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Dermatologic Clinics

Jane M Grant-Kels, Giovanni Pellacani, Caterina Longo
No abstract text is available yet for this article.
October 2016: Dermatologic Clinics
J Welzel, Raphaela Kästle, Elke C Sattler
In addition to reflectance confocal microscopy, multiwave confocal microscopes with different laser wavelengths in combination with exogenous fluorophores allow fluorescence mode confocal microscopy in vivo and ex vivo. Fluorescence mode confocal microscopy improves the contrast between the epithelium and the surrounding soft tissue and allows the depiction of certain structures, like epithelial tumors, nerves, and glands.
October 2016: Dermatologic Clinics
Josep Malvehy Guilera, Alicia Barreiro Capurro, Cristina Carrera Alvárez, Susana Puig Sardá
Reflectance confocal microscopy (RCM) allows the evaluation with superb accuracy of some skin tumors before, during, and after treatment. In clinical trials RCM has been shown to provide useful information for evaluation of efficacy of topical or systemic medication. With the recent introduction of handheld RCM a fast examination of the tumor can be done in minutes. In patients treated with surgery RCM plays a unique role to precisely map margins of the tumor in the skin surface and for the detection of subclinical recurrences...
October 2016: Dermatologic Clinics
Caterina Longo
The aim of the current review is to provide an overview of the use of reflectance confocal microscopy to detect early skin aging signs. This new imaging tool holds the promise to morphologically explore the epidermis and upper dermis at nearly histologic resolution and over time. The main confocal findings of aged skin include the presence of irregular honeycombed pattern, linear skin furrows, mottled pigmentation, and distinct collagen types (coarse and huddled).
October 2016: Dermatologic Clinics
Alexander Witkowski, Joanna Łudzik, H Peter Soyer
Reflectance confocal microscopy (RCM) is becoming more popular among dermatologists aiming to improve their bedside diagnostic accuracy and reduce unnecessary removal of benign cutaneous lesions. With increased interest in the field, limitation of experts, and dedicated training programs, telemedicine application to RCM (teleconfocal) helps to connect patients with experts at a distance. Diagnostic accuracy of store-and-forward telemedicine review of RCM images, patient safety, and cost-effectiveness are important considerations for proper acceptance and usage of the technology in the medical community...
October 2016: Dermatologic Clinics
Caterina Longo, Moira Ragazzi, Milind Rajadhyaksha, Kishwer Nehal, Antoni Bennassar, Giovanni Pellacani, Josep Malvehy Guilera
Confocal microscopy is a modern imaging device that has been extensively applied in skin oncology. More specifically, for tumor margin assessment, it has been used in two modalities: reflectance mode (in vivo on skin patient) and fluorescence mode (on freshly excised specimen). Although in vivo reflectance confocal microscopy is an add-on tool for lentigo maligna mapping, fluorescence confocal microscopy is far superior for basal cell carcinoma and squamous cell carcinoma margin assessment in the Mohs setting...
October 2016: Dermatologic Clinics
Marco Ardigo, Marina Agozzino, Chiara Franceschini, Francesco Lacarrubba
Reflectance confocal microscopy (RCM) allows real-time, noninvasive microscopic view of the skin at nearly histologic resolution serially over time. RCM increases the sensibility and sensitivity of the diagnosis of skin tumours. RCM evaluates descriptive features of psoriasis, lupus erythematosus, contact dermatitis, and others. Three groups of optical histology have been described: psoriasiform, spongiotic, and interface dermatitis. In a multicenter study, RCM patterns of spongiotic, hyperkeratotic, and interface dermatitis have been analyzed and an algorithmic method of analysis for fast application in the clinical setting based on a multivariate analysis has been proposed...
October 2016: Dermatologic Clinics
Elisa Cinotti, Bruno Labeille, Frédéric Cambazard, Jean-Luc Perrot
This article describes the use of confocal microscopy for special sites and unconventional applications. These new applications have been made possible thanks to the introduction on the market of a hand-held camera. Special sites discussed include mucosa, nails, and palms and soles. Special uses discussed include infections and infestations; tumor mapping; understanding clinical, dermoscopic, and histology features; videos and ex vivo confocal microscopy.
October 2016: Dermatologic Clinics
Syril Keena T Que, Jane M Grant-Kels, Harold S Rabinovitz, Margaret Oliviero, Alon Scope
The clinical diagnosis of tumors on the curved surfaces of the face, around the eyes, and on the mucosal surfaces can be difficult, while biopsies and excisions can have functional and aesthetic consequences. To avoid unnecessary surgery, clinicians have been aiming to attain accurate noninvasive diagnosis of lesions at these sites. However, acquisition of high-quality images with dermoscopy and with traditional wide-probe reflectance confocal microscopy (WP-RCM) have been hampered with technical difficulties...
