Confocal microscopy is a new imaging modality for noninvasive real-time tissue imaging
with high resolution and contrast comparable with conventional histology. Application of
this technology to skin imaging during the last decade has been an exciting advance in
dermatology, allowing a virtual widow into living skin without the need for a conventional
biopsy or histologic processing of tissue. High-resolution noninvasive skin imaging with
confocal microscopy has potential broad applications in the clinical and research arenas,
including differentiating between benign and malignant skin lesions, tumor margin mapping,
monitoring response to medical or surgical treatments, and pathophysiologic study of
Semin Cutan Med Surg 27:37-43 © 2008 Elsevier Inc. All rights reserved.
As a noninvasive diagnostic method, real-time B-mode sonography belongs to the diagnostic
standard procedures in various fields of clinical medicine, for example, internal
medicine, gynecology, and otorhinolaryngology. During the past 3 decades, ultrasound
technology has been extended to clinical dermatology. High-frequency ultrasound systems
with 20- to 50-MHz probes are used for the assessment of tumoral and inflammatory
processes of the skin, providing information about their axial and lateral extension. They are
of special interest in preoperative situations and for the monitoring of skin conditions under
therapy. In contrast to high-frequency ultrasound systems, the value of ultrasound technology
with the use of 7.5- to 15-MHz probes generally is not accepted worldwide, although
it can be used easily and without significant side effects. Promising results have been
reported from specialized diagnostic centers, especially for the assessment of peripheral
lymph nodes and soft-tissue tumors. Although it is unable to provide malignancy specific
information, ultrasound is nonetheless helpful in the follow-up of patients undergoing, for
example, chemotherapy or radiotherapy. The 3-dimensional size and outline of a tumor as
well as its relation to surrounding structures like vessels can be described. Moreover,
information about the tumor quality (solid, cyst, complex) and the inner structure of a tumor
(hypoechoic, hyperechoic, homogenous, inhomogenous, calcification foci, necroses) can
be provided. In addition to conventional B-mode-sonography, newer ultrasound techniques
like native and signal-enhanced color Doppler sonography as well as ultrasound-guided
fine needle aspiration cytology are reviewed.
Semin Cutan Med Surg 27:44-51 © 2008 Elsevier Inc. All rights reserved.
Photodynamic therapy is a relatively new and rapidly evolving therapeutic option in dermatology.
Initially used for the treatment of actinic damage and nonmelanotic skin cancer,
more recent work indicates efficacy in the treatment of a wide range of conditions, such as
acne, infectious processes, cutaneous T-cell lymphoma, and photorejuvenation, among
others. This article provides a comprehensive review of applications and outcomes that use
topical photodynamic therapy in the treatment of dermatologic disease.
Semin Cutan Med Surg 27:52-62 © 2008 Elsevier Inc. All rights reserved.
Fractional resurfacing is a new laser treatment modality that creates numerous microscopic
thermal injury zones of controlled width, depth, and density that are surrounded
by a reservoir of spared epidermal and dermal tissue, allowing for rapid repair of
laser-induced thermal injury. This unique modality, if implemented with proper laserdelivery
systems, enables high-energy treatments while minimizing risks. In this article,
we review the various fractional laser devices, including the new fractional ablative
devices, as well as the results of studies on the clinical efficacy of fractional photothermolysis.
This technology offers patients significant clinical improvement in photodamage,
melasma, and scarring with modest treatment-related downtime and minimal
risk of complications.
Semin Cutan Med Surg 27:63-71 © 2008 Elsevier Inc. All rights reserved.
Although suction-assisted liposuction under tumescent anesthesia remains the traditional
method for body sculpting, newer technologies promise to increase efficiency, decrease
surgeon fatigue, and minimize complication. Power-, ultrasound-, and laser-assisted devices
are ideal in large volume cases and in areas of fibrous tissues as an adjunct to
traditional liposuction. Although skepticism remains chemical lipolysis, more commonly
termed mesotherapy or lipodissolve may be an alternative to surgical treatment of localized
fat. This article reviews the recent advancements in the field of liposuction and the current
literature which support their use.
Semin Cutan Med Surg 27:72-82 © 2008 Elsevier Inc. All rights reserved.