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Introduction to reflectance confocal microscopy and its use in clinical practice
摘要： Re?ectance confocal microscopy (RCM) is a novel technology that provides noninvasive, in vivo imaging of the skin at nearly histologic resolution. In 2016, the US Centers for Medicare and Medicaid Services (CMS) established reimbursement codes for RCM image acquisition and for the reading and interpretation of images. The combination of RCM imaging with dermoscopy has improved the accuracy of skin cancer diagnosis while reducing the number of biopsies of benign skin lesions. With that, we are starting to see more dermatologists and dermatopathologists using RCM in clinical practice. This editorial is to serve as an introduction on RCM imaging with a focus on its usefulness in both the diagnosis and management of skin cancers. We end by brie?y describing the characteristic RCM features of normal skin to serve as a building block for later cases that will explore both the bene?ts and drawbacks of incorporating RCM imaging for benign and malignant lesions.
关键词： innovative technology,noninvasive imaging,skin cancer,melanoma,re?ectance confocal microscopy,lentigo maligna,nonmelanoma skin cancer
更新于2025-09-23 15:21:01
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Effect of a topical antioxidant serum containing vitamin C, vitamin E, and ferulic acid after Qa??switched 1064a??nm Nd:YAG laser for treatment of environmenta??induced skin pigmentation
摘要： Background: Extrinsic skin aging caused by atmospheric pollutants is associated with a sustained inflammatory response which is a significant risk factor for lentigines and melasma. Aims: The aim of this study was to evaluate the efficacy of topical application of combination formulation of vitamin C, vitamin E, and ferulic acid as an adjuvant to Q-switched Nd:YAG (QSNY) lasers treatment in individuals with lentigines and melasma. Methods: A single blinded, prospective, randomized split-face trial was conducted. Eighteen men and women between 26 and 53 years old were treated with a combination antioxidant serum on one randomized side of their face immediately after QSNY laser and twice daily for 2 weeks. Patients were evaluated using digital photography and spectrometry to assess the melanin index and erythema index. Melasma severity score and global improvement scores also were assessed. Results: The treated side of the face exhibited a significantly greater reduction in the melanin index. There was no significant difference in post-treatment erythema. More clinical improvement was observed on the treated side compared with the untreated side. Conclusions: Our study suggests that topical application of a combination vitamins C, E, and ferulic acid antioxidant formula may be effective as an adjuvant option in QSNY lasers.
关键词： air pollution,lentigo,QS Nd:YAG laser,vitamin C,antioxidant
更新于2025-09-23 15:19:57
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Ablative fractional laser‐assisted photodynamic therapy for lentigo maligna: a prospective pilot study
摘要： Background Lentigo maligna (LM) is an in situ form of melanoma carrying a risk of progression to invasive lentigo maligna melanoma (LMM). LM poses a clinical challenge, with subclinical extension and high recurrence rates after incomplete surgery. Alternative treatment methods have been investigated with varying results. Photodynamic therapy (PDT) with methylaminolaevulinate (MAL) has already proved promising in this respect. Objectives To investigate the efficacy of ablative fractional laser (AFL)-assisted PDT with 5-aminolaevulinic acid nanoemulsion (BF-200 ALA) for treating LM. Methods In this non-sponsored prospective pilot study, ten histologically verified LMs were treated with AFL-assisted PDT three times at 2-week intervals using a light dose of 90 J/cm2 per treatment session. Local anaesthesia with ropivacaine was used. Four weeks after the last PDT treatment the lesions were treated surgically with a wide excision and sent for histopathological examination. The primary outcome was complete histopathological clearance of the LM from the surgical specimen. Patient-reported pain during illumination and the severity of the skin reaction after the PDT treatments were monitored as secondary outcomes. Results The complete histopathological clearance rate was 7 out of 10 LMs (70%). The pain during illumination was tolerable, with the mean pain scores for the PDT sessions on a visual assessment scale ranging from 2.9 to 3.8. Some severe skin reactions occurred during the treatment period, however. Conclusions Ablative fractional laser-assisted PDT showed moderate efficacy in terms of histological clearance. It could constitute an alternative treatment for LM but due to the side effects it should only be considered in inoperable cases.
关键词： Histopathological clearance,5-aminolaevulinic acid,Ablative fractional laser,Photodynamic therapy,Lentigo maligna
更新于2025-09-11 14:15:04
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Confocal Microscopy and Lentigo Maligna: An in vivo Pilot Study for the Assessment of Response to Imiquimod Therapy
摘要： Background: Reflectance confocal microscopy (RCM) is a noninvasive technique that provides real-time in vivo images of the epidermal layer. Imiquimod has been recommended as an alternative treatment in lentigo maligna (LM) when surgical excision is not the treatment of choice. In the present study we compare the results of in vivo RCM to the histopathological examination before and after treatment of LM with topical imiquimod. Methods: Thirty-four patients with confirmed LM were included. Imiquimod 5% was applied until a weeping erosion appeared in the LM-affected skin. Evaluation was performed by clinical examination, dermatoscopy, histopathology and RCM. Results: During the follow-up, 27 of 34 patients (79.42%) demonstrated a total tumor clearance by imiquimod treatment. In the treated area, a significant decrease of atypical cells was detected using RCM (p < 0.0001). Furthermore, a significant positive correlation in the detected atypical cells was shown using confocal microscopy and histology (p = 0.0001, r = 0.7335, respectively). Conclusion: In patients not suitable for surgical intervention imiquimod treatment is an appropriate treatment alternative. Thereby, in vivo RCM was demonstrated to be an excellent examining device, which not only allows diagnosis of LM, but also therapy and follow-up examinations. An important benefit of RCM, in contrast to conventional histopathology, is the simple handling with in vivo examination of epidermal skin without any pain for the patient.
关键词： Imiquimod therapy,Lentigo maligna,Noninvasive follow-up,Reflectance confocal microscopy
更新于2025-09-04 15:30:14