Reflectance confocal microscopy of pigmented basal cell carcinoma

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Reflectance confocal microscopy of pigmented basal cell carcinoma Anna Liza Chan Agero, MD, Klaus J. Busam, MD, Cristiane Benvenuto-Andrade, MD, Alon Scope, MD, Melissa Gill, MD, Ashfaq A. Marghoob, MD, Salvador González, MD, PhD, Allan C. Halpern, MD, MS Journal of the American Academy of Dermatology Volume 54, Issue 4, Pages 638-643 (April 2006) DOI: 10.1016/j.jaad.2005.11.1096 Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 A, Reflectance confocal microscopy image showing pigmented tumor cords composed of tightly packed cells arranged parallel to each other (palisading) (P) and surrounded by dark nonrefractile cleftlike spaces (arrowheads). Admixed are bright oval to stellate structures with indistinct borders (melanophages) (arrows), bright dendritic structures (melanocytes or Langerhans cells), and bright dots and particles that may be melanin granules/dust5 or dendrites seen in cross section.6 Thickness of cord is 50 μm (scale bar: 25 μm) B, Corresponding histology demonstrates tumor cords with matching growth pattern. (Hematoxylin-eosin stain; original magnification: ×200.) C and D, Dermoscopic and clinical features, respectively, of highly pigmented basal cell carcinoma on chest of 73-year-old woman (case 1). Journal of the American Academy of Dermatology 2006 54, 638-643DOI: (10.1016/j.jaad.2005.11.1096) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 A, Reflectance confocal microscopy image, 2- × 2-mm mosaic at level of dermoepidermal junction. Polypoid nodules of tumor cells extending to papillary dermis, surrounded by cleftlike spaces (arrows), and refractile linear fibrous bundles (F) enclosing dermal stroma. Scattered bright oval, plump structures (arrowheads) resembling melanophages are located between tumor nodules. B, Corresponding histology at low power showing nodular masses of tumor cells extending to dermis, and enclosed by connective tissue stroma arranged in bundles. (Hematoxylin-eosin stain; original magnification: ×40.) Inset, Clinical (C) and dermoscopic (D) features of less pigmented basal cell carcinoma on back of 46-year-old man (case 3). Journal of the American Academy of Dermatology 2006 54, 638-643DOI: (10.1016/j.jaad.2005.11.1096) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 A, Reflectance confocal microscopy image showing tumor nodules/islands (∗) extending to dermis, with aggregates of very bright oval cells (melanophages) found between, including bright dots and granules that may be melanin granules/dust5 or dendrites seen in cross section6 (arrows). B, Corresponding histology demonstrates similar pigmented nodular masses, with melanin-laden melanophages found between nodules. (Hematoxylin-eosin stain; original magnification: ×200.) Journal of the American Academy of Dermatology 2006 54, 638-643DOI: (10.1016/j.jaad.2005.11.1096) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 A, Reflectance confocal microscopy (RCM) image showing dendritic cells with plump round nucleus, surrounded by short processes (arrow), and bright triangle-shaped cell (melanophage) inside tumor island. B, Corresponding A103 immunostained section showing colonization of tumor by melanocytes. (Original magnification: ×400.) C, RCM image of aggregates (∗) of variably bright round, triangle-, and star-shaped cells (melanophages). D, Corresponding histology showing presence of clusters of melanophages within connective tissue stroma. (Hematoxylin-eosin stain; original magnification: ×200.) Journal of the American Academy of Dermatology 2006 54, 638-643DOI: (10.1016/j.jaad.2005.11.1096) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions