Reflectance confocal microscopy of pigmented basal cell carcinoma

J Am Acad Dermatol. 2006 Apr;54(4):638-43. doi: 10.1016/j.jaad.2005.11.1096.


Background: Reflectance confocal microscopy (RCM) is a high-resolution imaging tool for in vivo noninvasive evaluation of skin lesions.

Objective: We sought to describe the relevant RCM features for pigmented basal cell carcinoma (BCC).

Methods: Pigmented skin lesions with a differential diagnosis of pigmented BCC were imaged using dermoscopy and RCM, followed by excision for histologic analysis.

Results: RCM demonstrated aggregations of tightly packed cells with palisading, forming cordlike structures and nodules with irregular borders and variable brightness; these represented nests of pigmented basaloid tumor cells on histopathology, and blue-gray ovoid areas on dermoscopy. These tumor nests were associated with bright dendritic structures, identified histologically as either melanocytes or Langerhans cells, together with numerous bright oval to stellate-shaped structures with indistinct borders representing melanophages, and with highly refractile granules of melanin.

Limitations: The pigmented BCCs imaged in this study were predominantly nodular; a different set or additional criteria may be necessary for detection of infiltrative and metatypical BCCs.

Conclusion: RCM may permit in vivo diagnosis of pigmented BCC.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Basal Cell / diagnosis
  • Carcinoma, Basal Cell / pathology*
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Melanoma / diagnosis
  • Melanoma / pathology
  • Microscopy, Confocal
  • Middle Aged
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / pathology*