Reflectance confocal microscopy for monitoring treatment response in superficial basal cell carcinoma: diagnostic challenges due to scar formation.

BACKGROUND

Reflectance confocal microscopy (RCM) criteria for the in vivo diagnosis of superficial basal cell carcinoma (sBCC) lesions have been validated, with studies indicating a high level of diagnostic sensitivity. However, there remains a paucity of data regarding the preservation of or changes in RCM features following biopsy or treatment.

OBJECTIVE

To use RCM to prospectively image biopsy-confirmed sBCC at baseline and 12 weeks post-treatment to determine clearance and identify any associated RCM features.

METHODS

Ten patients with biopsy-confirmed sBCC participated in this study. Clinical examination, dermoscopy and RCM imaging were performed at baseline, prior to treatment and 12 weeks post-treatment, with a 1064 Nd-YAG laser. Following treatment, RCM features were compared with clinical and histological findings.

RESULTS

Statistically significant changes in RCM features at baseline and follow-up included tumour islands with hyperreflective aggregates, dark silhouettes, peripheral palisading, peritumoral clefting, and dermal inflammatory cells. There were no significant changes in nuclear streaming, fibrosis or vasculature.

CONCLUSIONS

The features of nuclear streaming, fibrosis and dilated vessels may be observed during RCM imaging of biopsy-confirmed sBCC at baseline and post-treatment and should be interpreted with caution. Additional studies are needed to further validate these findings.