Reflectance confocal microscopy (RCM) allows noninvasive imaging of the epidermis and
superficial dermis. Like dermoscopy, RCM acquires images in the horizontal plane (en
face), allowing assessment of tissue pathology underlying dermoscopic structures of
interest at a cellular-level resolution. Thus, clinicians using dermoscopy may find RCM to
be particularly useful. Our aim was to show the value of RCM for diagnosis and management
decisions related to pigmented and nonpigmented skin neoplasms seen in daily
practice. Six cases of clinically and dermoscopically equivocal skin lesions, for which RCM
facilitated making the correct diagnosis, are presented. Final diagnoses were made based
on histopathologic analysis. Three flat pigmented skin lesions with dermoscopic signs
of regression showed distinct RCM features that allowed their correct classification as
pigmented basal cell carcinoma, pigmented actinic keratosis, and melanoma on sundamaged
skin. A flat nonpigmented skin lesion on the face, which did not show distinct
clinical or dermoscopic features, was correctly diagnosed as basal cell carcinoma based on
RCM findings. In addition, the response of a pigmented actinic keratosis and a melanoma
in situ on sun-damaged skin to noninvasive topical treatment was monitored using RCM.
RCM is a promising and practical imaging tool for the diagnosis and follow-up of pigmented
and nonpigmented skin lesions.
Semin Cutan Med Surg 28:180-189 © 2009 Elsevier Inc. All rights reserved.

Reflectance confocal microscopy (RCM) allows noninvasive imaging of the epidermis and
superficial dermis. Like dermoscopy, RCM acquires images in the horizontal plane (en
face), allowing assessment of tissue pathology underlying dermoscopic structures of
interest at a cellular-level resolution. Thus, clinicians using dermoscopy may find RCM to
be particularly useful. Our aim was to show the value of RCM for diagnosis and management
decisions related to pigmented and nonpigmented skin neoplasms seen in daily
practice. Six cases of clinically and dermoscopically equivocal skin lesions, for which RCM
facilitated making the correct diagnosis, are presented. Final diagnoses were made based
on histopathologic analysis. Three flat pigmented skin lesions with dermoscopic signs
of regression showed distinct RCM features that allowed their correct classification as
pigmented basal cell carcinoma, pigmented actinic keratosis, and melanoma on sundamaged
skin. A flat nonpigmented skin lesion on the face, which did not show distinct
clinical or dermoscopic features, was correctly diagnosed as basal cell carcinoma based on
RCM findings. In addition, the response of a pigmented actinic keratosis and a melanoma
in situ on sun-damaged skin to noninvasive topical treatment was monitored using RCM.
RCM is a promising and practical imaging tool for the diagnosis and follow-up of pigmented
and nonpigmented skin lesions.
Semin Cutan Med Surg 28:180-189 © 2009 Elsevier Inc. All rights reserved.