Vascular patterns of nonpigmented tumoral skin lesions: confocal perspectives.

BACKGROUND: The characteristic vascular patterns of nonpigmented skin tumors have been established by dermoscopy. Recently, in vivo reflectance confocal microscopy (RCM) has become an established method for the noninvasive examination of skin tumors. OBJECTIVES: Determination of the value of RCM on the vascularity of nonpigmented skin tumors. METHODS: One hundred and twenty two tumoral lesions have been evaluated by RCM in terms of their vascular structures. They were classified in five groups as basal cell carcinoma (BCC), seborrheic keratosis (SK), squamous cell carcinoma (SCC)/keratoacanthoma, actinic keratosis (AK)/Bowen disease and others. Vascular morphologies were investigated as curved linear, straight linear, branching, tubular/canalicular, round and polymorphic vessels in six types. LIMITATIONS: Relatively, small number of patients with some tumor subgroups is limitation. Larger prospective studies are required before firm conclusions can be drawn. RESULTS: Excellent compliance was obtained in interobserver analysis. Branching vessels had a high predictive value for basal cell carcinoma (BCC) with RCM (P < 0.001). Also vascular polymorphism was more frequently (69.4%) seen in malignant nonpigmented tumors (P < 0.05) than benign nonpigmented tumors (30.6%). Furthermore, vessels with opposite flows had high predictive value for malignant tumors (P < 0.05) compared with benign tumors. CONCLUSION: Vascular properties can be evaluated in the diagnosis of nonpigmented tumoral skin lesions via RCM.

Reflectance confocal microscopy vs. standardized skin surface biopsy for measuring the density of Demodex mites.

BACKGROUND: Reflectance confocal microscopy (RCM) has been recently shown to be effective for measuring the Demodex mite density. OBJECTIVES: To compare and demonstrate the advantages and disadvantages of standardized skin surface biopsy (SSSB) and RCM for measuring the density of Demodex mites. MATERIALS AND METHODS: Forty-eight patients (30 female, 18 male) and 47 healthy controls (30 female, 17 male) were enrolled in the study. The patients diagnoses were pityriasis folliculorum (n = 40), papulopustulary rosecea (n = 7) and erythema-telengiectatic rosacea (n = 1). The area with the most intense erythema on the right cheek was selected for imaging with RCM (VivaScope 3000) and SSSB. RESULTS: Forty-two patients demonstrated high Demodex density [(Dd) > 5 mites/cm(2) ] with SSSB (85.7%). RCM identified demodicosis in 48 patients (100%). The mean Dd measured with RCM (409.8 ± 209.2) was significantly higher than SSSB (15.33 ± 18.1) (P < 0.001). In the patients, RCM demonstrated the mean number of mites 40.90 ± 20.9 and 4.11 ± 6.4 in the controls per 10 mm(2) area. The corresponding mean number of 2.63 ± 0.77 mites was detected in the infested follicles per area of view compared to a mean of 0.77 ± 0.98 mites in the infested follicles in the controls (P < 0.001). CONCLUSION: Reflectance confocal microscopy is a fast, direct and noninvasive method for Demodex-associated diseases and it is superior to SSSB for Demodex mite detection.