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Evaluating the effect of detection modalities in the Danish clinical follow-up program of cutaneous melanoma—a retrospective cohort study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Dal Forno T, Milman LDM, Bakos L, Bakos RM. Dermoscopic Aspects of Traumatized Nevi After Dermabrasion. Dermatol Surg 2022; 48:299-303. [PMID: 34966122 DOI: 10.1097/dss.0000000000003278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Melanocytic nevi submitted to trauma can undergo clinical, dermoscopic, and even histological changes, making it difficult to differentiate them from a melanoma. OBJECTIVE The aim of this study is to evaluate the dermoscopic changes of traumatized nevi after dermabrasion. METHODS Dermoscopic images of acquired melanocytic nevi were compared before and 4 weeks after half of their area had undergone dermabrasion. RESULTS The sample consisted of 50 lesions from 15 patients. The homogeneous pattern was the most frequent, followed by the reticular, cobblestone, and globular patterns. After dermabrasion, nearly half of the lesions (46%) became dermatoscopically asymmetric. Among all lesions, structureless areas, dotted vessels and erythema were the most frequent new dermoscopic structures. CONCLUSION Trauma after dermabrasion may induce significant dermoscopic changes in melanocytic nevi. Although the global pattern did not change, most of the lesions became asymmetric, with the appearance or fading of dermoscopic structures and colors. A history of recent trauma should be investigated when evaluating pigmented lesions.
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Affiliation(s)
| | - Laura de Mattos Milman
- Dermatologist, Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lúcio Bakos
- Department of Dermatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Renato Marchiori Bakos
- Dermatologist, Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Dermatology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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3
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Progress in the application of reflectance confocal microscopy in dermatology. Postepy Dermatol Alergol 2021; 38:709-715. [PMID: 34849113 PMCID: PMC8610039 DOI: 10.5114/ada.2021.110077] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/10/2019] [Indexed: 12/23/2022] Open
Abstract
Reflectance confocal microscopy (RCM) is abbreviated as skin three-dimensional computed tomography, which can help clearly observe the structure of the epidermis and superficial dermis. It is a non-invasive skin disease examination method and provides fast access to real-time, dynamic skin micro-anatomical images. Therefore, RCM is widely used in the clinical diagnosis of skin diseases. For example, the RCM features of vitiligo are as follows: pigment loss or partial pigment loss in the lesion area, loss of the basal layer pigment ring. The RCM findings of Riehl melanosis are as follows: basal cell liquefaction and degeneration. The RCM results for verruca plana show: the Rose-like structure. The characteristics of psoriasis under RCM include: hyperkeratosis, parakeratosis, thickening of the spinous layer, capillary dilatation and hyperaemia, peripheral inflammatory cell infiltration. Epidermal brain-like structure was observed under RCM of seborrheic keratosis. With RCM, image acquisition and preservation of the skin is convenient, and the technique is convenient for comparing the development of lesions during long-term follow-up observation. Therefore, it helps to understand disease development in real time and dynamically and can be used to evaluate the curative effect. In this article, we briefly review the technical principles, diagnostic criteria for RCM application and RCM-related research progress in the diagnosis of pigmentary diseases, inflammatory diseases, skin tumours, and other common skin diseases.
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Jung JM, Cho JY, Lee WJ, Chang SE, Lee MW, Won CH. Emerging Minimally Invasive Technologies for the Detection of Skin Cancer. J Pers Med 2021; 11:951. [PMID: 34683091 PMCID: PMC8538732 DOI: 10.3390/jpm11100951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/23/2022] Open
Abstract
With the increasing incidence of skin cancer, many noninvasive technologies to detect its presence have been developed. This review focuses on reflectance confocal microscopy (RCM), optical coherence tomography (OCT), high-frequency ultrasound (HFUS), electrical impedance spectroscopy (EIS), pigmented lesion assay (PLA), and Raman spectroscopy (RS) and discusses the basic principle, clinical applications, advantages, and disadvantages of each technology. RCM provides high cellular resolution and has high sensitivity and specificity for the diagnosis of skin cancer. OCT provides lower resolution than RCM, although its evaluable depth is deeper than that of RCM. RCM and OCT may be useful in reducing the number of unnecessary biopsies, evaluating the tumor margin, and monitoring treatment response. HFUS can be mainly used to delineate tumor depths or margins and monitor the treatment response. EIS provides high sensitivity but low specificity for the diagnosis of skin malignancies. PLA, which is based on the genetic information of lesions, is applicable for the detection of melanoma with high sensitivity and moderate-to-high specificity. RS showed high accuracy for the diagnosis of skin cancer, although more clinical studies are required. Advances in these technologies for the diagnosis of skin cancer can lead to the realization of optimized and individualized treatments.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Ji Young Cho
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea;
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.M.J.); (W.J.L.); (S.E.C.); (M.W.L.)
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Shavlokhova V, Flechtenmacher C, Sandhu S, Vollmer M, Vollmer A, Pilz M, Hoffmann J, Ristow O, Engel M, Freudlsperger C. Feasibility and Implementation of Ex Vivo Fluorescence Confocal Microscopy for Diagnosis of Oral Leukoplakia: Preliminary Study. Diagnostics (Basel) 2021; 11:diagnostics11060951. [PMID: 34073373 PMCID: PMC8228631 DOI: 10.3390/diagnostics11060951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Oral leukoplakia is a potentially malignant lesion with a clinical impression similar to different benign and malignant lesions. Ex vivo fluorescence confocal microscopy is a developing approach for a rapid “chairside” detection of oral lesions with a cellular-level resolution. A possible application of interest is a quick differentiation of benign oral pathology from normal or cancerous tissue. The aim of this study was to analyze the sensitivity and specificity of ex vivo fluorescence confocal microscopy (FCM) for detecting oral leukoplakia and to compare confocal images with gold-standard histopathology. Methods: Imaging of 106 submosaics of 27 oral lesions was performed using an ex vivo fluorescence confocal microscope immediately after excision. Every confocal image was qualitatively assessed for presence or absence of leukoplakia by an expert reader of confocal images. The results were compared to conventional histopathology with H&E staining. Results: Leukoplakia was detected with an overall sensitivity of 96.3%, specificity of 92.3%, positive predictive value of 93%, and negative predictive value of 96%. Conclusion: The results demonstrate the potential of ex vivo confocal microscopy in fresh tissue for rapid real-time assessment of oral pathologies.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (O.R.); (M.E.); (C.F.)
