title: Detection of clinically amelanotic malignant melanoma and assessment of its margins by in vivo confocal scanning laser microscopy.
abstract: BACKGROUND
  Near-infrared confocal scanning laser microscopy (CSLM) represents a novel imaging technique for in vivo microscopic analysis of skin lesions, including pigmented lesions.
  
  
  OBJECTIVE
  To investigate the feasibility of detecting a clinically amelanotic malignant cutaneous melanoma using CSLM and to explore the use of this technique for assessing its margins.
  
  
  METHODS
  Two lesions from 2 patients were imaged and analyzed using CSLM. Sites suspected to represent melanoma or benign skin on CSLM were marked as such; then, biopsy specimens were obtained for diagnosis using conventional histological analysis. Both lesions were stained for melanin pigment and analyzed immunohistochemically for the expression of melanosomal markers. In 1 case, a biopsy specimen was also examined with electron microscopy.
  
  
  RESULTS
  The images obtained using CSLM allowed recognition of an abnormal intraepidermal melanocytic proliferation that was distinctly different from normal skin. Comparison of the sites examined using CSLM and subsequently using conventional histological methods revealed that CSLM correctly identified intraepidermal melanoma and benign skin. Fontana-Masson stains and immunohistochemical and ultrastructural studies showed that clinically amelanotic melanoma cells contained melanosomes and rare melanin granules.
  
  
  CONCLUSIONS
  We demonstrated, for the first time, the detection of clinically amelanotic melanoma using CSLM. This technique may aid in the early detection of clinically barely visible or nonpigmented melanomas and may facilitate preoperative noninvasive assessment of their margins.
authors.affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. busamk@mskcc.org
authors.forename: K J
authors.initials: KJ
authors.lastname: Busam
authors.forename: K
authors.initials: K
authors.lastname: Hester
authors.forename: C
authors.initials: C
authors.lastname: Charles
authors.forename: D L
authors.initials: DL
authors.lastname: Sachs
authors.forename: C R
authors.initials: CR
authors.lastname: Antonescu
authors.forename: S
authors.initials: S
authors.lastname: Gonzalez
authors.forename: A C
authors.initials: AC
authors.lastname: Halpern
mesh_terms: D000368:Aged; D001706:Biopsy; D002610:Cheek; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007259:Infrared Rays; D007866:Leg; D018328:Melanoma, Amelanotic / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D020460:Melanosomes / Q000473:pathology; D018613:Microscopy, Confocal / Q000295:instrumentation / Q000379:methods; D008854:Microscopy, Electron; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery