ABSTRACT
Reflectance confocal microscopic features of melanocytic and nonmelanocytic lesions have been described in detail and show excellent correlation with histology, specifically in the epidermis.1-9 The vast majority of nonmelanocytic skin tumors are biopsied using shave biopsy, as they tend to occur in the epidermis and/or at least in part the superficial dermis. As such, reflectance confocal microscopy (RCM), which allows for noninvasive imaging of the superficial skin, is an excellent addition to the armamentarium to aid in the diagnosis and management of nonmelanocytic skin tumors.10-12
When approaching any lesion on RCM, it is helpful to think like a histopathologist examining a very superficial shave biopsy; one must always consider two things: (1) what can I see? and (2) what may I be missing? Before one can consider utilizing RCM to evaluate a lesion, one must determine if the lesion is appropriate for RCM imaging; that is, will RCM provide reliable information? This first step is the pre-examination phase. In addition to requiring demographic data, clinical information/ images and mandatory dermoscopic images, rejection criteria have been suggested to identify lesions not amenable to RCM imaging (Figure 30.1). Factors particular to many nonmelanocytic tumors, such as thickening of the stratum corneum, acanthosis, crusts, and erosions, may impair resolution, resulting in visualization of only epidermal layers or the inability to visualize all of the diagnostic features of the lesion, including those at the dermal-epidermal junction (DEJ) or in the superficial dermis. Therefore, an understanding of imaging
obstacles specific to these nonmelanocytic tumors is a critical.