- Correspondence:
| | | | - Sameena Sandhu
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (O.R.); (M.E.); (C.F.)
| | - Michael Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (O.R.); (M.E.); (C.F.)
| | - Andreas Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (O.R.); (M.E.); (C.F.)
| | - Maximilian Pilz
- Department of Medical Biometry at the Institute of Medical Biometry and Informatics, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (O.R.); (M.E.); (C.F.)
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (O.R.); (M.E.); (C.F.)
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (O.R.); (M.E.); (C.F.)
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (S.S.); (M.V.); (A.V.); (J.H.); (O.R.); (M.E.); (C.F.)
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6
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Shavlokhova V, Flechtenmacher C, Sandhu S, Vollmer M, Hoffmann J, Engel M, Ristow O, Freudlsperger C. Features of oral squamous cell carcinoma in ex vivo fluorescence confocal microscopy. Int J Dermatol 2020; 60:236-240. [PMID: 33368199 DOI: 10.1111/ijd.15152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Real-time microscopic imaging of freshly excised oral squamous cell carcinomas (OSCCs) would be potentially supportive in rapid recognition of oral malignancy and an optimal and time-saving management of patients' surgical treatment. OBJECTIVES The aim of this study was to examine oral squamous cell cancer tissue in regards to the commonly known and well-described histomorphologic criteria for the diagnosis of OSCC in ex vivo confocal fluorescent microscopy and to analyze its correlation with grade of differentiation and level of invasiveness. METHODS Ex vivo confocal laser scanning microscopy (CLSM) images of 38 OSCCs were evaluated immediately after excision for presence or absence of various cytological and architectural features based on the histopathological background. Next, these features were compared to the grade of differentiation as elaborated via gold standard histologic examination. RESULTS Of 38 invasive OSCCs, 14 were well differentiated, while three moderately and 19 were poorly differentiated. The presence of the commonly known cytologic and histopathologic criteria for the diagnosis of oral squamous cell carcinoma such as the destruction of the basal cell membrane, cellular and nuclear pleomorphism, anisocytosis, intraepithelial keratinization, nuclear hyperchromasia, atypical mitotic figures as well as the presence of necrosis, and mixed inflammation could be observed in ex vivo fluorescence confocal microscopy (FCM). In ex vivo fluorescence confocal microscopy pictures, cellular pleomorphism and anisocytosis were observed more often in poorly differentiated OSCCs. Intraepithelial keratinization was associated with well differentiated and moderately differentiated OSCCs. CONCLUSION The results demonstrate the high potential of ex vivo fluorescence confocal microscopy in fresh tissue for rapid real-time diagnosis of OSCC.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Sameena Sandhu
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Ristow
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
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7
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Shavlokhova V, Flechtenmacher C, Sandhu S, Pilz M, Vollmer M, Hoffmann J, Engel M, Freudlsperger C. Detection of oral squamous cell carcinoma with ex vivo fluorescence confocal microscopy: Sensitivity and specificity compared to histopathology. JOURNAL OF BIOPHOTONICS 2020; 13:e202000100. [PMID: 32418329 DOI: 10.1002/jbio.202000100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
Real-time microscopic imaging of freshly excised tissue enables a rapid bedside-pathology. A possible application of interest is the detection of oral squamous cell carcinomas (OSCCs). The aim of this study was to analyze the sensitivity and specificity of ex vivo fluorescence confocal microscopy (FCM) for OSCCs and to compare confocal images visually and qualitatively with gold standard histopathology. Two hundred eighty ex vivo FCM images were prospectively collected and evaluated immediately after excision. Every confocal image was blindly assessed for the presence or absence of malignancy by two clinicians and one pathologist. The results were compared with conventional histopathology with hematoxylin and eosin staining. OSCCs were detected with a very high sensitivity of 0.991, specificity of 0.9527, positive predictive value of 0.9322 and negative predictive value of 0.9938. The results demonstrate the potential of ex vivo FCM in fresh tissue for rapid real-time surgical pathology.
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Affiliation(s)
- Veronika Shavlokhova
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Sameena Sandhu
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Pilz
- Department of Medical Biometry at the Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Vollmer
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michel Engel
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Shahriari N, Grant-Kels JM, Rabinovitz H, Oliviero M, Scope A. Reflectance confocal microscopy: Principles, basic terminology, clinical indications, limitations, and practical considerations. J Am Acad Dermatol 2020; 84:1-14. [PMID: 32553679 DOI: 10.1016/j.jaad.2020.05.153] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022]
Abstract
Reflectance confocal microscopy (RCM) is a noninvasive imaging tool used for in vivo visualization of the skin. It has been extensively studied for use in the evaluation of equivocal cutaneous neoplasms to decrease the number of biopsy procedures in patients with benign lesions. Furthermore, its applications are broadening to include presurgical cancer margin mapping, tumor recurrence surveillance, monitoring of ablative and noninvasive therapies, and stratification of inflammatory disorders. With the approval of category I Current Procedural Terminology reimbursement codes for RCM image acquisition and interpretation, use of this technology has been increasingly adopted by dermatologists. The first article in this 2-part continuing medical education series highlights basic terminology, principles, clinical applications, limitations, and practical considerations in the clinical use of RCM technology.
