The role of reflectance confocal microscopy in the diagnosis and management of squamous cell carcinoma in situ treated with photodynamic therapy.

BACKGROUND: Reflectance confocal microscopy (RCM) is increasingly used for noninvasive in vivo diagnosis of skin cancers. We seek to determine if RCM is useful for the diagnosis and follow-up of squamous cell carcinoma in situ (SCCIS) posttreatment to document clearance. METHODS: A pilot prospective study enrolled 10 patients with a total of 11 SCCIS lesions. Clinical, confocal, histological features and fluorescence diagnosis (FD) were recorded pre- and posttreatment. RESULTS: Four SCCIS lesions underwent RCM imaging prior to biopsy, while 11 SCCIS lesions were followed up with RCM imaging. Clinical features of persistent SCCIS post-PDT in four out of 11 follow-up cases were confirmed with RCM and FD. There were no RCM features of SCCIS in seven lesions which were clinically cured. All eight (four new SCCIS and four follow-up) cases displayed atypical honeycomb pattern. Two cases (25%) showed numerous epidermal dendritic cells, while small bright refractive cells were present in the epidermis in two lesions (25%). Round blood vessels in the superficial dermis were seen in four lesions (50%), while three lesions (37.5%) showed dermal inflammatory cells. CONCLUSION: There was good correlation between histological and confocal features in patients who underwent RCM imaging prior to biopsy. RCM may be a complementary tool in diagnosing SCCIS and to monitor response to nonsurgical treatment by avoiding unnecessary biopsies especially in lesions with persistent residual postinflammatory erythema.

Chronic leg ulcers in adult patients with rheumatological diseases - a 7-year retrospective review.

Chronic leg ulcers in patients with rheumatological diseases can cause significant morbidity. We performed a retrospective case review to describe the epidemiology, clinical features and outcome of chronic leg ulcers in this group of patients. Twenty-nine patients with underlying rheumatological conditions, such as, rheumatoid arthritis (15 patients), systemic lupus erythematosus (8 patients), overlap syndromes (3 patients), systemic sclerosis (1 patient) and ankylosing spondylitis (1 patient) were included. The ulcers were mostly located around the ankle (55·2%) and calves (37·9%). The predominant aetiology of the ulcers, in decreasing order of frequency, was venous disease, multifactorial, vasculitis or vasculopathy, infective, pyoderma gangrenosum, ischaemic microangiopathy and iatrogenic. Treatment modalities included aggressive wound bed preparation, compression therapy (17 patients), changes in immunosuppressive therapy (15 patients), hyperbaric oxygen therapy (4 patients) and cellular skin grafting (2 patients). Management of chronic leg ulcers in rheumatological patients is challenging and the importance of careful clinicopathological correlation and treatment of the underlying cause cannot be overemphasised.