Reflectance confocal microscopy (RCM) allows noninvasive imaging of the skin at cellular-level resolution. However, unlike pathologic analysis, RCM obtains horizontal optical sections (en face). We present RCM images (Figure 1A and Figure 2A) with histopathologic correlation (Figure 1B and Figure 2B) of molluscum contagiosum, a viral infection that manifests clinically as solitary or multiple umbilicated, dome-shaped papules (Figure 1C). The 4 × 4-mm RCM mosaic image (Figure 1A) shows a round, well-circumscribed lesion with central round cystic areas filled with brightly refractile material. The corresponding histopathologic image (Figure 1B [hematoxylin-eosin, original magnification ×20]) shows several regular, rounded, squamoid lobules opening into central dilated infundibula filled with keratotic plugs. (The line in Figure 1B indicates the level of the corresponding Figure 1A RCM image.) The characteristic molluscum bodies seen on histopathologic analysis (Figure 2B, arrow [hematoxylin-eosin, original magnification ×100]) correlated with refractile structures seen on 0.5 × 0.5-mm RCM optical sections (Figure 2A, arrow). This is a repeatable pattern seen on RCM of patients with molluscum.
Scope A, Benvenuto-Andrade C, Gill M, Ardigo M, Gonzalez S, Marghoob AA. Reflectance Confocal Microscopy of Molluscum Contagiosum. Arch Dermatol. 2008;144(1):134. doi:10.1001/archderm.144.1.134