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Affiliation(s)
- Neda Shahriari
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Dermatology, University of Florida, Gainesville, Florida
| | - Harold Rabinovitz
- Skin and Cancer Associates, Plantation, Florida; Dermatology Department, Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - Alon Scope
- The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dermatology Service, Memorial Sloan-Kettering Center, New York, New York
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9
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Navarrete-Dechent C, Cordova M, Liopyris K, Rishpon A, Aleissa S, Rossi AM, Lee E, Chen CCJ, Busam KJ, Marghoob AA, Nehal KS. Reflectance confocal microscopy and dermoscopy aid in evaluating repigmentation within or adjacent to lentigo maligna melanoma surgical scars. J Eur Acad Dermatol Venereol 2019; 34:74-81. [PMID: 31325402 DOI: 10.1111/jdv.15819] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Determining whether repigmentation within or adjacent to lentigo maligna or lentigo maligna melanoma (LM/LMM) scars represents recurrence of melanoma is challenging. The use of reflectance confocal microscopy (RCM) and dermoscopy may aid in differentiating true melanoma recurrence from other causes of repigmentation. OBJECTIVES To describe the characteristics of repigmentation within or adjacent to LM/LMM scars observable on RCM and dermoscopy. METHODS We retrospectively analysed patients who presented with new pigmentation within or adjacent to scars from surgically treated LM/LMM between January 2014 and December 2018. Clinical and demographic characteristics and time to recurrence were recorded. RCM was used to evaluate areas of pigmentation before biopsy. If available, dermoscopic images were also evaluated. RESULTS In total, 30 confocal studies in 29 patients were included in the study cohort. Twenty-one patients had biopsy-confirmed recurrent LM/LMM; the remainder had pigmented actinic keratosis (n = 4) or hyperpigmentation/solar lentigo (n = 5). RCM had sensitivity of 95.24% (95% CI, 76.18-99.88%), specificity of 77.7% (95% CI, 39.99-97.19%), positive predictive value of 90.91% (95% CI, 74.58-97.15%) and negative predictive value of 87.5% (95% CI, 50.04-98.0%). The most common dermoscopic feature observed among patients with recurrent LM/LMM was focal homogeneous or structureless areas of light-brown pigmentation (92.8% vs. 37.5% in patients with other diagnoses; P = 0.009). LM-specific dermoscopic criteria were present in only 28.5% of patients with recurrent LM/LMM. CONCLUSIONS Reflectance confocal microscopy and dermoscopy are valuable tools for the comprehensive evaluation of repigmentation within or adjacent to LM scars.
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Affiliation(s)
- C Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Dermatology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - M Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K Liopyris
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Rishpon
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
| | - E Lee
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C-C J Chen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K S Nehal
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Longo C, Pampena R, Bombonato C, Gardini S, Piana S, Mirra M, Raucci M, Kyrgidis A, Pellacani G, Ragazzi M. Diagnostic accuracy of ex vivo fluorescence confocal microscopy in Mohs surgery of basal cell carcinomas: a prospective study on 753 margins. Br J Dermatol 2019; 180:1473-1480. [PMID: 30512198 DOI: 10.1111/bjd.17507] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Frozen histological sections are used for intraoperative margin assessment during Mohs surgery. Fluorescence confocal microscopy (FCM) is a new tool that offers a promising and faster alternative to frozen histology. OBJECTIVES To evaluate prospectively in a clinical setting the accuracy of FCM vs. frozen sections in margin assessment of basal cell carcinoma (BCC). METHODS Patients with BCC scheduled for Mohs surgery were prospectively enrolled. Freshly excised surgical specimens were examined by FCM and then frozen sections were evaluated. Permanent sections were obtained, in order to validate the sample technique. A blind re-evaluation was also performed for discordant cases. Sensitivity and specificity levels, as well as positive and negative predictive values (PPV and NPV, respectively), were calculated and receiver-operating characteristic curves generated. RESULTS We enrolled 127 BCCs in as many patients (40·2% females). Seven hundred and fifty-three sections were examined. All BCCs were located in the head and neck area. In evaluating the performance of FCM vs. frozen sections, sensitivity was 79·8%, specificity was 95·8%, PPV was 80·5% and NPV was 95·7% [area under the curve 0·88, 95% confidence interval 0·84-0·92 (P < 0·001)]. Forty-nine discordant cases were re-evaluated; 24 were false positive and 25 false negative. The performance of FCM and frozen sections was also evaluated according to the final histopathological assessment. CONCLUSIONS We found high levels of accuracy for FCM vs. frozen section evaluation in intraoperative BCC margin assessment during Mohs surgery. Some technical issues prevent the wide use of this technique, but new devices promise to overcome these limitations.
