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Ayelet Rishpon, MD; Nancy Kim, MD; Alon Scope, MD; Leeor Porges, BS; Margaret C. Oliviero, FNP, BC; Ralph P. Braun, MD; Ashfaq A. Marghoob, MD; Christi Alessi Fox, BS; Harold S. Rabinovitz, MD

Arch Dermatol. 2009;145(7):766-772.

Objective  To identify criteria for the diagnosis of squamous cell carcinoma (SCC) and actinic keratosis (AK) by in vivo reflectance confocal microscopy (RCM).

Design  Prospective RCM imaging of lesions suspected clinically and/or dermoscopically to be SCC or AK, followed by RCM assessment of the biopsy-proven SCCs and AKs.

Setting  Private skin cancer clinic, Plantation, Florida.

Patients  A total of 38 lesions in 24 patients were assessed, including 7 AKs, 25 SCCs in situ, 3 invasive SCCs, and 3 keratoacanthomas.

Interventions  Prior to undergoing biopsy, all lesions were assessed by RCM.

Results  Mosaic RCM images at the stratum corneum level revealed scale in 29 SCCs (95%) and in all 7 AKs. Polygonal nucleated cells at the stratum corneum were seen in 3 SCCs (10%) and 1 AK (14%). All 38 cases displayed an atypical honeycomb and/or a disarranged pattern of the spinous-granular layer of the epidermis; round nucleated cells were seen in the spinous-granular layer in 20 SCCs (65%) and 1 AK (14%). Round blood vessels in the superficial dermis were seen in 28 SCCs (90%) and 5 AKs (72%).

Conclusions  An increasing frequency of abnormal RCM features can be observed across the spectrum of keratinocytic neoplasias. The presence of an atypical honeycomb or a disarranged pattern of the spinous-granular layer, round nucleated cells at the spinous-granular layer, and round blood vessels traversing through the dermal papilla are the key RCM features of SCC.

Author Affiliations: Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel (Dr Rishpon); Skin and Cancer Associates, Plantation, Florida (Drs Rishpon, Oliviero, and Rabinovitz and Mr Porges); Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida (Drs Kim, Oliviero, and Rabinovitz); Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (Drs Scope and Marghoob); Department of Dermatology, University Hospital Zurich, Zurich, Switzerland (Dr Braun); and Lucid Inc, Rochester, New York (Ms Fox).

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