Prospective differentiation of clinically difficult to distinguish nodular basal cell carcinomas and intradermal nevi by non-invasive Reflectance Confocal Microscopy: a case series study.
BACKGROUND
Clinical differentiation between a nodular basal cell carcinoma (nBCC) and a benign intradermal nevus can be difficult. Even with additional dermoscopic evaluation, a correct diagnosis may be difficult. Currently, histopathological examination of a biopsy is the gold standard to differentiate between these lesions. However, this is an invasive technique and sampling errors can occur. In vivo Reflectance Confocal Microscopy (RCM) is a non-invasive technique to evaluate a skin lesion at a microscopic level. RCM features of nBCCs and intradermal nevi have been described in research setting. However, the use of RCM for prospective differentiation between difficult to diagnose nodules into nBCCs and intradermal nevi in clinical practice has not been demonstrated yet.


OBJECTIVE
In this study, we aim to address a common clinical scenario; to differentiate clinically and dermoscopically difficult to distinguish nodules, into nBCCs and intradermal nevi by RCM.


METHODS
Six patients with clinically and dermoscopically difficult to distinguish nodular skin lesions were evaluated by RCM to differentiate prospectively between nBCCs and intradermal nevi. In five out of six cases, a 3 mm punch biopsy was obtained to confirm the RCM diagnosis.


RESULTS
Observed RCM features that allowed differentiation between nBCCs and intradermal nevi were the dermal-epidermal junction patterns, the appearance of the nests and the degree of vascularization.


CONCLUSIONS
This case series study demonstrates the value of non-invasive in vivo RCM imaging in routine patient care, with respect to the prospective diagnosis of clinically difficult to distinguish nBCCs and intradermal nevi. Subsequently, biopsies of benign lesions in cosmetic areas could be avoided.
Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
L
L
Hoogedoorn
Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
M
M
Peppelman
Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.
W A M
WAM
Blokx
Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
P E J
PEJ
van Erp
Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
M-J P
MP
Gerritsen
D000328:Adult; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D009506:Nevus / Q000175:diagnosis*; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis*