Reflectance Confocal Microscopy

This chapter will discuss the technologyTechnology behind reflectance confocal microscopyReflectance confocal microscopy (RCM). RCM is a non-invasive horizontal imaging technique that illuminates the skin at a specific area or lesion of the epidermis. The confocal pinhole of the RCM focuses the reflective light on the pinhole to prevent it from focusing on any other areas of the skin. Additionally, this chapter will evaluate its applications as a form of non-invasive imagingNon-invasive imaging in the diagnosis and monitoring of treatment for dermatologic conditions including skin cancerSkin cancer and inflammatory skin conditionsInflammatory skin conditions. Some of these conditions include psoriasisPsoriasis, scarring and nonscarring alopeciaAlopecia, dermatitis/eczema, and parasitic skin infections with scabies. The benefits of using RCM include evaluation of free movement across the skin, in addition to challenging smaller areas, such as the periocular regions, nasal crease, concha, and interdigital web spaces. This device also allows for free movement across the skin. Physicians can assess Mohs micrographic surgery margins with RCM, as well as the effectiveness of topical treatments. In contrast, the limitations of RCM include evaluation of hyperkeratotic lesions, hair covered areas of the skin, nodular lesions, areas of fibrin, coagulated blood, and keratin aggregates, and the palms and soles. Current modalities, such as the Vivascope® 1500, have increased the imaging up to 8 × 8 mm areas and aided in the diagnosis of dermoscopy alone.