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Affiliation(s)
- C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - R Pampena
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - C Bombonato
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - S Gardini
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - S Piana
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy
| | - M Mirra
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - M Raucci
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - A Kyrgidis
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M Ragazzi
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Pathology Unit, Reggio Emilia, Italy
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11
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Hartmann D, Krammer S, Bachmann MR, Mathemeier L, Ruzicka T, Bagci IS, von Braunmühl T. Ex vivo confocal microscopy features of cutaneous squamous cell carcinoma. JOURNAL OF BIOPHOTONICS 2018; 11:e201700318. [PMID: 29227042 DOI: 10.1002/jbio.201700318] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/07/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Rapid microscopic evaluation of cutaneous squamous cell carcinoma (SCC), its grade of differentiation and level of invasiveness would enable better management of patients' therapy. OBJECTIVES Analyzing specific ex vivo confocal microscopy criteria whether they can predict diagnosis of invasive SCC vs carcinoma in situ and poorly differentiated or undifferentiated vs well and moderately differentiated SCC. METHODS Ex vivo confocal images of 102 SCCs in 57 patients were evaluated immediately after excision for the presence of predefined criteria based on confocal and histological knowledge. RESULTS In histopathological examination, 30 SCCs were in situ and 72 invasive. Of these, 29 invasive SCC tumors were well, 19 moderately, 15 poorly differentiated and 9 undifferentiated. χ2 analysis demonstrated that presence of erosion/ulceration, plump bright or speckled cells in dermis, keratin pearls and peritumoral inflammatory infiltrate correlated with diagnosis of invasive SCC. Erosion/ulceration and peritumoral inflammatory infiltrate were observed more frequently in poorly differentiated or undifferentiated tumors. Plump bright or speckled cells in the dermis were observed less often in well-differentiated tumors. The presence of keratin pearls was associated with well or moderately differentiated tumors. CONCLUSION Ex vivo CLSM allowed rapid examination of SCC and provided useful information on invasiveness and grading of the tumor.
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Affiliation(s)
- Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Sebastian Krammer
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Mario R Bachmann
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Leonie Mathemeier
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Isin S Bagci
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
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12
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Hartmann D, Krammer S, Vural S, Bachmann MR, Ruini C, Sárdy M, Ruzicka T, Berking C, von Braunmühl T. Immunofluorescence and confocal microscopy for ex-vivo diagnosis of melanocytic and non-melanocytic skin tumors: A pilot study. JOURNAL OF BIOPHOTONICS 2018; 11:e201700211. [PMID: 28949458 DOI: 10.1002/jbio.201700211] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/16/2017] [Accepted: 09/22/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Ex-vivo confocal laser scanning microscopy (ex-vivo CLSM) offers rapid examination of freshly excised tissue. During the conventional examination immunohistochemistry enables to distinguish various cell types. The possibility of immunofluorescent techniques could enhance the accuracy of the diagnosis performed by ex-vivo CLSM. METHODS The tissue probes from various skin tumors were stained with FITC-labeled S-100A10, Melan-A and anti-Ber-EP4 antibodies before examination with ex-vivo CLSM in the fluorescence and reflectance modes. Results were compared to negative controls and conventional histopathology. The staining protocols were evaluated by establishing a scoring system according to the signal intensity found in ex-vivo CLSM. RESULTS S100 immunostaining was successful in 55.6%. Dilution of 1:200 resulted in the best possible evaluation of the tumor. The best suitable protocol was protocol B (phosphate buffered saline [PBS], without blocking agent). Melan A immunostaining was positive in 66.7%, the best dilution was 1:500 and protocol B (PBS, without blocking agent) was the most suitable. Ber-EP4 immunostaining presented a signal in 85.7%, the best dilutions were 1:200 and 1:500 and protocol A (PBS, with blocking agent) showed most optimal results. CONCLUSION The use of fluorescent-labeled antibodies in ex-vivo CLSM is possible and could improve intraoperative diagnostics of skin tumors.
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Affiliation(s)
- Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Sebastian Krammer
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Secil Vural
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | | | - Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Miklós Sárdy
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Thomas Ruzicka
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
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13
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Yélamos O, Jain M, Busam KJ, Marghoob AA. Recurrent nevus as a pitfall of melanoma diagnosis under reflectance confocal microscopy. Australas J Dermatol 2017; 59:227-229. [PMID: 28990158 DOI: 10.1111/ajd.12733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Oriol Yélamos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Manu Jain
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Klaus J Busam
- Pathology Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppauge, New York, USA
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14
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Castagna RD, Stramari JM, Chemello RML. The recurrent nevus phenomenon. An Bras Dermatol 2017; 92:531-533. [PMID: 28954104 PMCID: PMC5595602 DOI: 10.1590/abd1806-4841.20176190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022] Open
Abstract
Recurrent melanocytic nevus is a proliferation of melanocytes arising from a melanocytic nevus removed partially. Asymmetry and irregular pigmentation may lead to misdiagnosis of melanoma. We report a patient presented with a lesion on the lower abdomen, which was removed by shave excision. Anatomopathological examination revealed an intradermal melanocytic nevus. Two months later, a new irregular hyperpigmented lesion appeared in the surgical scar. Histopathology of the excisional biopsy revealed a recurrent melanocytic nevus. Recurrent melanocytic nevus manifests as a scar with hyper or hypopigmented areas, linear streaking, stippled pigmented halos, and/or diffuse pigmentation patterns. Histologically, the dermoepidermal junction and the superficial dermis show melanocytic proliferation overlying the scarred area. When a pathological report of the previous lesion is not available, complete excision is the gold standard. Otherwise, regular dermoscopic monitoring is a therapeutic option. The present report emphasizes the importance of histopathological examination of the excised material - even in cases of suspected benign lesions - and warns patients about the possibility of recurrence in case of incompletely removed lesions.
