In Vivo Confocal Scanning Laser Microscopy of a Series of Congenital Melanocytic Nevi Suggestive of Having Developed Malignant Melanoma | Congenital Defects | JAMA Dermatology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Marghoob  AA Congenital melanocytic nevi Rigel  DSedFriedman  RedDzubow  LMedReintgen  DSedBystryn  J-CedMark  Red Cancer of the Skin Philadelphia, Pa Elsevier Saunders2005;221- 241Google Scholar
Marghoob  AA Congenital melanocytic nevi: evaluation and management  Dermatol Clin 2002;20607- 616PubMedGoogle ScholarCrossref
Ruiz-Maldonado  R Measuring congenital melanocytic nevi  Pediatr Dermatol 2004;21178- 179PubMedGoogle ScholarCrossref
Illig  LWeidner  FHundeiker  M  et al.  Congenital nevi less than or equal to 10 cm as precursors to melanoma: 52 cases, a review, and a new conception  Arch Dermatol 1985;1211274- 1281PubMedGoogle ScholarCrossref
Rhodes  ARMelski  JW Small congenital nevocellular nevi and the risk of cutaneous melanoma  J Pediatr 1982;100219- 224PubMedGoogle ScholarCrossref
Clemmensen  OAckerman  AB All small congenital nevi need not be removed  Am J Dermatopathol 1984;6(suppl)189- 194PubMedGoogle Scholar
Sahin  SLevin  LKopf  AW  et al.  Risk of melanoma in medium-sized congenital melanocytic nevi: a follow-up study  J Am Acad Dermatol 1998;39428- 433PubMedGoogle ScholarCrossref
Bono  ABartoli  CZurrida  SMDel Prato  IClemente  CCascinelli  N Let's stop worrying about pigmented skin lesions in children [letter]  Eur J Cancer 1994;30A417PubMedGoogle ScholarCrossref
Marghoob  AAFu  JMSachs  D Dermoscopic features of congenital melanocytic nevi Marghoob  AAedBraun  RPedKopf  AWed Atlas of Dermoscopy. London, England Taylor & Francis Group2005;141- 159Google Scholar
Braun  RPCalza  AMKrischer  J  et al.  The use of digital dermoscopy for the follow-up of congenital nevi: a pilot study  Pediatr Dermatol 2001;18277- 281PubMedGoogle ScholarCrossref
Seidenari  SPellacani  G Surface microscopy features of congenital nevi  Clin Dermatol 2002;20263- 267PubMedGoogle ScholarCrossref
Seidenari  SMartela  APellicani  G Polarized light-surface microscopy for description and classification of small and medium-sized congenital melanocytic nevi  Acta Derm Venereol 2003;83271- 276PubMedGoogle ScholarCrossref
Lodha  RMcDonald  WSElgart  GW  et al.  Dermoscopy for congenital melanocytic nevi  J Craniofac Surg 2003;14661- 665PubMedGoogle ScholarCrossref
Marghoob  AASwindle  LDMoricz  CZM  et al.  Instruments and new technologies for the in vivo diagnosis of melanoma  J Am Acad Dermatol 2003;49777- 797PubMedGoogle ScholarCrossref
Gonzalez  SSwindells  KRajadhyaksha  MTorres  A Changing paradigms in dermatology: confocal microscopy in clinical and surgical dermatology  Clin Dermatol 2003;21359- 369PubMedGoogle ScholarCrossref
Rajadhyaksha  MGonzalez  SZavislan  JMAnderson  RRWebb  RH In vivo confocal scanning laser microscopy of human skin, II: advances in instrumentation and comparison with histology  J Invest Dermatol 1999;113293- 303PubMedGoogle ScholarCrossref
Rajadhyaksha  MGonzalez  SZavislan  JM Detectability of contrast agents for confocal reflectance imaging of skin and microcirculation  J Biomed Opt 2004;9323- 331PubMedGoogle ScholarCrossref
Rajadhyaksha  MGrossman  MEsterowitz  DWebb  RHAnderson  RR In vivo confocal scanning laser microscopy of human skin: melanin provides strong contrast  J Invest Dermatol 1995;104946- 952PubMedGoogle ScholarCrossref
Pellacani  GCesinaro  AMGrana  CSeidenari  S In vivo confocal scanning laser microscopy of pigmented Spitz nevi: comparison of in vivo confocal images with dermoscopy and routine histopathology  J Am Acad Dermatol 2004;51371- 376PubMedGoogle ScholarCrossref
Tannous  ZMihm  MFlotte  TGonzalez  S In vivo examination of lentigo maligna, in situ malignant melanoma, lentigo maligna type by near-infrared confo-cal microscopy: comparison of confocal images with histologic sections  J Am Acad Dermatol 2002;46260- 263PubMedGoogle ScholarCrossref
