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February 2005

Confocal Scanning Laser Reflectance Microscopy: Why Bother?

Arch Dermatol. 2005;141(2):212-215. doi:10.1001/archderm.141.2.212

Technology is a gift of God. After the gift of life it is perhaps the greatest of God’s gifts. It is the mother of civilizations, of arts, and of sciences.1

Freeman Dyson, physicist (1923–)

The ability to noninvasively visualize the body’s organs in vivo at the macroscopic and microscopic levels has been a goal of clinicians and researchers alike for more than a century. In recent decades, enormous strides have been made in macroscopic and functional in vivo imaging with the development and refinement of computed tomography, magnetic resonance imaging, and positron emission tomography technologies, just to name a few. The impetus to continuously improve existing technologies and to invent new imaging modalities lies in the potential of these technologies to empower physicians to detect subclinical life-threatening disease and to less invasively diagnose clinically evident disease. Today, we take for granted the availability of sophisticated imaging modalities such as computed tomography and magnetic resonance imaging. However, it must be remembered that these advances in imaging technology were initially met with significant resistance and skepticism. The resistance to technological innovations in medicine stems partly from the recognition of the increased costs associated with their development and implementation. Nonetheless, expensive technologies are readily incorporated into our health care delivery system if they are perceived to improve quality of care. The skepticism associated with the adoption of new technologies stems partly from the innate resistance of clinicians to change. This was true for ultrasonography, computed tomography, magnetic resonance imaging, and dermoscopy, among others; however, the passage of time has proved that many of these imaging technologies did indeed revolutionize the way medicine is practiced, and each new advance continues to improve our ability to noninvasively examine patients. These advances ultimately increase our ability to identify patients who may benefit from invasive procedures while reducing the number of patients subjected to unnecessary procedures and therapies. Furthermore, each advance heralds new ideas and innovative research that may lead to the discovery of new and improved technologies for the evaluation of biological processes in health and disease.

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