The problem:
Evaluation of large skin lesions or linear scars with reflectance confocal microscopy (RCM) can be challenging. The arm-mounted RCM (Vivascope 1500, Caliber ID, NY) can image only up to 8x8 mm areas. In contrast, the handheld RCM can image larger areas, but navigation is not easily tracked. To overcome this limitation, the use of paper rings has been used as an easy and safe navigation tool.1 However, a ‘ring’ shape is not always appropriate and may not be useful in the evaluation of large irregularly-shaped skin lesions or linear scars.
The solution:
To evaluate large skin lesions with RCM, we use a low-cost, widely available, hypoallergenic adhesive paper tape (Micropore®, 3M, St. Paul, MN, US). We delineate the lesion, position the tape at 3 – 5 mm from the lesion or scar margins, and then explore with handheld RCM (Vivascope 3000, Caliber ID, NY) (Figure 1 and 2). We first assess the center of the lesion and then the margins following the paper tape as a guide. The paper fibers can be easily visualized under RCM due to its refractility without interfering with image acquisition. This approach may help delineate the area for diagnosis, direct biopsies, guide excisions or re-excisions, and/or monitor non-invasive treatment responses (e.g. imiquimod). The use of paper tape is a simple and inexpensive strategy to evaluate large and irregularly-shaped lesions under RCM that does not affect the clinical evaluation and poses no risk to the patient.
Figure 1: Lesion demarcation for reflectance confocal microscopy (RCM) navigation using paper tape on a linear scar.
A. Biopsy-proven recurrent lentigo maligna (asterisks show 2 biopsy sites) with a linear scar showing no pigmentation. Paper tape was positioned forming a ‘square’ at 5 mm from the visible scar. B. RCM image with multiple large, bright, dendritic cells (red arrows) surrounding a hair follicle (white asterisk). Image obtained from the red dashed square in panel A (750 x 750 μm). C. RCM videomosaic evaluating the 5 mm margin at paper tape border. Groups of bright, large, nucleated dendritic cells with folliculotropism (red arrows). Paper tape fibers demarcate the lesion (red asterisks). Image obtained from the blue dashed square in panel A.
Figure 2: Lesion demarcation for reflectance confocal microscopy (RCM) navigation using paper tape on a large irregular lesion.
A. Biopsy-proven ill-defined superficial basal cell carcinoma. Paper tape was positioned 5 mm from the lesion in a geometric outline. B. RCM image with cord-like structures (red arrows) with palisading and clefting (yellow arrow) extending beyond clinical margins. Paper tape fibers are visualized at the 5 mm margins (red asterisk). Image obtained from the red dashed square on panel A (750 x 750 μm).
Acknowledgments
Funding source: This research was funded, in part, by National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748. The funder played no role in any aspect of the study.
Disclosures: Anthony Rossi: Dr. Rossi has no relevant conflicts of interest related to this manuscript but has received grant funding from The Skin Cancer Foundation and the A. Ward Ford Memorial Grant for research related to this work. He also served on advisory board, as a consultant, or given educational presentations: for Allergan, Inc; Galderma Inc; Evolus Inc; Elekta; Biofrontera, Quantia; Merz Inc; Dynamed; Skinuvia, Perf-Action, and LAM therapeutics.
Footnotes
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Prior presentation: None.
References:
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