Nori  SRius-Díaz  FCuevas  J  et al.  Sensitivity and specificity of reflectance-mode confocal microscopy for in vivo diagnosis of basal cell carcinoma: a multi-center study  J Am Acad Dermatol 2004;51923- 930PubMedGoogle ScholarCrossref
Gonzalez  STannous  Z Real-time, in vivo confocal reflectance microscopy of basal cell carcinoma  J Am Acad Dermatol 2002;47869- 874PubMedGoogle ScholarCrossref
Sauermann  KGambichler  TWilmert  M  et al.  Investigation of basal cell carcinoma by confocal laser scanning microscopy in vivo  Skin Res Technol 2002;8141- 147PubMedGoogle ScholarCrossref
Gonzalez  SGonzalez  EWhite  WMRajadhyaksha  MAnderson  RR Allergic contact dermatitis: correlation of in vivo confocal imaging to routine histology  J Am Acad Dermatol 1999;40708- 713PubMedGoogle ScholarCrossref
Gonzalez  SRajadhyaksha  MGonzalez-Serva  AWhite  WMAnderson  RR Confocal reflectance imaging of folliculitis in vivo: correlation with routine histology  J Cutan Pathol 1999;26201- 205PubMedGoogle ScholarCrossref
Pellacani  GCesinaro  AMSeidenari  S In vivo assessment of melanocytic nests in nevi and melanomas by reflectance confocal microscopy  Mod Pathol 2005;18469- 474PubMedGoogle ScholarCrossref
Yamashita  TKuwahara  TGonzalez  STakahashi  M Non-invasive visualization of melanin and melanocytes by reflectance-mode confocal microscopy  J Invest Dermatol 2005;124235- 240PubMedGoogle ScholarCrossref
Busam  KJCharles  CLee  GHalpern  AC Morphologic features of melanocytes, pigmented keratinocytes, and melanophages by in vivo confocal scanning laser microscopy  Mod Pathol 2001;14862- 868PubMedGoogle ScholarCrossref
Langley  RRajadhyaksha  MDwyer  PSober  AFlotte  TAnderson  RR Confocal scanning laser microscopy of benign and malignant melanocytic skin lesions in vivo  J Am Acad Dermatol 2001;45365- 376PubMedGoogle ScholarCrossref
Busam  KJCharles  CLohmann  CMMarghoob  AGoldgeier  MHalpern  AC Detection of intraepidermal malignant melanoma in vivo by confocal scanning laser microscopy  Melanoma Res 2002;12349- 355PubMedGoogle ScholarCrossref
Curiel-Lewandrowski  CWilliams  CMSwindells  KJ  et al.  Use of in vivo confocal microscopy in malignant melanoma: an aid in diagnosis, and assessment of surgical and non-surgical therapeutic approaches  Arch Dermatol 2004;1401127- 1132Google ScholarCrossref
Stolz  WRiemann  ACognetta  AB  et al.  ABCD rule of dermatoscopy: a new practical method for early recognition of malignant melanoma  Eur J Dermatol 1994;4521- 527Google Scholar
Kittler  HSeltenheim  MDawid  MPehamberger  HWolff  KBinder  M Morphologic changes of pigmented skin lesions: a useful extension of the ABCD rule for dermatoscopy  J Am Acad Dermatol 1999;40558- 562PubMedGoogle ScholarCrossref
Gerger  AKoller  SKern  T  et al.  Diagnostic applicability of in vivo confocal laser scanning microscopy in melanocytic skin tumors  J Invest Dermatol 2005;124493- 498PubMedGoogle ScholarCrossref
Nehal  KSOliveria  SAMarghoob  AA  et al.  Use of and beliefs about baseline photography in the management of patients with pigmented lesions: a survey of dermatology residency programmes in the United States  Melanoma Res 2002;12161- 167PubMedGoogle ScholarCrossref
Soyer  HPedArgenziano  GedChimenti  SedMenzies  SWedPehamberger  HedRabinovitz  HSed Dermoscopy of Pigmented Lesions: An Atlas Based on the Consensus Net Meeting on Dermoscopy 2000.  Milan, Italy Edra Medical Publishing & New Media2001;
Barnhill  RLFleischli  M Histologic features of congenital melanocytic nevi in infants 1 year of age or younger  J Am Acad Dermatol 1995;33780- 785PubMedGoogle ScholarCrossref
Yadav  SVossaert  KAKopf  AWSilverman  MGrin-Jorgensen  C Histopathologic correlates of structures seen on dermoscopy (epiluminescence microscopy)  Am J Dermatopathol 1993;15297- 305PubMedGoogle ScholarCrossref
November 2005

