ABSTRACT
Most cases of malignancy in oral and genital mucosa are relatively advanced at diagnosis. Early diagnosis and adequate management significantly increase survival and improve patient prognosis. However, the initial lesions can often be indistinguishable from benign conditions based only on clinical examination, and histology remains the gold standard for a conclusive diagnosis. At present, in vivo reflectance confocal microscopy (RCM) is widely used in dermatology for in vivo microscopic imaging of melanocytic and nonmelanocytic skin tumors and management of inflammatory skin diseases. On the basis of its proven effectiveness in healthy and pathological skin imaging, RCM may also be advantageously used to evaluate healthy1-3 and pathological oral4,5 and genital mucosa as previously reported in literature.6,7 The correlation between images of RCM and histopathology was consistent in several previous studies.4,6 The possibility of noninvasive imaging of mucosa represents an interesting solution for screening, diagnosis, and follow-up of those small mucosal sites where biopsy-representing at the moment the gold standard for diagnosis-is accompanied by drawbacks such as time required for histopathological analysis, morbidity and postoperative complications due to the surgical wound, low patient compliance, and need for multiple biopsies for extended or plurifocal lesions. Thus, in order to enhance the diagnostic management of mucosal diseases, RCM is a valid support to spare biopsies or to orient the clinician and surgeon toward the most representative sites to biopsy. The mucosa is particularly suitable for RCM, showing better resolution and contrast, and deeper penetration through the epithelial and subepithelial layers, than in skin analysis. The absence of keratinization and pigmentation and the thickness of this epithelium allow higher definition and deeper penetration of the laser (with no consequent light backscattering) with the possibility of a better-detailed
visualization of cellular morphology and dermal structures in comparison with the skin tissue.
