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- Presentation
How to incorporate RCM into a busy practice with examples of BCC, SCC, lichen planus-like keratosis, nevi, and melanoma
Description
The talk explains how reflectance confocal microscopy (RCM) can be integrated into a busy dermatology practice to improve diagnosis and avoid unnecessary biopsies, especially when dermoscopy is inconclusive. Through multiple cases, the speaker highlights characteristic RCM findings for common skin cancers and mimickers: basal cell carcinoma with tumor islands, clefting, tortuous vessels, and bright dendritic cells; squamous cell carcinoma with a disorganized or atypical honeycomb pattern, pleomorphic cells, and atypical vessels; melanoma on sun-damaged skin with pagetoid or dendritic cells extending into follicles, sheets of dendrites, and bright atypical cells; and metastatic melanoma with distinct nests and pagetoid cells. Other examples include pigmented squamous cell carcinoma, collision tumors where RCM outperformed dermoscopy, lichen planus-like keratosis with regressive features and no pagetoid cells or dendrites, and benign nevi with uniform honeycomb/cobblestone patterns. The overall message is that RCM is practical, highly useful in everyday patient care, and especially valuable for challenging lesions, guiding biopsy decisions, and improving confidence in diagnosis. The speaker also encourages training through courses, image review, and educational resources like confocal101.com.
View moreConclusions
- Reflectance confocal microscopy can substantially improve bedside diagnosis of pigmented and nonpigmented skin lesions when dermoscopy is ambiguous.
- RCM is especially useful for identifying basal cell carcinoma when clinical appearance and dermoscopy are obscured by sun damage or scar-like change.
- In sun-damaged skin, pagetoid or dendritic cells extending down hair follicles are a strong clue for melanoma in situ.
- An atypical or disarranged honeycomb pattern is the key confocal feature supporting squamous cell carcinoma, including pigmented variants.
- RCM can help distinguish pigmented squamous cell carcinoma from melanoma and other mimickers by showing characteristic bright-rimmed circles and atypical keratinocyte patterns.
- The technique can reveal malignant components in collision tumors more often than dermoscopy and shows excellent agreement with histopathology.
- RCM can reduce unnecessary biopsies by supporting confident recognition of benign lesions such as lichen planus-like keratosis and benign nevi.
- Overall, the presentation argues that RCM is a practical and valuable adjunct to clinical judgment and dermoscopy in everyday dermatology practice.
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