Techniques and monitoring
Confocal microscopy in vivo is an advanced non-invasive technique for the study of skin lesions that allows imaging with cellular resolution similar to histology conventional biopsy, without any risk to the patient and completely painless way . In this way, an analysis of the skin is achieved without the need to remove tissue assuming an advance in the research, the non-invasive diagnosis of skin tumors and in the monitoring of skin treatments.
Diagnosis Dermatologica team is a pioneer center in the world in this technique and has the most advanced confocal microscopy systems (Vivascope 1500) that are combined with integrated high-resolution digital dermatoscopy. in the same system (Vivacam) for structural anatomical correlation and navigation during the examination.
The combination of confocal microscopy and high resolution dermatoscopy allows presurgical diagnosis of melanoma, cutaneous carcinoma and other cutaneous tumors . Likewise, this technique allows to confirm the evaluation before and after a treatment in photodynamic therapy or laser treatment in multiple indications. This is especially important in the immediate diagnosis of injuries to the face and other difficult areas, or injuries to children . This is achieved by avoiding the biopsy or in case this is necessary to select the best point to obtain a sample for a diagnostic skin biopsy.
In February 2008, the International Confocal Working Group was created in San Antonio (USA), the main international group of confocal in vivo microscopy for the dissemination, standardization of protocols and the development of international multicentre studies. Dr. Josep Malvehy and Dr. Susan Puig medical directors of Diagnosis Dermatologica are founding members of this consortium.
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Indications of the exploration with Confocal Microscopy in vivo and high resolution digital Dermatoscopy
Non-invasive diagnosis of skin tumors, including benign melanocytic lesions, malignant melanoma, basal cell and squamous carcinoma, seborrheic keratosis, actinic keratosis, dermatofibroma and vascular lesions among others. Confocal microscopy in vivo allows the recognition of amelanotic lesions.
Noninvasive exploration of the lesions of the face, where the consultation for unstable "spots" is frequent, the confocal microscopy allows to avoid unnecessary biopsies. Therefore, it is very useful in the evaluation of these lesions before laser treatment or other non-invasive procedures. On the other hand, in certain lesions that are not suspicious, foci of malignant lentigo melanoma or carcinomas that could go unnoticed may be found.
Diagnosis and monitoring of treatments such as photodynamic therapy, imiquimod or cryotherapy of cutaneous carcinoma, actinic keratosis or premalignant lentigo or laser treatments of pigmented aesthetic lesions.
Diagnosis of oral (labial) / genital mucosal pigmentation, where the biopsy is especially uncomfortable for the patient, it is of great interest the confocal microscopy examination that confirms the benignity of the pigmented lesions.
The new imaging techniques in dermatology allow us to advance a new era in the research and development of cutaneous tumors. In several studies, diagnostic criteria and algorithms have been obtained in skin cancer based on dermatoscopy and confocal microscopy.
Non-invasive diagnosis of skin tumors, including benign melanocytic lesions, malignant melanoma, basal cell and squamous carcinoma, seborrheic keratosis, actinic keratosis, dermatofibroma and vascular lesions among others. Confocal microscopy in vivo allows to identify lesions without pigment.
Hypopigmented malignant melanoma. The dermatoscopy allows to observe the presence of irregular vessels, remains of brown pigment and a blue focal area that corresponds with confocal microscopy to a nest of pleomorphic melanocytic cells with large evident nuclei.
Non-invasive exploration of facial lesions, where consultation for unattractive "spots" is frequent, confocal microscopy allows to avoid unnecessary biopsies. Therefore, it is very useful in the evaluation of these lesions before a laser treatment or other non-invasive procedures. On the other hand, in certain lesions that are not suspicious, foci of malignant lentigo melanoma or carcinomas that could go unnoticed can be found. Finally these techniques can guide the surgical margins in these tumors.
Melanoma on malignant lentigo in a patient consulting for an inesthetic pigmented lesion. In the examination of high resolution dermatoscopy and confocal microscopy it is possible to navigate through the lesion in real time and obtain characteristic images of the tumor in a few minutes with the presence of atypical dendritic melanocytic cells invading the epidermis and annexal areas
Detection of tumor recurrence. Occasionally, tumor recurrence in a scar must be distinguished after surgical treatment of melanoma or skin cancer. . These recurrences may initially appear as invisible lesions due to their absence of pigment.
Superficial basal cell carcinoma that had been oriented as an inflammatory lesion and treated with a corticoid cream previously. Clinically, it consists of a desquamative erythematous plaque 6 x 5 mm in diameter. Due to dermatoscopy, telangiectasias are observed that make the diagnosis of superficial basal cell carcinoma suspect. By confocal microscopy this diagnosis is confirmed with the observation of basaloid cell nests with a hyporrefractile separation, polarization of characteristic nuclei and telangiectasias in the superficial dermis. The patient receives treatment with imiquimod that is monitored with confocal microscopy in vivo confirming its cure.
Patient with a history of surgical treatment of malignant lentigo melanoma in the right malar region. Recurrence detection with presence of intraepidermal invasion of round melanocytic cells and dendritic cells showing cellular pleomorphism. Map of the affected area with the limits of affected skin for the design of the tumor surgery.
Diagnosis and treatment monitoring such as photodynamic therapy , imiquimod or cryotherapy of cutaneous carcinoma, actinic keratosis or premalignant lentigo or the laser treatments of pigmented aesthetic lesions.
Diagnosis of oral (labial) / genital mucosal pigmentation , where biopsy is especially uncomfortable for the patient, is of great interest confocal microscopy examination confirming the benignity of pigmented mucosal lesions.
Patient consulting for a genital pigmented lesion. By confocal microscopy, a regular pattern lesion composed of pigmented keratinocytes in suprabasal epidermal layer (paving pattern) and dermoepidermal junction is observed. Absence of cellular atypia and nests that suggest a melanocytic lesion. Dx: idiopathic mucosal melanosis. Absence of malignancy Plan: dermatological monitoring
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