title: Use of in vivo confocal microscopy in malignant melanoma: an aid in diagnosis and assessment of surgical and nonsurgical therapeutic approaches.
abstract: BACKGROUND
  Melanomas with poorly defined borders, lack of pigmentation, lentiginous extension, and location in cosmetically sensitive regions represent diagnostic and therapeutic challenges. Repeated surgical reexcisions are frequently required to achieve tumor-free margins. The use of reflectance mode confocal microscopy as an noninvasive method has shown to be a promising tool for diagnosing pigmented lesions in vivo.
  
  
  METHODS
  We report 3 clinical cases of melanoma: amelanotic melanoma (case 1), locally recurrent melanoma (case 2), and lentigo maligna melanoma (case 3). In case 1, in vivo confocal microscopy was instrumental in making the diagnosis and in monitoring the response to imiquimod therapy for in situ residual disease. It was also used to successfully delineate preoperative surgical margins in cases 2 and 3.
  
  
  CONCLUSIONS
  As new methods for treating melanoma emerge and become more available, confocal microscopy can play a significant role by improving sensitivity in diagnosis, by increasing rates of successful initial excision, and by serving as a noninvasive means of monitoring therapy.
authors.affiliation: Department of Dermatology, the Cutaneous Oncology Program, and the Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. ccuriel@bidmc.harvard.edu
authors.forename: Clara
authors.initials: C
authors.lastname: Curiel-Lewandrowski
authors.forename: Christy M
authors.initials: CM
authors.lastname: Williams
authors.forename: Kirsty Joanna
authors.initials: KJ
authors.lastname: Swindells
authors.forename: Steven R
authors.initials: SR
authors.lastname: Tahan
authors.forename: Susie
authors.initials: S
authors.lastname: Astner
authors.forename: Robert A
authors.initials: RA
authors.lastname: Frankenthaler
authors.forename: Salvador
authors.initials: S
authors.lastname: González
mesh_terms: D000634:Aminoquinolines / Q000627:therapeutic use; D001707:Biopsy, Needle; D005153:Facial Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D000077271:Imiquimod; D007150:Immunohistochemistry; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D018613:Microscopy, Confocal; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods; D009367:Neoplasm Staging; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012867:Skin / Q000648:ultrastructure*; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000634:Aminoquinolines; D000077271:Imiquimod