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Role of Reflectance Confocal Microscopy in Cryosurgery

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Cryosurgery

Abstract

Reflectance Confocal Microscopy (RCM) is a noninvasive in vivo imaging technique intended to help the clinician diagnostically view skin lesions in real time while avoiding trauma or scar formation from surgical biopsies. RCM’s principles rely on the natural variation of refractive indices in tissue structures at different depths of the skin. With the use of a near-infrared diode laser, light projected from the confocal microscope focuses on a specific point in the skin. Reflected light from this point is captured through a pinhole-sized opening by a detector. The use of such a small aperture segregates reflected light from the focal section of interest from other areas of tissue. The depth of light penetration is dependent on wavelength, laser power, reflectivity of the superficial layers of skin, and scattering properties of the dermis. Of all these factors, only laser power can be changed. At longer wavelengths deeper penetration is gained at the expense of resolution, therefore present single laser confocal microscopes are fixed at 830 nm. Each section projects as a two-dimensional image with dimensions of 0.5 mm laterally and 4 mm axially that are oriented parallel (en face) to the skin surface. The resolution of each image is comparable to those of histological sections. A clinical breakthrough in RCM has been the capability to bring to the bedside an almost equivalent tool to histological evaluation without the need for invasive diagnostic procedures. In the setting of cryosurgery, RCM has the capability to aid in the diagnostic decision of a lesion prior to undergoing therapy, which has the advantage of avoiding postponing the treatment until the diagnosis is histologically confirmed. The sensitivity and specificity of RCM varies significantly across tumor types, level of training of the operator, and expertise of the individual interpreting the confocal images. This chapter will cover the applications of RCM.

Disclosures

Clara Curiel-Lewandrowski: MelaSciences, Inc-Consulting; Medical Directions, Inc-Consulting; DermSpectra LLC-Founder/Member.

Funding Source

Supported by a contract (NO1-CN-35158) from the National Cancer Institute, Division of Cancer Prevention, the Arizona Cancer Center Support Grant (CA023074), and Janice and Alan Levine Endowed Chair in Cancer Research, Arizona Cancer Center, University of Arizona.

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Author information

Authors and Affiliations

  1. Department of Dermatology, University of Arizona Medical Center, 1501 N. Campbell Avenue, Tucson, AZ, 85724, USA

    Joseph Chao

  2. Department of Dermatology, Medical University Graz, Auenbruggerplatz 8, Graz, 8036, Austria

    Rainer Hofmann-Wellenhof MD

  3. Section of Dermatology, Department of Medicine, University of Arizona Cancer Center, 1515 N. Campbell Ave, Tucson, 85724, AZ, USA

    Clara Curiel-Lewandrowski MD

Authors
  1. Joseph Chao
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  2. Rainer Hofmann-Wellenhof MD
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  3. Clara Curiel-Lewandrowski MD
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Corresponding authors

Correspondence to Joseph Chao or Clara Curiel-Lewandrowski MD .

Editor information

Editors and Affiliations

  1. Department of Dermatology, Pius Hospital de Valls, Valls, Tarragona, Spain

    Paola Pasquali

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Chao, J., Hofmann-Wellenhof, R., Curiel-Lewandrowski, C. (2015). Role of Reflectance Confocal Microscopy in Cryosurgery. In: Pasquali, P. (eds) Cryosurgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-43939-5_14

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  • DOI: https://doi.org/10.1007/978-3-662-43939-5_14

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-43938-8

  • Online ISBN: 978-3-662-43939-5

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