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Affiliation(s)
- Rafaella Daboit Castagna
- Department of Clinical Medicine, Universidade Federal de Santa Maria (UFSM) - Santa Maria (RS), Brazil
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15
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Manfredini M, Longo C, Ferrari B, Piana S, Benati E, Casari A, Pellacani G, Moscarella E. Dermoscopic and reflectance confocal microscopy features of cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2017; 31:1828-1833. [PMID: 28696052 DOI: 10.1111/jdv.14463] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/22/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Squamous cell carcinoma (SCC) of the skin is a highly prevalent neoplasm. The management and the prognosis of this tumour are dependent on its invasiveness and its grade of differentiation. OBJECTIVES To evaluate whether specific dermoscopic and reflectance confocal microscopy (RCM) criteria can predict the diagnosis of invasive SCC vs. in situ SCC and poorly differentiated compared with well- and moderately differentiated SCC. METHODS Dermoscopic and RCM images of SCC were retrospectively evaluated for the presence of predefined criteria. RESULTS Among 143 SCCs, 121 cases had a complete set of images and thus were included in the study set. The head and neck area was the most frequently involved body site (74/121; 61.1%) followed by extremities (36/121, 29.7%) and trunk (11/121, 9.1%). Seventy tumours were in situ (57.8%), while 51 were invasive (42.1%), of these 11 were poorly differentiated (21.5%), 16 were moderately differentiated (31.3%), and 24 were well differentiated (47.0%). Chi-squared analysis demonstrated that invasive SCCs were characterized by polymorphic vessels, erosion/ulceration, architectural disarrangement, speckled nucleated cells in the dermis, irregularly dilated vessels and absence of hyperkeratosis. Buttonhole vessels, white structureless areas and dotted or glomerular vessels were significantly associated with in situ lesions. Poorly differentiated SCCs were typified by red areas, erosion/ulceration and architectural disarrangement. Well- or moderately differentiated SCCs were associated with white areas and speckled nucleated cells in the epidermis. CONCLUSION Clinical, dermoscopic and RCM images provide useful information that should be integrated in order to achieve the optimal therapeutic management for the patient.
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Affiliation(s)
- M Manfredini
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - B Ferrari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Piana
- Pathology Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - E Benati
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - A Casari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - E Moscarella
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
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16
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Guida S, Bencini PL, Manganoni AM, Gianotti R, Lospalluti L, Greco P, Pellacani G, Farnetani F. Recurrence of melanocytic lesions after laser treatment: benign vs. malignant upon dermoscopy. J Eur Acad Dermatol Venereol 2017; 31:e526-e528. [PMID: 28602022 DOI: 10.1111/jdv.14394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Guida
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - P L Bencini
- Istituto di Chirurgia e Laser Terapia in Dermatologia (ICLID), Milan, Italy
| | - A M Manganoni
- Unità Funzionale Interdipartimentale Melanoma, Dermatology Unit, University Hospital "Spedali" Civili Brescia, Brescia, Italy
| | - R Gianotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - L Lospalluti
- Dermatology Unit, University of Bari, Bari, Italy
| | - P Greco
- Dermatology Unit, University of Bari, Bari, Italy
| | - G Pellacani
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - F Farnetani
- Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
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17
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Porto AC, Blumetti TP, de Paula Ramos Castro R, Pinto CAL, Mendes ASP, Duprat Neto JP, Rezze GG, Tavoloni Braga JC. Recurrent halo nevus: Dermoscopy and confocal microscopy features. JAAD Case Rep 2017; 3:256-258. [PMID: 28580411 PMCID: PMC5447382 DOI: 10.1016/j.jdcr.2017.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ana Carolina Porto
- Cutaneous Oncology Department, AC Camargo Cancer Center, São Paulo, Brazil
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18
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Abstract
Reflectance confocal microscopy (RCM) together with dermoscopy enables improved differentiation of melanomas from most nevi. The resulting high sensitivity for detecting melanoma with RCM is complemented by a concomitant increased specificity, which results in the reduction of unnecessary biopsies of nevi. Although RCM can achieve high diagnostic accuracy for early melanoma detection, false-negative and false-positive cases of melanoma are occasionally encountered. This article reviews the essential clues and pitfalls for the diagnosis of melanoma via RCM and highlights the importance of evaluating RCM findings in light of the clinical scenario and dermoscopic features.
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Affiliation(s)
- Cristina Carrera
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Raras, Instituto de Salud Carlos III, University of Barcelona, Villarroel 170, Escala 1-4, Barcelona 08036, Spain
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd Floor, Hauppauge, NY 11788, USA.
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19
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Katoulis AC, Sgouros D, Argenziano G, Rallis E, Panayiotides I, Rigopoulos D. Surgical suturing-induced melanocytic nevi. A new type of eruptive melanocytic nevi? J Dermatol Case Rep 2016; 10:49-52. [PMID: 28400894 DOI: 10.3315/jdcr.2016.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nevogenesis is a complex process involving several pathogenetic mechanisms, including genetic factors, hormonal influences and UV-radiation. Trauma has been described as a triggering factor for an alternative pathway of nevogenesis. Eruptive melanocytic nevi (EMN), related either to immunosuppression or to blistering disorders, represent a special type of nevi probably induced by the disruption of the dermo-epidermal junction and consequent proliferation of quiescent pigment cells during re-epithelization. MAIN OBSERVATIONS We report two patients with three melanocytic nevi that developed de novo along the direction of surgical suturing, following surgical operation for other reason. The lesions exhibited special dermoscopic characteristics and histology revealed features of acquired melanocytic nevi. CONCLUSIONS Such cases may represent a new type of eruptive nevus, the surgical suturing-induced nevus, which should be included in the differential diagnosis of new pigmentation developing within a scar.
