Confocal microscopy-guided laser ablation for superficial and early nodular Basal cell carcinoma: a promising surgical alternative for superficial skin cancers.
OBJECTIVE
Laser ablation is a rapid and minimally invasive approach for the treatment of superficial skin cancers, but efficacy and reliability vary owing to lack of histologic margin control. High-resolution reflectance confocal microscopy (RCM) may offer a means for examining margins directly on the patient.


METHODS
We report successful elimination of superficial and early nodular basal cell carcinoma (BCC) in 2 cases using RCM imaging to guide Er:YAG laser ablation. Three-dimensional (3D) mapping is feasible with RCM to delineate the lateral border and thickness of the tumor. Thus, the surgeon may deliver laser fluence and passes with localized control-ie, by varying the ablation parameters in sublesional areas with specificity that is governed by the 3D topography of the BCC. We further demonstrate intraoperative detection of residual BCC after initial laser ablation and complete removal of remaining tumor by additional passes. Both RCM imaging and histologic sections confirm the final clearance of BCC.


CONCLUSIONS
Confocal microscopy may enhance the efficacy and reliability of laser tumor ablation. This report represents a new translational application for RCM imaging, which, when combined with an ablative laser, may one day provide an efficient and cost-effective treatment for BCC.
Memorial Sloan Kettering Skin Cancer Center, Hauppauge, New York2Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Chih-Shan Jason
CS
Chen
Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Heidy
H
Sierra
Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Miguel
M
Cordova
Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Milind
M
Rajadhyaksha
D000328:Adult; D002280:Basal Cell Carcinoma / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D018613:Microscopy, Confocal; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D055815:Young Adult