Reflectance confocal microscopy enables lesions in skin to be examined without excision, but with improved diagnostic accuracy, assessment of dermoscopic-histologic correlation, assessment of surgical margins, as well as speed and convenience for the physician and patient. This extensively enlarged and updated text reviews the current and future state of the art for those involved with the diagnosis and treatment of skin tumors, with a greatly increased amount of material on the expected normal patterns of skin throughout life and on non-melanocytic tumors.
Table of Contents
Fundamentals and Technology Advances: Fundamentals of reflectance confocal microscopy.
Confocal application in everyday practice. Computational methods in skin confocal microscopy. The role of teledermatology in Reflectance Confocal Microscopy. Miniature confocal microscopy devices for imaging skin. Reflectance confocal microscopy-guided microbiopsies for targeted molecular analysis. Strip-Mosaicking. Multimodal confocal microscopy for non-melanoma skin cancers ex vivo. Intra-operative Reflectance Confocal Microscopy to potentially guide Mohs surgery and other dermatologic surgeries. Laser ablation of basal cell carcinoma guided by confocal microscopy. Normal Skin and Mucosa: Normal skin: Terminology. Adnexal and sensory structures of the skin. Topographic and skin phototype variations of skin with special emphasis on facial and acral skin. Infant skin maturation: structural changes revealed by in vivo reflectance confocal microscopy and future perspectives. Cutaneous photoageing: Description and algorithms. Healthy oral and genital mucosa. Melanocytic Tumors: RCM diagnosis of melanocytic neoplasms: Terminology, algorithms, and their accuracy, and clinical integration. RCM-histology correlation in melanocytic lesions. Common nevi. Congenital melanocytic nevi. Spitz-Reed nevi. Dysplastic nevi. How genetic traits may influence the dermoscopic and confocal morphology of nevi. Superficial spreading and nodular melanoma (including amelanotic melanoma). Lentigo maligna and lentigo maligna melanoma. Nevi and melanoma. Melanoma in special locations. Lesions Revealing Regressive Structures. Non-Melanocytic Tumors: Terminology, pattern analysis and algorithms, and accuracy studies of Reflectance Confocal Microscopy applied to non-melanocytic tumors. Reflectance Confocal Microscopy—histology correlations for non-melanocytic tumors. Vascular patterns in non-melanocytic tumors. Pigmented actinic keratosis and porokeratosis. Squamous neoplasia (subtypes) and progression. Basal cell carcinoma: Subtypes. Basal cell carcinoma simulators: Poroma, trichoepithelioma, and fibrous papules of the face. Sebaceous hyperplasia and adenoma: Clear cell acanthoma and dermatofibroma. Solar lentigo and lichen planus-like keratosis. Seborrheic keratosis: The main clues to avoid misdiagnosing seborrheic keratosis-like simulators. In vivo Reflectance Confocal Microscopy for diagnosis and management of extramammary Paget Disease. Benign vascular tumors and malformations, and Kaposi sarcoma. Mycosis fungoides and other cutaneous T cell lymphomas. Clinical Applications: Diagnostic accuracy of Reflectance Confocal Microscopy in a clinical setting. Integration of Reflectance Confocal Microscopy for the management of patients with multiple nevi. Lentigo Maligna Melanoma: Monitoring of non-invasive treatment and margin mapping prior surgery. Nail tumor management by intraoperative confocal microscopy. Field cancerization and monitoring of treatment. Monitoring of non-invasive treatment of Basal Cell Carcinoma. Ex vivo Fluorescent Confocal Microscopy to guide microscopic Mohs surgery
Salvador Gonzalez has dual appointments at both Alcalá University and Hospital Ramon y Cajal, Madrid, Spain, and Memorial Sloan-Kettering Cancer Center, New York, USA. The current President of the International Society of Confocal Microscopy, he is active in research and clinical practice internationally.