Reflectance confocal microscopy is a useful non-invasive tool in the in vivo diagnosis of pigmented basal cell carcinoma in Asians.
BACKGROUND
The clinical differentiation between pigmented basal cell carcinoma (BCC) and other benign pigmented skin lesions can be challenging even with an additional dermoscopic evaluation, especially if the lesion is small. In vivo reflectance confocal microscopy (RCM) is an emerging, non-invasive imaging tool that allows near-microscopic evaluation of skin lesions. The features of RCM for pigmented BCC and seborrhoeic keratosis have previously been described. However, the use of RCM to differentiate between these clinically and dermoscopically challenging pigmented skin lesions among Asians has not yet been demonstrated.


OBJECTIVES
We aimed to evaluate the usefulness of non-invasive RCM to differentiate between clinically and dermoscopically challenging pigmented skin lesions among Asians in a series of 11 lesions.


METHODS
Nine patients with 11 clinically and dermoscopically difficult to distinguish pigmented skin lesions were evaluated by RCM to differentiate between pigmented BCC and benign lesions. In all cases, a histological confirmation of the RCM diagnosis was obtained.


RESULTS
The clinical or dermoscopical characteristics were non-specific in all 10 cases. RCM detected features of pigmented BCC in nine patients and seborrhoeic keratosis in one patient. These were all confirmed by histological examination.


CONCLUSIONS
This case series shows the value of non-invasive in vivo RCM imaging in the differentiation of malignant and benign pigmented lesions. Early diagnosis of small, pigmented BCC allows earlier excision with better prognosis. Future biopsies of benign lesions in cosmetic areas could also be avoided.
['Chuah|Sai Yee|SY|', 'Tee|Shang Ian|SI|', 'Tan|Wee Ping|WP|', 'Lee|Siong See Joyce|SSJ|', 'Ng|See Ket|SK|', 'Chua|Sze Hon|SH|', 'Thng|Tien Guan Steven|TGS|']
D000368:Aged D000369:Aged, 80 and over D044466:Asians D002280:Carcinoma, Basal Cell D003937:Diagnosis, Differential D005260:Female D006801:Humans D000069416:Intravital Microscopy D017492:Keratosis, Seborrheic D008297:Male D018613:Microscopy, Confocal D008875:Middle Aged D012878:Skin Neoplasms
reflectance confocal microscopy non-invasive pigmented basal cell carcinoma seborrhoiec keratosis