Reflectance confocal microscopy criteria for squamous cell carcinomas and actinic keratoses.
OBJECTIVE
To identify criteria for the diagnosis of squamous cell carcinoma (SCC) and actinic keratosis (AK) by in vivo reflectance confocal microscopy (RCM).


METHODS
Prospective RCM imaging of lesions suspected clinically and/or dermoscopically to be SCC or AK, followed by RCM assessment of the biopsy-proven SCCs and AKs.


METHODS
Private skin cancer clinic, Plantation, Florida. Patients A total of 38 lesions in 24 patients were assessed, including 7 AKs, 25 SCCs in situ, 3 invasive SCCs, and 3 keratoacanthomas. Interventions Prior to undergoing biopsy, all lesions were assessed by RCM.


RESULTS
Mosaic RCM images at the stratum corneum level revealed scale in 29 SCCs (95%) and in all 7 AKs. Polygonal nucleated cells at the stratum corneum were seen in 3 SCCs (10%) and 1 AK (14%). All 38 cases displayed an atypical honeycomb and/or a disarranged pattern of the spinous-granular layer of the epidermis; round nucleated cells were seen in the spinous-granular layer in 20 SCCs (65%) and 1 AK (14%). Round blood vessels in the superficial dermis were seen in 28 SCCs (90%) and 5 AKs (72%).


CONCLUSIONS
An increasing frequency of abnormal RCM features can be observed across the spectrum of keratinocytic neoplasias. The presence of an atypical honeycomb or a disarranged pattern of the spinous-granular layer, round nucleated cells at the spinous-granular layer, and round blood vessels traversing through the dermal papilla are the key RCM features of SCC.
Rishpon
Ayelet
A
Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel.
Kim
Nancy
N
Scope
Alon
A
Porges
Leeor
L
Oliviero
Margaret C
MC
Braun
Ralph P
RP
Marghoob
Ashfaq A
AA
Fox
Christi Alessi
CA
Rabinovitz
Harold S
HS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D006801:Humans; D055623:Keratosis, Actinic / Q000473:pathology*; D018613:Microscopy, Confocal; D008875:Middle Aged; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000473:pathology*