Reflectance confocal microscopy of pigmented basal cell carcinoma.
BACKGROUND
Reflectance confocal microscopy (RCM) is a high-resolution imaging tool for in vivo noninvasive evaluation of skin lesions.


OBJECTIVE
We sought to describe the relevant RCM features for pigmented basal cell carcinoma (BCC).


METHODS
Pigmented skin lesions with a differential diagnosis of pigmented BCC were imaged using dermoscopy and RCM, followed by excision for histologic analysis.


RESULTS
RCM demonstrated aggregations of tightly packed cells with palisading, forming cordlike structures and nodules with irregular borders and variable brightness; these represented nests of pigmented basaloid tumor cells on histopathology, and blue-gray ovoid areas on dermoscopy. These tumor nests were associated with bright dendritic structures, identified histologically as either melanocytes or Langerhans cells, together with numerous bright oval to stellate-shaped structures with indistinct borders representing melanophages, and with highly refractile granules of melanin.


CONCLUSIONS
The pigmented BCCs imaged in this study were predominantly nodular; a different set or additional criteria may be necessary for detection of infiltrative and metatypical BCCs.


CONCLUSIONS
RCM may permit in vivo diagnosis of pigmented BCC.
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
Anna Liza Chan
AL
Agero
Klaus J
KJ
Busam
Cristiane
C
Benvenuto-Andrade
Alon
A
Scope
Melissa
M
Gill
Ashfaq A
AA
Marghoob
Salvador
S
González
Allan C
AC
Halpern
D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology; D018613:Microscopy, Confocal; D008875:Middle Aged; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology*