Amanda Levine, MD, Orit Markowitz, MD, FAAD JAAD Case Reports

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Presentation transcript:

Introduction to reflectance confocal microscopy and its use in clinical practice Amanda Levine, MD, Orit Markowitz, MD, FAAD JAAD Case Reports Volume 4, Issue 10, Pages 1014-1023 (November 2018) DOI: 10.1016/j.jdcr.2018.09.019 Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 A, RCM image (0.5 × 0.5 mm) of stratum corneum in normal skin. Dark linear furrows (blue star) represent dermatoglyphs (skin folds). B, Close up of anucleated corneocytes in the stratum corneum. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05397. JAAD Case Reports 2018 4, 1014-1023DOI: (10.1016/j.jdcr.2018.09.019) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 A, RCM image (0.5 × 0.5 mm) of normal honeycomb pattern at the stratum granulosum–spinosum level. B, RCM image (0.5 × 0.5 mm) of a broadened honeycomb pattern at the stratum granulosum–spinosum level. C and D, RCM image (0.5 × 0.5 mm) of an irregular honeycomb pattern as displayed by a disruption of the honeycomb pattern with cells of variable size, shape and contour thickness. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05398. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05400. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05399. JAAD Case Reports 2018 4, 1014-1023DOI: (10.1016/j.jdcr.2018.09.019) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Disarranged pattern in a biopsy-proven melanoma displays a disarray of normal architecture of the superficial layers with unevenly distributed bright granular particles and cells, in the absence of honeycombed or cobblestone. This pattern is more frequently observed in invasive melanomas, usually associated with pagetoid cells although can be seen in other skin malignancies. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05401. JAAD Case Reports 2018 4, 1014-1023DOI: (10.1016/j.jdcr.2018.09.019) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 RCM image (0.5 × 0.5 mm) of bright cells in pagetoid spread and dendritic cells extending down the follicular infundibulum in a biopsy-proven lentigo maligna. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05407. JAAD Case Reports 2018 4, 1014-1023DOI: (10.1016/j.jdcr.2018.09.019) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 5 Pigmented basal keratinocytes at the suprabasilar layer displaying a cobblestone pattern owing to the high refractive index of their supranuclear melanin caps. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05402. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05403. JAAD Case Reports 2018 4, 1014-1023DOI: (10.1016/j.jdcr.2018.09.019) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 6 A, RCM image (0.5 × 0.5 mm) of dermal papillae surrounded by bright basal keratinocytes and melanocytes (edged papillae) at the DEJ. B, RCM mosaic (1.0 × 1.0 mm) of papillary contours that are not well outlined (nonedged) in a melanoma in situ. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05404. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05405. JAAD Case Reports 2018 4, 1014-1023DOI: (10.1016/j.jdcr.2018.09.019) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 7 RCM mosaic of the superficial dermis, which appears less refractile and contains dark tubular or canalicular blood vessels and bright collagen fibers. A high-resolution version of this slide for use with the Virtual Microscope is available as eSlide: VM05406. JAAD Case Reports 2018 4, 1014-1023DOI: (10.1016/j.jdcr.2018.09.019) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions