGoogle Scholar
  19. 19.
    Ahkami RN, Schwartz RA. Nevus anemicus. Dermatology. 1999;198(4):327–9.CrossRefGoogle Scholar
  20. 20.
    Spitz S. Melanomas of childhood. Am J Pathol. 1948;24(3):591–609.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Pellacani G, Longo C, Ferrara G, Cesinaro AM, Bassoli S, Guitera P, et al. Spitz nevi: in vivo confocal microscopic features, dermatoscopic aspects, histopathologic correlates, and diagnostic significance. J Am Acad Dermatol. 2009;60(2):236–47.CrossRefGoogle Scholar
  22. 22.
    Vaidya DC, Schwartz RA, Janniger CK. Nevus spilus. Cutis. 2007;80(6):465–8.PubMedGoogle Scholar
  23. 23.
    Schaffer JV, Orlow SJ, Lazova R, Bolognia JL. Speckled lentiginous nevus--classic congenital melanocytic nevus hybrid not the result of “collision”. Arch Dermatol. 2001;137(12):1655.PubMedGoogle Scholar
  24. 24.
    Haenssle HA, Kaune KM, Buhl T, Thoms KM, Padeken M, Emmert S, et al. Melanoma arising in segmental nevus spilus: detection by sequential digital dermatoscopy. J Am Acad Dermatol. 2009;61(2):337–41.CrossRefGoogle Scholar
  25. 25.
    Prodinger C, Tatarski R, Laimer M, Ahlgrimm-Siess V. Large congenital nevus spilus-improved follow-up through the use of in vivo reflectance confocal microscopy. Dermatol Pract Concept. 2013;3(2):55–8.CrossRefGoogle Scholar
  26. 26.
    Laing ME, Coates E, Jopp-McKay A, Scolyer RA, Guitera P. Atypical naevus spilus: detection by in vivo confocal microscopy. Clin Exp Dermatol. 2014;39(5):616–9.CrossRefGoogle Scholar
  27. 27.
    Goldstein AM, Tucker MA. Dysplastic nevi and melanoma. Cancer Epidemiol Biomark Prev. 2013;22(4):528–32.CrossRefGoogle Scholar
  28. 28.
    Rosendahl CO, Grant-Kels JM, Que SK. Dysplastic nevus: fact and fiction. J Am Acad Dermatol. 2015;73(3):507–12.CrossRefGoogle Scholar
  29. 29.
    NIH consensus conference. Diagnosis and treatment of early melanoma. JAMA. 1992;268(10):1314–9.CrossRefGoogle Scholar
  30. 30.
    Pellacani G, Farnetani F, Gonzalez S, Longo C, Cesinaro AM, Casari A, et al. In vivo confocal microscopy for detection and grading of dysplastic nevi: a pilot study. J Am Acad Dermatol. 2012;66(3):e109–21.CrossRefGoogle Scholar
  31. 31.
    Nikolaou V, Stratigos AJ. Emerging trends in the epidemiology of melanoma. Br J Dermatol. 2014;170(1):11–9.CrossRefGoogle Scholar
  32. 32.
    Usher-Smith JA, Emery J, Kassianos AP, Walter FM. Risk prediction models for melanoma: a systematic review. Cancer Epidemiol Biomark Prev. 2014;23(8):1450–63.CrossRefGoogle Scholar
  33. 33.
    Scheibner A, Milton GW, McCarthy WH, Norlund JJ, Pearson LJ. Multiple primary melanoma - a review of 90 cases. Australas J Dermatol. 1982;23(1):1–8.CrossRefGoogle Scholar
  34. 34.
    Gupta BK, Piedmonte MR, Karakousis CP. Attributes and survival patterns of multiple primary cutaneous malignant melanoma. Cancer. 1991;67(7):1984–9.CrossRefGoogle Scholar
  35. 35.
    Braun RP, Saurat JH, French LE. Dermoscopy of pigmented lesions: a valuable tool in the diagnosis of melanoma. Swiss Med Wkly. 2004;134(7–8):83–90.PubMedGoogle Scholar
  36. 36.
    Guitera P, Menzies SW. State of the art of diagnostic technology for early-stage melanoma. Expert Rev Anticancer Ther. 2011;11(5):715–23.CrossRefGoogle Scholar
  37. 37.
    Guitera P, Menzies SW, Longo C, Cesinaro AM, Scolyer RA, Pellacani G. In vivo confocal microscopy for diagnosis of melanoma and basal cell carcinoma using a two-step method: analysis of 710 consecutive clinically equivocal cases. J Invest Dermatol. 2012;132(10):2386–94.CrossRefGoogle Scholar
  38. 38.
    Guitera P, Moloney FJ, Menzies SW, Stretch JR, Quinn MJ, Hong A, et al. Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy. JAMA Dermatol. 2013;149(6):692–8.CrossRefGoogle Scholar
  39. 39.
    Guitera P, Haydu LE, Menzies SW, Scolyer RA, Hong A, Fogarty GB, et al. Surveillance for treatment failure of lentigo maligna with dermoscopy and in vivo confocal microscopy: new descriptors. Br J Dermatol. 2014;170(6):1305–12.CrossRefGoogle Scholar
  40. 40.
    Guitera P, Pellacani G, Crotty KA, Scolyer RA, Li LX, Bassoli S, et al. The impact of in vivo reflectance confocal microscopy on the diagnostic accuracy of lentigo maligna and equivocal pigmented and nonpigmented macules of the face. J Invest Dermatol. 2010;130(8):2080–91.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Melanoma Diagnostic Centre, Royal Prince Alfred HospitalSydneyAustralia
  2. 2.Department of DermatologyMelanoma Diagnostic Centre, Royal Prince Alfred Hospital and Melanoma Institute Australia, University of SydneySydneyAustralia

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