Reflectance confocal microscopy : Principles, basic terminology, clinical indications, limitations, and practical considerations - 05/12/20

Doi : 10.1016/j.jaad.2020.05.153

Neda Shahriari, MD ^a,^⁎ , Jane M. Grant-Kels, MD ^a,^b, Harold Rabinovitz, MD ^c,^d, Margaret Oliviero, NP ^c, Alon Scope, MD ^e,^f
^a Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
^b Department of Dermatology, University of Florida, Gainesville, Florida
^c Skin and Cancer Associates, Plantation, Florida
^d Dermatology Department, Medical College of Georgia at Augusta University, Augusta, Georgia
^e The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
^f Dermatology Service, Memorial Sloan-Kettering Center, New York, New York

^∗Reprint requests: Neda Shahriari, MD, Department of Dermatology, University of Connecticut Health Center, 21 South Rd, Farmington, CT 06032.Department of DermatologyUniversity of Connecticut Health Center21 South RdFarmingtonCT06032

Abstract

Reflectance confocal microscopy (RCM) is a noninvasive imaging tool used for in vivo visualization of the skin. It has been extensively studied for use in the evaluation of equivocal cutaneous neoplasms to decrease the number of biopsy procedures in patients with benign lesions. Furthermore, its applications are broadening to include presurgical cancer margin mapping, tumor recurrence surveillance, monitoring of ablative and noninvasive therapies, and stratification of inflammatory disorders. With the approval of category I Current Procedural Terminology reimbursement codes for RCM image acquisition and interpretation, use of this technology has been increasingly adopted by dermatologists. The first article in this 2-part continuing medical education series highlights basic terminology, principles, clinical applications, limitations, and practical considerations in the clinical use of RCM technology.

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Key words : basic terminology, billing, logistics, optical principles, presurgical planning, reflectance confocal microscopy, specificity and sensitivity, tumor recurrence surveillance

Abbreviations used : BCC, DEJ, LM, NNE, OCT, RCM, SCC

Plan

Basic optical and image acquisition principles

RCM of normal skin

Skin surface/corneal layer

Granular layer

Spinous layer

Basal layer and the dermoepidermal junction

Superficial dermis

RCM basic terminology

Clinical indications

Diagnosis of cutaneous neoplasms

Presurgical applications

Monitoring of ablative and noninvasive therapy

Tumor recurrence surveillance

Applications in inflammatory disorders

Limitations of RCM imaging

Practical considerations

Billing

Logistics

Conclusion

	Supported by the Israel Science Foundation (ISF-1546-16).
	Dr Rabinowitz is a speaker for Caliber and has received equipment in the past. Ms Oliviero is a speaker and consultant for Caliber ID. Drs Shahriari, Grant-Kels, and Scope have no conflicts of interest to declare.
	Date of release: January 2021.
	Expiration date: January 2024.