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Affiliation(s)
- Alexander C Katoulis
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" University General Hospital, 1 Rimini str, 12462, Chaidari, Athens, Greece
| | - Dimitrios Sgouros
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" University General Hospital, 1 Rimini str, 12462, Chaidari, Athens, Greece
| | - Giuseppe Argenziano
- Dermatology Unit, 2nd University of Naples, 43 Antonio Vivaldi str, 81100, Caserta CE, Naples, Italy
| | - Efstathios Rallis
- Department of Dermatology, Veterans Administration Hospital, 10 Monis Petraki str, 11521, Athens, Greece
| | - Ioannis Panayiotides
- 2nd Department of Pathology, National and Kapodistrian University of Athens, Medical School, "Attikon" University General Hospital, 1 Rimini str, 12462, Chaidari, Athens, Greece
| | - Dimitrios Rigopoulos
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" University General Hospital, 1 Rimini str, 12462, Chaidari, Athens, Greece
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20
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Abstract
Melanoma is a malignancy most commonly arising from the skin; therefore, primary melanoma characteristics are usually the first cutaneous manifestations of melanoma. Cutaneous metastases, which can occur locally or diffusely, are important to detect in a timely manner as treatments for advanced melanoma that impact survival are now available. Melanoma can be associated with local or diffuse pigmentation changes, including depigmentation associated with the leukodermas and hyperpigmentation associated with diffuse melanosis cutis. The leukodermas occur frequently, illustrate the immunogenic nature of melanoma, and may impact prognosis. Paraneoplastic syndromes in association with melanoma are rare, though can occur.
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Affiliation(s)
- Ritva Vyas
- Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jacqueline Selph
- Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Meg R Gerstenblith
- Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
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21
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Sattler EC, Hoffmann VS, Ruzicka T, Braunmühl TV, Berking C. Reflectance confocal microscopy for monitoring the density of Demodex mites in patients with rosacea before and after treatment. Br J Dermatol 2015; 173:69-75. [PMID: 25801631 DOI: 10.1111/bjd.13783] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Demodex mites seem to serve as a pathogenic trigger in many Demodex-associated diseases such as rosacea. In facial skin of patients with rosacea significantly higher numbers of Demodex mites have been shown compared with healthy controls. Reflectance confocal microscopy (RCM) allows the detection and quantification of Demodex mites in vivo noninvasively. It is hypothesized that a reduction of Demodex mites under rosacea therapy can be monitored by RCM. OBJECTIVES To use RCM to monitor the density of Demodex mites in patients with rosacea before and after treatment. METHODS In 25 patients with facial rosacea RCM was performed before and after therapy. Mosaics of 5 × 5 mm(2) and 8 × 8 mm(2) were scanned, and the total numbers of mites per follicle and per area were counted, along with the number of follicles per area. RESULTS In all patients Demodex folliculorum could be detected and quantified using RCM. RCM showed significant differences pre- and post-treatment (P = 0.0053 for 5 × 5 mm(2) and P < 0.001 for 8 × 8 mm(2)). The mean numbers of mites per follicle were 0.63 (range 0.16-2.28) per 8 × 8 mm(2) area and 0.70 (range 0.11-2.20) per 5 × 5 mm(2) area before treatment, and 0.41 (range 0.074-1.75) and 0.51 (range 0.094-1.70), respectively, after treatment. The corresponding mean numbers of mites were 155 (range 45-446) and 86.2 (range 12-286), respectively, before treatment and 96.2 (range 18-363) and 58.5 (range 12-230), respectively, after treatment. CONCLUSIONS By RCM, a reduction in the density of Demodex mites in facial skin of patients with rosacea under therapy, correlating to clinical improvement, can be quantified and monitored noninvasively. Possible reasons for this therapeutic effect are discussed.
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Affiliation(s)
- E C Sattler
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - V S Hoffmann
- Institute of Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig-Maximilian University Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - T V Braunmühl
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
| | - C Berking
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstraße 9-11, 80337, Munich, Germany
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22
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Łudzik J, Witkowski AM, Pellacani G. Pseudomelanoma follow-up of a recurrent naevus with dermoscopy and reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2015; 30:718-9. [DOI: 10.1111/jdv.13019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. Łudzik
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
- Department of Biostatistics and Telemedicine; Jagiellonian University Medical College; Krakow Poland
| | - A. M. Witkowski
- Department of Biostatistics and Telemedicine; Jagiellonian University Medical College; Krakow Poland
| | - G. Pellacani
- Department of Biostatistics and Telemedicine; Jagiellonian University Medical College; Krakow Poland
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23
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Scope A, Longo C. Recognizing the benefits and pitfalls of reflectance confocal microscopy in melanoma diagnosis. Dermatol Pract Concept 2014; 4:67-71. [PMID: 25126463 PMCID: PMC4132003 DOI: 10.5826/dpc.0403a13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 04/12/2014] [Indexed: 10/31/2022] Open
Affiliation(s)
- Alon Scope
- Department of Dermatology, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Caterina Longo
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, (Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS), Reggio Emilia, Italy
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24
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Agozzino M, Guichard A, Ardigò M. Dermoscopy and confocal microscopy correlates in inflammatory skin conditions. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.13.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Zalaudek I, Cota C, Ferrara G, Moscarella E, Guitera P, Longo C, Piana S, Argenziano G. Flat pigmented macules on sun-damaged skin of the head/neck: Junctional nevus, atypical lentiginous nevus, or melanoma in situ? Clin Dermatol 2014; 32:88-93. [DOI: 10.1016/j.clindermatol.2013.05.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Kelly JW, Shen S, Pan Y, Dowling J, McLean CA. Postexcisional melanocytic regrowth extending beyond the initial scar: a novel clinical sign of melanoma. Br J Dermatol 2013; 170:961-4. [PMID: 24328996 DOI: 10.1111/bjd.12780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recurrent naevi are widely recognized to occur commonly following incomplete removal of melanocytic lesions. These lesions have been generally understood as representing benign imitators of melanoma. OBJECTIVES To provide a formal description of the clinical findings of postexcisional melanocytic regrowth. METHODS We examined all cases of recurrent pigmentation adjacent to scars from previous excisional biopsies of melanocytic naevi treated at a private dermatology practice from 1995 to 2012. RESULTS We report nine cases of recurrence of melanocytic lesions that were melanomas. The most suspicious clinical feature for melanoma in these cases was the growth of the lesion beyond the confines of the initial scar, into the surrounding normal skin. CONCLUSIONS This pattern of recurrence of a melanocytic lesion represents a little recognized and distinctive clinical presenting sign of melanoma.
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Affiliation(s)
- J W Kelly
- Victorian Melanoma Service, The Alfred Hospital, Commercial Road, Prahran, 3181, Victoria, Australia
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27
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Larre Borges A, Zalaudek I, Longo C, Dufrechou L, Argenziano G, Lallas A, Piana S, Moscarella E. Melanocytic nevi with special features: clinical-dermoscopic and reflectance confocal microscopic-findings. J Eur Acad Dermatol Venereol 2013; 28:833-45. [DOI: 10.1111/jdv.12291] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- A. Larre Borges
- Dermatology Unit; Hospital de Clínicas ‘Dr. Manuel Quintela’; Montevideo Uruguay
| | - I. Zalaudek
- Department of Dermatology; Medical University of Graz; Graz Austria
- Skin Cancer Unit; Arcispedale S. Maria Nuova IRCCS; Reggio Emilia Italy
| | - C. Longo
- Skin Cancer Unit; Arcispedale S. Maria Nuova IRCCS; Reggio Emilia Italy
| | - L. Dufrechou
- Dermatology Unit; Hospital de Clínicas ‘Dr. Manuel Quintela’; Montevideo Uruguay
| | - G. Argenziano
- Skin Cancer Unit; Arcispedale S. Maria Nuova IRCCS; Reggio Emilia Italy
| | - A. Lallas
- Skin Cancer Unit; Arcispedale S. Maria Nuova IRCCS; Reggio Emilia Italy
| | - S. Piana
- Skin Cancer Unit; Arcispedale S. Maria Nuova IRCCS; Reggio Emilia Italy
| | - E. Moscarella
- Skin Cancer Unit; Arcispedale S. Maria Nuova IRCCS; Reggio Emilia Italy
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28
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Gill M, Longo C, Farnetani F, Cesinaro AM, González S, Pellacani G. Non-invasive in vivo dermatopathology: identification of reflectance confocal microscopic correlates to specific histological features seen in melanocytic neoplasms. J Eur Acad Dermatol Venereol 2013; 28:1069-78. [PMID: 24147614 DOI: 10.1111/jdv.12285] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 09/16/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) allows for non-invasive, in vivo evaluation of skin lesions and it has been extensively applied in skin oncology although systematic studies on nevi characterization are still lacking. OBJECTIVE The aim of this study was to determine whether reliable RCM correlates to histological features used to diagnose melanocytic neoplasms exist. METHODS We blindly evaluated the RCM and histological features of 64 melanocytic neoplasms (19 non-dysplastic nevi, 27 dysplastic nevi, 14 melanomas) and analysed the data using Spearman's rho calculation. RESULTS Many histological features can be identified using RCM. Elongated rete ridges corresponded on RCM to edge papillae, whereas flattened rete ridges to several features which involve dermal-epidermal junction disruption. Bridging of junctional nesting (JN) corresponded on RCM to both JN with irregular size/shape and JN with short interconnections. While we could reliably identify dermal melanocytes, the RCM features did not reliably distinguish between benign and concerning dermal melanocytic arrangements, suggesting further refinement of dermal melanocytic RCM features is needed. CONCLUSION Reliable correlates for epidermal and junctional histological features used to diagnose melanocytic neoplasms are identifiable on RCM, suggesting harnessing histological criteria may be a reasonable method to move beyond the algorithmic approach.
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Affiliation(s)
- M Gill
- Dobbs Ferry, Skin Medical Research and Diagnostics, New York, NY, USA
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29
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Pigmentation in a scar: Use of dermoscopy in the management decision. J Am Acad Dermatol 2013; 69:e115-6. [DOI: 10.1016/j.jaad.2013.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/11/2013] [Indexed: 11/22/2022]
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30
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Sattler EC, Maier T, Hoffmann VS, Hegyi J, Ruzicka T, Berking C. Noninvasive in vivo detection and quantification of Demodex mites by confocal laser scanning microscopy. Br J Dermatol 2013; 167:1042-7. [PMID: 22716072 DOI: 10.1111/j.1365-2133.2012.11096.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In many Demodex-associated skin diseases Demodex mites are present in abundance and seem to be at least partially pathogenic. So far all diagnostic approaches such as scraping or standardized superficial skin biopsy are (semi-)invasive and may cause discomfort to the patient. OBJECTIVES To see whether confocal laser scanning microscopy (CLSM) - a noninvasive method for the visualization of superficial skin layers - is able to detect and quantify D. folliculorum in facial skin of patients with rosacea. METHODS Twenty-five patients (34-72 years of age) with facial rosacea and 25 age- and sex-matched normal controls were examined by CLSM. Mosaics of 8 × 8 mm and 5 × 5 mm were created by scanning horizontal layers of lesional skin and quantification of mites per follicle and per area as well as follicles per area was performed. RESULTS In all patients D. folliculorum could be detected by CLSM and presented as roundish or lengthy cone-shaped structures. CLSM allowed the quantification of Demodex mites and revealed significant differences (P < 0·0001): the mean number of mites was 165·4 per 8 × 8 mm area and 94·2 per 5 × 5 mm area in the patients compared with 34·7 and 22·4, respectively, in the controls. The corresponding mean number of mites per follicle was 0·7 and 0·8, respectively, in the patients and 0·1 and 0·2, respectively, in the controls. CONCLUSIONS With the help of CLSM it is possible to detect, image and quantify Demodex mites noninvasively in facial skin of patients with rosacea.
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Affiliation(s)
- E C Sattler
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstr. 9-11, 80337 Munich, Germany.
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Abstract
Reflectance confocal microscopy (RCM) enables the noninvasive in vivo imaging of the skin with a horizontal axis and a cellular-level resolution allowing the study of the skin from superficial layers to papillary dermis. It has arisen an important tool in the study of tumors and specially an important role in the characterization of melanoma. Melanocytic lesions present a large number of characteristic findings visible in upper parts of the tumors, such as in the case of melanoma: pagetoid roundish or dendritic cells in superficial epidermis, atypical nests at the dermoepidermal junction, nonedged papillae and atypical nucleated cells in papillary dermis. Several studies have demonstrated that RCM may improve the accuracy in the differentiation of benign and malignant melanocytic lesions as an adjuvant technique to dermoscopy, and three main algorithms have been developed to apply in equivocal lesions. The advantage of in vivo observation in real time of the tumor at the bedside is opening the clinical applications of RCM in the evaluation of melanocytic lesions, and in particular in the study of facial maculae and lentigo maligna melanoma, amelanotic melanoma, and management of subclinical margins, recurrences, or monitoring noninvasive treatment of tumors.
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Affiliation(s)
- Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
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Tschandl P. Recurrent nevi: report of three cases with dermatoscopic-dermatopathologic correlation. Dermatol Pract Concept 2013; 3:29-32. [PMID: 23785634 PMCID: PMC3663383 DOI: 10.5826/dpc.0301a08] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/03/2012] [Indexed: 11/23/2022] Open
Affiliation(s)
- Philipp Tschandl
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria
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de Queiroz Fuscaldi LAN, Buçard AM, Alvarez CDQ, Barcaui CB. Epidermolysis bullosa nevi: report of a case and review of the literature. Case Rep Dermatol 2012; 3:235-9. [PMID: 22220143 PMCID: PMC3250666 DOI: 10.1159/000334832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 10-year-old female patient, being treated for dystrophic bullous epidermolysis in a Pediatric Hospital, was referred to our Dermoscopy Ambulatory because of a newly observed mole in the submandibular area. Clinically, the lesion presented as an irregular double-colored macule of about 2 cm in diameter, with irregular borders, suspicious of malignancy. Dermoscopy showed a multicomponent pattern, with multiple colors, ill-defined network, black blotches, streaks, multiple dots, a blue-whitish veil and granularity at the periphery. Although it had a clinical appearance of malignancy, dermoscopy every semester was proposed due to the revision of a recently described entity, named bullous epidermolysis nevi, that we made in these children. The fragile skin of this particular patient was also taken into account, and overtreatment was avoided. Bullous epidermolysis nevi is the term given to large, asymmetrical and often irregularly pigmented melanocytic nevi that occur in former areas of blistering in patients with the dystrophic forms of the disease. Despite its atypical clinical appearance, and sometimes also atypical dermoscopy, malignant transformation has not been reported yet. Similarly to recurrent nevi, where melanocytes proliferate in a previous area of trauma, clinical aspect, dermoscopy, and histopathology may tempt clinicians to diagnose benign moles as melanoma. Here we report one case of this entity, scarcely reported on in literature, and review clinical and dermatoscopical features of epidermolysis bullosa nevi confronting it with recurrent nevi. The usefulness of dermoscopy as a treatment strategy is stressed.
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Intradermal indocyanine green for in vivo fluorescence laser scanning microscopy of human skin: a pilot study. PLoS One 2011; 6:e23972. [PMID: 21904601 PMCID: PMC3164142 DOI: 10.1371/journal.pone.0023972] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 07/27/2011] [Indexed: 11/27/2022] Open
Abstract
Background In clinical diagnostics, as well as in routine dermatology, the increased need for non-invasive diagnosis is currently satisfied by reflectance laser scanning microscopy. However, this technique has some limitations as it relies solely on differences in the reflection properties of epidermal and dermal structures. To date, the superior method of fluorescence laser scanning microscopy is not generally applied in dermatology and predominantly restricted to fluorescein as fluorescent tracer, which has a number of limitations. Therefore, we searched for an alternative fluorophore matching a novel skin imaging device to advance this promising diagnostic approach. Methodology/Principal Findings Using a Vivascope®-1500 Multilaser microscope, we found that the fluorophore Indocyanine-Green (ICG) is well suited as a fluorescent marker for skin imaging in vivo after intradermal injection. ICG is one of few fluorescent dyes approved for use in humans. Its fluorescence properties are compatible with the application of a near-infrared laser, which penetrates deeper into the tissue than the standard 488 nm laser for fluorescein. ICG-fluorescence turned out to be much more stable than fluorescein in vivo, persisting for more than 48 hours without significant photobleaching whereas fluorescein fades within 2 hours. The well-defined intercellular staining pattern of ICG allows automated cell-recognition algorithms, which we accomplished with the free software CellProfiler, providing the possibility of quantitative high-content imaging. Furthermore, we demonstrate the superiority of ICG-based fluorescence microscopy for selected skin pathologies, including dermal nevi, irritant contact dermatitis and necrotic skin. Conclusions/Significance Our results introduce a novel in vivo skin imaging technique using ICG, which delivers a stable intercellular fluorescence signal ideal for morphological assessment down to sub-cellular detail. The application of ICG in combination with the near infrared laser opens new ways for minimal-invasive diagnosis and monitoring of skin disorders.
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