ABSTRACT
During the last decade, reflectance confocal microscopy (RCM) has advanced into becoming a valuable tool for in vivo assessment of skin cancers. As previously reported, RCM can be used to visualize skin cancers in intact skin, demonstrating high sensitivity and specificity1-5 for diagnoses. While RCM imaging has been shown to be capable of guiding noninvasive detection and diagnosis, a new and emerging area is the utilization of RCM for guiding surgical treatments such as Mohs surgery and nonsurgical treatments such as topical imiquimod, photodynamic therapy cryotherapy, radiotherapy, and laser therapy.5,6-9
Mohs micrographic surgery (MMS) is considered the standard treatment among the surgical techniques for removal of nonmelanoma skin cancers (NMSCs) such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). MMS consists of staged excisions that are prepared in parallel with the surgery, to enable histologic assessment for residual tumor in the peripheral (epidermal) and deep subcutaneous (dermal) margins at each stage. However, preparation of frozen pathology can range from 20 to 60 minutes per stage,5,10,11 leading to an overall slow and inefficient Mohs procedure. The tedious and laborious nature of MMS could benefit from a noninvasive imaging modality such as RCM. Intraoperative imaging with RCM may improve the efficiency and speed of the MMS procedure,5,12-16 thus leading to a less invasive procedure that maximizes tissue preservation, minimizes waiting time in the operating room, and reduces costs.
