Diagnostic And Therapeutic Applicability Of Reflectance Confocal Microscopy In Malignant Skin Tumors

Part?The RCM features of some changes in dermatopathologyObjective:To study the RCM features of normal skin and some changes in dermatopathology.Methods:10 normal volunteers and 250 patients need to be biopsied were enrolled in the study. The RCM examination was performed before the biopsy. The RCM features of the normal skin and lesions were studied and concluded according to the results of dermatopathology. Results:The structures of epidermis and dermal papilla including the skin appendages, hair follicles and apocrine glands, can be observed by RCM. 13 terms and changes in dermatopathology of epidermis and dermal papilla can be observed. Conclusion:The study concluded the RCM features correspondence to the changes in dermatopathology. This study contributed to the application study of reflectance confocal microscopy in malignant skin tumors and laid the foundation.Part?In vivo examination of malignant melanoma and nevocellular nevus by RCM Objective:To study the RCM features of malignant melanoma and nevocellular nevus. Methods:60 patients suspected of malignant melanoma to be biopsied or undergo surgical excision were enrolled in the study. In vivo RCM examination was performed before the biopsy. The RCM features of malignant melanoma and nevocellular nevus were studied according to the results of dermatopathology and some immunohistochemistry study. The shape and arrangement of melanocytes were paid close attention. The RCM image database of skin tumors was established, the sensitivity and specificity of each RCM features of malignant melanoma were obtained based on the database. Results:5 RCM features of malignant melanoma and 3 RCM features of nevocellular nevus were found in the study. The RCM features of malignant melanoma and nevocellular nevus corresponded well with histopathological features. The structures of epidermis and dermal papilla including the skin appendages, hair follicles and apocrine glands, can be observed by RCM.13 terms and changes in dermatopathology of epidermis and dermal papilla can be observed. The differential diagnosis features between malignant melanoma and nevocellular nevus were obtained. The sensitivity and specificity of RCM features of malignant melanoma were high, especially the combination of 2 RCM features of malignant melanoma. Conclusion:The study concluded the RCM features and RCM differential features of malignant melanoma and nevocellular nevus.Part III Diagnostic and therapeutic applicability of RCM in basal cell carcinomaObjective:To study the RCM features of basal cell carcinoma and define the RCM diagnostic criteria of basal cell carcinoma. Study the diagnostic value of in vivo RCM imaging. Study the application of RCM to define the surgical boundaries. Methods:75 patients suspect of basal cell carcinoma to be biopsied were enrolled in the study. in vivo RCM examination was performed before the biopsy. The RCM features of basal cell carcinoma were studied according to the results of dermatopathology and some immunohistochemistry studies. The RCM image database of skin tumors was established, the sensitivity and specificity of each RCM features of malignant melanoma were obtained based on the database. The RCM diagnostic criterion was established. Two dermatologists were invited to diagnosis the RCM images using the RCM diagnostic criterion twice. The diagnostic accuracy, repeatability and efficiency were calculated.10 patients to be treated with local surgical excision were enrolled in the study. Before the surgery, RCM examinations were performed to delineate the margins of the lesions. The lesions were treated with local surgical excision in tradition way. Intraoperative frozen biopsy and histopathology were performed to ascertain the RCM margins. The sizes of surgical area were calculated. Results:5 RCM features of basal cell carcinoma were found in the study. The RCM features of basal cell carcinoma correlated well with histopathological features. RCM features of basal cell carcinoma may vary according to the histopathological subtypes.2 RCM features of basal cell carcinoma with the highest sensitivity and specificity when used simultaneously were defined as diagnostic criterion. The diagnostic criterion was that the presence both of "bright dendritic cells" and "aggregates of atypical basaloid cells". The sensitivities of 2 dermatologists were 79.03%and 85.48%, the specificities were 83.87%and 88.71%, the positive predictive value were 80.00%and 88.30%, the negative predictive value were 88.33%and 85.94%. The Kappa value of the consistency of two observer was 0.648, and the Kappa values of two observation were 0.824 and 0.712. The study confirmed the accuracy of the surgical boundary delineated by RCM. The sizes of the operation area delineated by RCM were smaller than by tradition way significantly. Conclusion:The study concluded the RCM features of basal cell carcinoma. The RCM diagnostic accuracy and efficiency of basal cell carcinoma were high. The consistency of diagnosis was moderate. RCM can be used to delineate surgical basal cell carcinoma boundary and reduce the surgical excision area. Part?Diagnostic and therapeutic applicability of reflectance confocal microscopy in extramammary paget's disease.Objective:To study the RCM features of extramammary paget's disease and define the RCM diagnostic criteria of extramammary paget's disease. Study the diagnostic value of in vivo RCM imaging. Study the application of RCM to define the surgical boundaries. Methods:32 patients suspect of extramammary paget's disease to be biopsied were enrolled in the study. In vivo RCM examination was performed before the biopsy. The RCM features of extramammary paget's disease were studied according to the results of dermatopathology and some immunohistochemistry studies. The RCM image database of skin tumors was established, the sensitivity and specificity of each RCM features of extramammary paget's disease were obtained based on the database. The RCM diagnostic criterion was established. Two dermatologists were invited to diagnosis the RCM images using the RCM diagnostic criterion twice. The diagnostic accuracy, repeatability and efficiency were calculated.10 patients to be treated with local surgical excision were enrolled in the study. Before the surgery, RCM examinations were performed to delineate the margins of the lesions. The lesions were treated with local surgical excision in tradition way. Intraoperative frozen biopsy was performed to ascertain the margins. The sizes of surgical area were calculated. Results:5 RCM features of extramammary paget's disease were found in the study. The RCM features of extramammary paget's disease correlated well with histopathological features. The RCM features of three colors of lesions were different.2 RCM features of basal cell carcinoma with the high sensitivity and specificity when combination used were defined as diagnostic criterion. The diagnostic criterion was that the presence both of "Paget cells" and "the nest structures in the basal layer". The sensitivities of 2 dermatologists were 87.10% and 93.55%, the specificities were 96.77% and 90.32%, the positive predictive value were 96.43% and 90.63%, the negative predict ive value were 88.24% and 93.33%. The Kappa value of the consistency of two observer was 0.814, and the Kappa values of two observation were 0.838 and 0.855. The study confirmed the positive rate of the surgical boundary delineated by RCM is lower than tradition.The sizes of the operation area delineated by RCM were larger than by tradition way significantly. Conclusion:The study concluded the RCM features of extramammary paget's disease. The RCM diagnostic accuracy and efficiency of extramammary paget's disease were high. The consistency of diagnosis was excellent. RCM can be used to delineate surgical basal cell carcinoma boundary and reduce the positive rate.