Reflectance Confocal Microscopy in the Diagnosis of Skin Lesions: Early Clinical Experiences

Conclusions

• Reflectance confocal microscopy appears to improve real-world dermatologic diagnosis when dermoscopy is equivocal or non-specific.
• RCM is especially useful for identifying basal cell carcinoma by showing tumor islands, fibrotic stroma, clefting, and characteristic vascular and dendritic features.
• RCM helps distinguish melanoma on sun-damaged skin by revealing pagetoid or dendritic cells, especially when they extend down hair follicles.
• For squamous cell carcinoma in situ, the most important confocal clue is an atypical or disarranged honeycomb pattern, often with scale and atypical keratinocytes.
• RCM can clarify pigmented lesions that mimic one another, including pigmented SCC, actinic damage, melanoma, and benign regressional lesions.
• The device is valuable for evaluating collision tumors because it can detect malignant components more reliably than dermoscopy alone.
• In scarred or clinically confusing areas, RCM can localize occult neoplasms and help avoid unnecessary blind biopsy or missed lesions.
• The presentation suggests that certain RCM patterns, such as small white-rimmed circles and bright round cells, correspond well with histopathology and can be diagnostically meaningful.
• RCM can support recognition of benign lesions such as seborrheic keratosis, lichen planus-like keratosis, and congenital/Clark nevus when malignant features are absent.
• Overall, the talk concludes that RCM does add meaningful value to patient care by increasing diagnostic confidence and refining biopsy decisions in difficult skin lesions.