title: Intraoperative diagnosis of nonpigmented nail tumours with ex vivo fluorescence confocal microscopy: 10 cases.
abstract: BACKGROUND
  Ex vivo fluorescence confocal microscopy (FCM) permits real-time imaging of freshly excised skin tissues. Its usefulness as a time-sparing alternative to frozen sections in Mohs surgery of basal cell carcinoma is well documented.
  
  
  OBJECTIVE
  The purpose of this study was to describe the ex vivo FCM features of a series of benign and malignant nonpigmented tumours of the nail unit, and to correlate them with conventional histopathology.
  
  
  METHODS
  Nail apparatus tumours from 10 patients were imaged during surgical exploration using ex vivo FCM after immersion in acridine orange. Confocal mosaics of the freshly performed biopsies were evaluated in real time and retrospectively compared with haematoxylin and eosin sections.
  
  
  RESULTS
  Our series included two invasive epithelial tumours (Group 1), four in situ or minimally invasive squamous cell carcinomas (SCC) (Group 2), three benign epithelial tumours (Group 3) and one nodular melanoma (Group 4). The correlation was excellent for malignant epithelial tumours exhibiting marked cytological and architectural atypias (Bowen disease, invasive SCC and onycholemmal carcinoma). Onychomatricomas exhibited a very peculiar aspect with densely cellular papillae. The correlation was less favourable for minimally invasive well-differentiated SCCs with slight cytological atypias. The correlation was poor for our case of amelanotic invasive subungual melanoma.
  
  
  CONCLUSIONS
  Ex vivo FCM could be a useful tool to shorten management of nonpigmented nail tumours: in the case of a malignant tumour, it could indeed lead to performing wide excision during the same surgical procedure and possibly assessing the surgical margins.
authors.affiliation: Department of Dermatology, Centre Hospitalier Lyon Sud, 69 495, Pierre Bénite Cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Debarbieux
authors.forename: R
authors.initials: R
authors.lastname: Gaspar
authors.forename: L
authors.initials: L
authors.lastname: Depaepe
authors.forename: S
authors.initials: S
authors.lastname: Dalle
authors.forename: B
authors.initials: B
authors.lastname: Balme
authors.forename: L
authors.initials: L
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D018328:Melanoma, Amelanotic / Q000473:pathology* / Q000601:surgery; D018613:Microscopy, Confocal / Q000379:methods; D008856:Microscopy, Fluorescence / Q000379:methods; D008875:Middle Aged; D009260:Nail Diseases / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery