Silvia Koller

Discrimination of Actinic Keratoses from Normal Skin with Reflectance Mode Confocal Microscopy

BACKGROUND Recently, a wide range of new noninvasive therapies has been introduced for the treatment of actinic keratoses. As these treatment options do not provide tissue for histopathologic examination, in vivo confocal laser scanning microscopy may become an important method for obtaining a reliable diagnosis. OBJECTIVE The objective was to validate the diagnostic confocal examination of actinic keratoses. METHODS Thirty actinic keratoses and skin fields from the contralateral sides of the patients were consecutively sampled and examined using a confocal microscope. Stored images were rated by four independent observers. RESULTS Distinct diagnostic morphologic features could be visualized. Overall, sensitivity of 93.34% and specificity of 88.34% could be achieved by two clinical dermatooncologists (positive predictive value 88.94%, negative predictive value 93.15%). Assessment of distinct confocal microscopy features showed a moderate interobserver correlation (κ = 0.4–0.6 in five of seven criteria). Classification and regression tree analysis yielded a one-step algorithm based on only one criterion (irregular keratinocyte cell borders), facilitating a correct classification in 86.67% of actinic keratoses and 85% of normal skin. LIMITATIONS Hyperkeratotic actinic keratoses were excluded from the study set. CONCLUSIONS This study provides a set of morphologic confocal microscopy criteria showing promise as a noninvasive monitoring tool in the treatment of actinic keratoses.

In vivo confocal laser scanning microscopy of melanocytic skin tumours: diagnostic applicability using unselected tumour images.

Background  In vivo confocal laser scanning microscopy (CLSM) represents a novel imaging tool that allows the noninvasive examination of skin cancer morphology in real time at a ‘quasi‐histopathological’ resolution viewing microanatomical structures and individual cells.

Monitoring efficacy of cryotherapy for superficial basal cell carcinomas with in vivo reflectance confocal microscopy: A preliminary study

BACKGROUND Superficial BCCs (sBCCs) usually appear as multiple lesions in chronic sun-damaged skin of elderly people and may show a destructive growth if left untreated. Non-invasive treatment modalities, such as cryotherapy have been employed for sBCCs, all failing to provide tissue for confirming diagnosis and assessing adequacy of tumour removal. Reflectance confocal microscopy (RCM), a new non-invasive imaging technique has proven to be a useful tool for detection of basal cell carcinoma in vivo. OBJECTIVE To non-invasively assess efficacy of cryotherapy for sBCCs by cytomorphologic analysis using RCM. METHODS We examined 10 histologically proven sBCCs located on the trunk of 5 consecutive patients with a mean age of 84.6 years. SBCCs were frozen twice using a spray nitrogen cryoprobe. RCM imaging was performed in each sBCC before cryotherapy and after 5 and 24h to monitor resulting tissue injury. Distinct cytomorphologic characteristics were determined by three observers allowing non-invasive evaluation of therapeutic efficacy of treatment immediately after cryotherapy. Tumour clearance was assessed by RCM imaging 3 months after therapy followed by histopathologic examination. RESULTS Characteristic RCM-features of BCC were present in all lesions before cryotherapy. Five hours after cryotherapy, all 10 sBCCs showed small bright round to polygonal structures at basal layer and black round to oval areas of varying size with such bright structures floating therein, correlating to cell necrosis and incipient blistering. Eight sBCCs showed also cell necrosis in upper dermis. After 24h all sBCCs showed necrotic cells beneath collagen bundles. Tumour clearance on later histopathologic examination was only proven in those lesions showing damage to the upper dermis after 5h with RCM. CONCLUSION Early cell necrosis within upper dermal structures seems to correlate with ablation of overlying tumour tissue. When it is not produced by cryotherapy, a second treatment should be considered.

Reflectance confocal microscopy of facial lentigo maligna and lentigo maligna melanoma: a preliminary study.

Background  Facial lentigo maligna (LM) and lentigo maligna melanoma (LMM) may be difficult to diagnose clinically and dermoscopically. Reflectance confocal microscopy (RCM) enables the in vivo assessment of equivocal skin lesions at a cellular level.

In vivo confocal scanning laser microscopy of common naevi with globular, homogeneous and reticular pattern in dermoscopy

Background  A systematic examination and comparison of confocal scanning laser microscopy (CSLM) features of benign naevi showing different dermoscopic patterns has never been performed.

In vivo reflectance confocal microscopy of erythematosquamous skin diseases.

Background:  In vivo reflectance confocal microscopy (RCM) represents a promising imaging tool that allows a non‐invasive examination of skin morphology in real time at nearly histological resolution, showing microanatomical structures and individual cells.

The use of confocal laser-scanning microscopy in microsurgery for invasive squamous cell carcinoma

Background  Ex‐vivo confocal laser‐scanning microscopy offers rapid imaging of excised tissue specimens without conventional histotechnical procedures. As vertical sections are prepared, morphological features can be assessed according to standard criteria used in conventional histopathology.

A mobile-phone based teledermatology system to support self-management of patients suffering from psoriasis

Psoriasis is one of the most common chronic skin diseases, affecting about 2% of the population world wide. Continuous clinical monitoring with periodic assessment of the state of the disease is essential for long-term therapy optimization. We present a mobile phone based telemedical compliance management system for psoriasis-patients. Using special software, patients can acquire health parameters such as their body weight, take photos of their psoriasis lesions, and report adverse effects. The data are automatically sent to a monitoring centre, where they are provided to the patients physician via the use of a web-browser. In case of therapy relevant events, email or SMS notifications can be sent to the physician. If necessary, the physician can send feedback messages to the patient, e.g. for admitting the patient to the clinic for further examinations. The system has been implemented and functional tests have proven its functionality. Currently, the system is used in the course of a medical case series.

In vivo reflectance confocal microscopy: automated diagnostic image analysis of melanocytic skin tumours

Background  In vivo reflectance confocal microscopy (RCM) has been shown to be a valuable imaging tool in the diagnosis of melanocytic skin tumours. However, diagnostic image analysis performed by automated systems is to date quite rare.

Follow-up of actinic keratoses after shave biopsy by in-vivo reflectance confocal microscopy – a pilot study

Background  Monitoring of treatment efficacy after shave biopsy of actinic keratoses (AK) is often difficult, as clinical and dermoscopic features may not be reliable.