In Vivo Confocal Scanning Laser Microscopy of a Series of Congenital Melanocytic Nevi Suggestive of Having Developed Malignant Melanoma

Author Affiliations

Author Affiliations: Dermatology Service (Drs Marghoob, Busam, Rajadhyaksha, and Halpern) and Departments of Medicine and Pathology (Dr Busam), Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Fla (Dr Charles); Northeastern University, Center for Subsurface Imaging and Systems, Boston, Mass (Dr Rajadhyaksha); Pathology Services, St John’s Mercy Medical Center, St Louis, Mo (Dr Lee); and Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York (Dr Clark-Loeser).

Arch Dermatol. 2005;141(11):1401-1412. doi:10.1001/archderm.141.11.1401

Objective  To determine the utility of confocal scanning laser microscopy (CSLM) in the in vivo evaluation of congenital melanocytic nevi (CMNs) that are suggestive of having developed melanoma.

Design  The CMNs suggestive of melanoma by clinical and dermoscopic examination were imaged by CSLM, and the findings correlated with the features seen on dermoscopic and histologic examination.

Setting  Dermatology clinic specializing in pigmented lesions.

Patients  Seven patients with clinically irregular small to medium CMNs.

Interventions  The areas imaged by CSLM were sampled with 3-mm punch biopsy specimens. The entire lesion was subsequently excised. The punch biopsy specimens were step sectioned horizontally to correlate with the CSLM images. Excised samples were step sectioned and processed routinely. Histologic features observed on CSLM were correlated with the features seen on dermoscopic and light microscopic examination.

Main Outcome Measure  Correlation of the structures seen using CSLM with the dermoscopic and histologic features of CMNs and melanoma.

Results  The CSLM illustrated histologic characteristics of CMNs, including the presence of hyperpigmented keratinocytes, nevus cells, melanophages, and a normal “honeycomb” epidermal architecture. Features suggestive of melanoma were not evident by CSLM in 6 histologically proven benign CMNs. Histologic features associated with melanoma, such as an increased number of intraepidermal atypical melanocytes (pagetoid) and loss of normal epidermal cellular architecture, were identified by CSLM in 1 lesion, which on histologic analysis revealed melanoma in association with a CMN.

Conclusion  Our results illustrate that CSLM may be useful for clinicopathologic correlations and for the preliminary noninvasive diagnosis of pigmented neoplasms in vivo.