title: Reflectance confocal microscopy for the diagnosis of vulvar melanoma and melanosis: preliminary results.
abstract: BACKGROUND
  In the early stages, vulvar melanoma can mimic vulvar melanosis and therefore the diagnosis is often late and carries a poor prognosis. In vivo reflectance-mode confocal microscopy (RCM) is an emerging technique that allows noninvasive high-resolution imaging of the skin and mucosa, but it has not been employed in the study of genital pigmentation.
  
  
  OBJECTIVE
  To analyze the characteristics of vulvar melanosis and vulvar melanoma using RCM to define the confocal aspects that allow a correct differential diagnosis.
  
  
  METHODS
  Features of eight melanoses and two melanomas of the vulva were analyzed using RCM. RCM diagnosis was then compared with clinical and histologic diagnosis.
  
  
  RESULTS
  Two major characteristics are associated with vulvar melanosis: papillae rimmed by bright monomorphous cells and possible presence of a few dendritic bright cells in the basal layer of the epithelium. Two major features of vulvar melanoma have been identified: atypical cells in the epithelium and loss of normal architecture of chorion papillae.
  
  
  CONCLUSIONS
  Reflectance Confocal Microscopy can play a role in noninvasive differentiation between vulvar melanoma and vulvar melanosis, but further broader studies are needed to validate our observations.
authors.affiliation: Department of Dermatology, Hôpital Nord, Saint Etienne Cedex 2, France.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cinotti
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Perrot
authors.forename: Bruno
authors.initials: B
authors.lastname: Labeille
authors.forename: Huges
authors.initials: H
authors.lastname: Adegbidi
authors.forename: Frédéric
authors.initials: F
authors.lastname: Cambazard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008548:Melanosis / Q000175:diagnosis*; D018613:Microscopy, Confocal; D008875:Middle Aged; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014845:Vulvar Diseases / Q000175:diagnosis / Q000473:pathology; D014846:Vulvar Neoplasms / Q000175:diagnosis* / Q000473:pathology