title: Carbon dioxide laser ablation of basal cell carcinoma with visual guidance by reflectance confocal microscopy: a proof-of-principle pilot study.
abstract: BACKGROUND
  Laser ablation is an alternative, nonsurgical treatment modality for low-risk basal cell carcinoma (BCC). However, lack of confirmative tumour destruction or residual tumour presence has been a limiting factor to its adoption. Reflectance confocal microscopy (RCM) provides noninvasive, cellular-level resolution imaging of the skin and is capable of identifying tumour.
  
  
  OBJECTIVE
  To evaluate the use of RCM to guide carbon dioxide (CO2 ) laser ablation of BCC, confirm destruction and correlate findings with histology.
  
  
  METHODS
  RCM was used preablation to evaluate for features of BCC. Ablation was performed with a CO2 laser, and the response rapidly assessed using handheld RCM to evaluate for residual tumour. Confirmative pathology was used to verify confocal imaging.
  
  
  RESULTS
  Preablation RCM imaging identified tumour with features not identified on normal, surrounding skin. Postablation, RCM documented complete removal of tumour in six cases and residual tumour in two. Histological examination identified the ablated area and confirmed clearance of tumour in the six aforementioned cases and corroborated confocal findings for residual tumour in the other two cases.
  
  
  CONCLUSIONS
  We report successful treatment of superficial and nodular BCC using CO2 laser ablation augmented by RCM imaging for preablation guidance and verification of tumour removal postablation. Akin to complete circumferential and deep margin control techniques, using RCM helps to map peripheral and deep BCC margins to hone in on areas exhibiting persistent tumour after ablation. CO2 laser ablation visually guided by RCM can help circumvent previously cited limiting factors of laser ablation for tumour destruction by providing cellular-level resolution imaging of tumour and margin assessment in between each laser pass and postablation.
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: B P
authors.initials: BP
authors.lastname: Hibler
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: H
authors.initials: H
authors.lastname: Sierra
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: M
authors.initials: M
authors.lastname: Cordova
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: W
authors.initials: W
authors.lastname: Phillips
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: M
authors.initials: M
authors.lastname: Rajadhyaksha
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: K S
authors.initials: KS
authors.lastname: Nehal
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, U.S.A.
authors.forename: A M
authors.initials: AM
authors.lastname: Rossi
mesh_terms: D002280:Basal Cell Carcinoma / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D054020:Lasers, Gas / Q000627:therapeutic use; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D018365:Neoplasm, Residual; D010865:Pilot Projects; D012878:Skin Neoplasms / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome