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Ashfaq A. Marghoob, MD; Carlos A. Charles, MD; Klaus J. Busam, MD; Milind Rajadhyaksha, PhD; Grace Lee, MD; Lesley Clark-Loeser, MD; Allan C. Halpern, MD

Arch Dermatol. 2005;141:1401-1412.

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.

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).

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