Alice Casari

Skin aging: In vivo microscopic assessment of epidermal and dermal changes by means of confocal microscopy

BACKGROUND Skin aging is thought to be a complex biological process that is traditionally classified as intrinsic and extrinsic aging. Several clinical score and instrumental devices have been applied to obtain a precise assessment of skin aging. Among them, confocal microscopy has emerged as a new technique capable of assessing cytoarchitectural changes with a nearly histopathologic resolution. OBJECTIVE We sought to determine the microscopic skin changes occurring on the face in different age groups by means of confocal microscopy. METHODS The skin of the cheek in 63 volunteers belonging to distinct age groups was analyzed by confocal microscopy. In 4 cases, routine histopathology was performed on site-matched surplus areas from routine excisions for obtaining a better comparison with confocal findings. RESULTS Young skin was characterized by regular polygonal keratinocytes and thin reticulated collagen fibers. With aging, more irregularly shaped keratinocytes and areas with unevenly distributed pigmentation and increased compactness of collagen fibers were observed. In the elderly, thinning of the epidermis, marked keratinocyte alterations, and huddles of collagen and curled fibers, corresponding to elastosis, were present. A side-by-side correlation between confocal descriptors and histopathologic aspects has been provided in a few cases. LIMITATIONS Reticular dermal changes cannot be assessed because of the limited depth laser penetration. CONCLUSIONS Confocal microscopy was successfully applied to identify in vivo skin changes occurring in aged skin at both the epidermal and dermal levels at histopathologic resolution. This offers the possibility to test cosmetic product efficacy and to identify early signs of sun damage.

Reflectance confocal microscopy as a second-level examination in skin oncology improves diagnostic accuracy and saves unnecessary excisions: a longitudinal prospective study

Dermatoscopy increases both the sensitivity and specificity of melanoma diagnosis. Reflectance confocal microscopy (RCM) is a noninvasive technique that complements dermatoscopy in the evaluation of equivocal lesions at cellular resolution.

In vivo confocal microscopy for detection and grading of dysplastic nevi: A pilot study

BACKGROUND Dysplastic nevi are thought to be precursors of melanoma during a stepwise process. However, this concept is still controversial and precise correlation between clinical and histopathologic features is lacking. In vivo confocal microscopy represents a noninvasive imaging technique producing horizontal sections at nearly histopathologic resolution. OBJECTIVE We sought to determine whether specific histologic features in dysplastic nevi have reliable correlates on confocal microscopy and to develop an in vivo microscopic grading system. METHODS Sixty melanocytic lesions with equivocal dermatoscopic aspects, corresponding to 19 nondysplastic nevi, 27 dysplastic nevi, and 14 melanomas, were analyzed by confocal microscopy and histopathology, using the Duke grading criteria. RESULTS All architectural and cytologic features of the Duke grading score had significant reflectance confocal microscopy correlates. Confocally, dysplastic nevi were characterized by a ringed pattern, in association with a meshwork pattern in a large proportion of cases, along with atypical junctional cells in the center of the lesion, and irregular junctional nests with short interconnections. A simplified algorithm was developed to distinguish dysplastic nevi from melanoma and nondysplastic nevi. The contemporary presence of cytologic atypia and of atypical junctional nests (irregular, with short interconnections, and/or with nonhomogeneous cellularity) was suggestive of histologic dysplasia, whereas a widespread pagetoid infiltration, widespread cytologic atypia at the junction, and nonedged papillae suggested melanoma diagnosis. LIMITATIONS A small number of cases were evaluated because of the necessity to analyze numerous histopathologic and confocal features. CONCLUSION The possibility to detect dysplastic nevi in vivo may lead to an appropriate management decision.

Confocal microscopy of recurrent naevi and recurrent melanomas: a retrospective morphological study.

Background  Repigmentation within a scar after different procedures (shave biopsy, partial excision, cryotherapy, laser) is a challenging diagnostic situation.

Confocal Microscopy Insights into the Treatment and Cellular Immune Response of Basal Cell Carcinoma to Photodynamic Therapy

Background: Photodynamic therapy (PDT) represents an optimal treatment for basal cell carcinoma (BCC). Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that has been applied in skin oncology and for BCC diagnosis. Moreover, RCM is a useful tool to determine noninvasive treatment efficacy of nonmelanoma skin cancer. Objective: We aimed to investigate the role of RCM in assessing the efficacy of PDT in the treatment of BCC and to evaluate the skin changes following the PDT. Methods: Ten patients with 12 BCCs were treated with PDT. Dermoscopy and RCM imaging were performed at baseline as well as 7 days (T1), 30 days and 18 months after PDT. Cytological examination was taken at baseline and in case of BCC persistence. Results: At T1, RCM showed the presence of several dendritic-shaped cells within the epidermis, corresponding to activated Langerhans cells. After 1 month, RCM showed the persistence of 2 BCCs, which escaped the clinical and dermoscopic diagnosis. At the long-term follow-up, none of the tumors revealed signs of persistence or recurrence. Conclusion: RCM is a valuable noninvasive tool for the diagnosis and treatment monitoring of BCC using PDT.

Proposal for an in vivo histopathologic scoring system for skin aging by means of confocal microscopy

Many instrumental devices have been testing in analysing and quantifying the skin aging signs. However, histopathology still remains the only methods that allow a microscopic assessment of the skin. However, a skin biopsy is not feasible in aesthetically critical areas such as the face. Recently, confocal microscopy has been discovered as a noninvasive tool with a nearly histologic resolution. Distinct morphologic confocal aspects on facial skin have been described and correlated with the histopathologic counterparts.

Towards an in vivo morphologic classification of melanocytic nevi

Nevi are common benign neoplasms and the main diagnostic entity in the differential diagnosis of melanoma. Reflectance confocal microscopy (RCM), a novel technique for skin imaging at cellular‐level magnification, has been shown to be useful for differentiating nevi from melanoma. However, systematic studies of the specific RCM features of nevi are still lacking.

A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index.

Actinic keratosis (AK) severity is currently evaluated by subjective assessment of patients.

Grading keratinocyte atypia in actinic keratosis: A correlation of reflectance confocal microscopy and histopathology

Actinic Keratosis (AK) is the clinical manifestation of cutaneous dysplasia of epidermal keratinocytes, with progressive trend towards squamous cell carcinoma.

CDKN2A and MC1R variants influence dermoscopic and confocal features of benign melanocytic lesions in multiple melanoma patients

Non‐invasive diagnostic tools are effective in the histomorphological study of melanocytic lesions. The role of melanoma susceptibility genes on melanocytic nevi histopathological features is not clear. The current study aimed to correlate genetic alterations and histomorphological features of melanocytic nevi. Clinical, dermoscopic and confocal features of 34 multiple melanoma patients and 34 controls were compared. Among patients with melanoma, carriers of CDKN2A mutations and/or MC1R variants, and wild‐type genes were also compared. In patients with melanoma, a lighter phototype (P = 0.051), a higher number of nevi (P < 0.01) and clinically atypical nevi (P < 0.01) were observed. At dermoscopy, these nevi showed a complex pattern (P = 0.011), atypical network (P = 0.018) and irregular pigmentation (P = 0.037); at confocal, an irregular meshwork pattern (P = 0.026) with atypical nests (P = 0.016) and an inflammatory infiltrate (P = 0.048) were observed. Among patients with melanoma genetically tested, CDKN2A G101W mutation carriers were more frequently younger (P = 0.023), with clinically atypical nevi (P = 0.050), with cytological atypia (P = 0.033) at confocal. G101W mutation and MC1R variants carriers showed hypopigmented nevi (P = 0.002) and, at confocal, roundish cells infiltrating the junction (P = 0.019). These data suggest an influence of CDKN2A mutation and MC1R variants in the development of dysplastic melanocytic lesions. Non‐invasive histomorphological evaluation, together with genetic studies, improves melanoma risk identification and early diagnosis, for a patient‐tailored management.