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Journal of Biomedical Optics

Clinical applicability of in vivo fluorescence confocal microscopy for noninvasive diagnosis and therapeutic monitoring of nonmelanoma skin cancer
Author(s): Susanne Astner; Susanne Dietterle; Nina Otberg; Hans-Joachim Röwert-Huber; Eggert Stockfleth; Jürgen M. Lademann
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Paper Abstract

Excisional biopsies and routine histology remains the gold standard for the histomorphologic evaluation of normal and diseased skin. However, there is increasing interest in the development of noninvasive optical technologies for evaluation, diagnosis, and monitoring of skin disease in vivo. Fluorescent confocal microscopy is an innovative optical technology that has previously been used for morphologic evaluation of live human tissue. We evaluate the clinical applicability of a fluorescent confocal laser scanning microscope (FLSM) for a systematic evaluation of normal and diseased skin in vivo and in correlation with routine histology. A total of 40 patients were recruited to participate in the study. Skin sites of 10 participants with no prior history of skin disease served as controls and to evaluate topographic variations of normal skin in vivo. Thirty patients with a suspected diagnosis of nonmelanoma skin cancer were evaluated, whereby FLSM features of actinic keratoses (AK) and basal cell carcinoma (BCC) were recorded in an observational analysis. Selected BCCs were monitored for their skin response to topical therapy using Imiquimod as an immune-response modifier. A commercially available fluorescence microscope (OptiScan Ltd., Melbourne, Australia) was used to carry out all FLSM evaluations. Common FLSM features to AK and BCC included nuclear pleomorphism at the level of the granular and spinous layer and increased vascularity in the superficial dermal compartment. Even though the presence of superficial disruption and mere atypia of epidermal keratinocytes was more indicative of AK, the nesting of atypical basal cells, increased blood vessel tortuosity, and nuclear polarization were more typical for BCC. All diagnoses were confirmed by histology. FLSM allowed a monitoring of the local immune response following therapy with Imiquimod and demonstrated a continuous normalization of diseased skin on repeated evaluations over time. (Partial Abstract)

Paper Details

Date Published: 1 January 2008
PDF: 12 pages
J. Biomed. Opt. 13(1) 014003 doi: 10.1117/1.2837411
Published in: Journal of Biomedical Optics Volume 13, Issue 1
Show Author Affiliations
Susanne Astner, Charité Universitätsmedizin Berlin (Germany)
Susanne Dietterle, Charité Universitätsmedizin Berlin (Germany)
Nina Otberg, Charité-Univ. Medicine Berlin (Germany)
Hans-Joachim Röwert-Huber, Charité Universitätsmedizin Berlin (Germany)
Eggert Stockfleth, Charité Universitätsmedizin Berlin (Germany)
Jürgen M. Lademann, Charité Universitätsmedizin Berlin (Germany)

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