October 2016: Dermatologic Clinics
Martin Ulrich, Iris Zalaudek, J Welzel
Actinic keratosis, Bowen disease, and invasive squamous cell carcinoma represent different steps within the disease continuum of squamous neoplasia. Although these stages of squamous neoplasia share common findings, reflectance confocal microscopy may be applied for their differentiation and distinction from other benign or malignant lesions. Hyperkeratosis represents the most important limitation in the evaluation of squamous neoplasia as it may impair the analysis of deeper epidermal and dermal structures significantly...
October 2016: Dermatologic Clinics
Melissa Gill, Salvador González
Solitary pink lesions can pose a particular challenge to dermatologists because they may be almost or completely featureless clinically and dermoscopically, previously requiring biopsy to exclude malignancy. However, these lesions usually are not particularly challenging histopathologically. Thus, the incorporation of in vivo reflectance confocal microscopy into the clinical practice, which allows for noninvasive examination of the skin at the cellular level revealing features previously seen only on histopathology, is particularly useful for this subset of clinically difficult lesions...
October 2016: Dermatologic Clinics
Susana Puig Sardá, Rodolfo Suárez, Josep Malvehy Guilera
Reflectance confocal microscopy patterns and structures of clinically dark lesions are described. Because many of the dark lesions have melanin in superficial skin layers these lesions show great semiology by confocal. Limitations and pitfalls of reflectance confocal microscopy in clinically dark lesions are also detailed.
October 2016: Dermatologic Clinics
Phoebe Star, Pascale Guitera
Distinguishing lentigo maligna (LM) and lentigo maligna melanoma (LMM) from background pigmented non-melanoma lesions is challenging. The field of solar damage can obscure clinical assessment, and diagnostic ambiguities are created due to the overlap of the clinical features of LM with other benign lesions. Moreover, margin assessment on histology is limited by the resemblance between melanocytic hyperplasia of actinically damaged skin and scattered atypical melanocytes of LM/LMM. Dermoscopy has made a significant contribution but is often not sufficient for diagnosis and margin assessment...
October 2016: Dermatologic Clinics
Caterina Longo, Giovanni Pellacani
Melanomas are a wide range of tumors that differ in their epidemiology, morphology, genetic profile, and biological behavior. They can be grouped as superficial spreading melanoma, lentigo maligna, and nodular melanoma. Reflectance confocal microscopy is useful for the evaluation of skin lesions that are dermoscopically doubtful by increasing diagnostic accuracy and specificity. This article provides a comprehensive overview of the different confocal main morphologies of distinct melanoma types as a function of the anatomic location of the tumor...
October 2016: Dermatologic Clinics
Cristina Carrera, Ashfaq A Marghoob
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...
October 2016: Dermatologic Clinics
Juliana Casagrande Tavoloni Braga, Raquel de Paula Ramos Castro, Tatiana Cristina Moraes Pinto Blumetti, Fernanda Berti Rocha Mendes, Juliana Arêas de Souza Lima Beltrame Ferreira, Gisele Gargantini Rezze
The knowledge of histopathology and in vivo reflectance confocal microscopy correlation has several potential applications. Reflectance confocal microscopy can be performed in all skin tumors, and in this article, the most common histopathologic features of confocal microscopic findings in melanocytic skin tumors and nonmelanocytic skin tumors are described.
October 2016: Dermatologic Clinics
Syril Keena T Que, Jane M Grant-Kels, Caterina Longo, Giovanni Pellacani
The use of reflectance confocal microscopy (RCM) and other noninvasive imaging devices can potentially streamline clinical care, leading to more precise and efficient management of skin cancer. This article explores the potential role of RCM in cutaneous oncology, as an adjunct to more established techniques of detecting and monitoring for skin cancer, such as dermoscopy and total body photography. Discussed are current barriers to the adoption of RCM, diagnostic workflows and standards of care in the United States and Europe, and medicolegal issues...
October 2016: Dermatologic Clinics
Murad Alam
No abstract text is available yet for this article.
July 2016: Dermatologic Clinics
Maria L Marino, Cristina Carrera, Michael A Marchetti, Ashfaq A Marghoob
Early detection remains the most important strategy to reduce melanoma mortality. The identification and evaluation of new or changing skin lesions are important components of melanoma screening and are best performed today using complementary noninvasive imaging technologies, such as total body photography (TBP), dermoscopy, sequential digital dermoscopic imaging (SDDI), and reflectance confocal microscopy (RCM). Despite strong evidence showing that these screening techniques improve diagnostic accuracy for melanoma, they are not widely used by dermatologists...
July 2016: Dermatologic Clinics
Murad Alam, Abigail Waldman, Keyvan Nouri, M Laurin Council, Todd V Cartee
This article discusses current practice in laser dermatology, the gaps in practice, and recommendations for improvement. As is the case with other areas of cosmetic dermatology, there is a rapid development of new laser and light devices with limited epidemiologic data available to inform best practice. The high fixed cost associated with new laser devices, limited space available in some practices, and inconsistent training may limit the adoption of needed therapies. Improving research in this area; training opportunities for physicians, residents, and staff; and cost-effective laser/light device rentals programs could improve quality of current practice...
July 2016: Dermatologic Clinics
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