CRC REFL CONFCL MICRSCP CUT TUMRS PDF

Preface

Since the dawn of recorded medical history, the skin has been recognized as a window to the diagnosis and evaluation of disease. Ironically, the skin has been largely ignored and bypassed in the recent evolution of non-invasive diagnostic imaging technologies due to the readiness of visual inspection of the skin and ease of invasive skin biopsy. At the same time, a growing reliance on skin biopsy, blood tests, and radiologic assessments has diminished the morphologic dermatologic acumen of most clinicians including dermatologists. Fortunately, this situation has recently begun to change for the better. The growing popularity of dermoscopy has revived and expanded the attention of dermatologists to surface and subsurface morphologic details. At the same time, a host of exciting non-invasive technologies are being developed and investigated as adjuncts to the clinical examination. Examples of these technologies include high-frequency ultrasound, optical coherence tomography, spectroscopy, surface magnetic resonance imaging, and reflectance confocal microscopy (RCM).

Among these exciting new skin imaging technologies, RCM has especially caught the attention of the dermatology community. This probably reflects the strong reliance on skin biopsy and dermatopathology in clinical practice as well as the emphasis of dermatopathology in the training of dermatologists. Among all of the non-invasive imaging techniques, only RCM provides morphologic imaging with sufficient resolution to permit recognition of individual cells, resulting in quasi-histologic images.

Large expensive bench-top transmission confocal microscopes are widely used in the laboratory for highresolution imaging of thin samples of living tissues. Smaller reflectance confocal microscopes have been developed for superficial subsurface imaging of intact skin. The technique permits real-time imaging of the epidermis and superficial dermis with sufficient resolution to resolve individual cells. The process is completely safe and painless, allowing repetitive application of the technique and observation of dynamic changes in situ over time.

This is the first atlas of RCM of the skin. It focuses on cutaneous tumor. In this atlas, we present RCM images of the most common skin neoplasms with their associated clinical, dermoscopic, and histologic appearance. Whereas we have gone to great lengths to provide good-quality RCM images, the individual frame still images included in the atlas fail to capture the wealth of information that can be gleaned during a real-time imaging session. At the bedside, images can be acquired at multiple depths within the skin, permitting one to focus up and down on individual elements within an area of interest and thus provide a three-dimensional context. Furthermore, dynamic processes such as blood flow can be observed in real time.

In the atlas, we cover various applications of confocal microscopy to the diagnosis, evaluation, and surgical management of cutaneous neoplasms. In this very young field, there are a limited number of centers studying RCM of skin tumors. This atlas represents a highly collaborative effort among many of the leaders in the field. It is a first step in what promises to be a very exciting and productive process of bringing this new technology into clinical practice. This process will require the development of a new lexicon for the description and interpretation of RCM images. A glossary provided at the end of the text (Appendix 1) will help the reader begin to become familiar with the current usage of RCM terminology.

We hope that you will share our enthusiasm for this technology and enjoy the outstanding contributions of our collaborators and colleagues.