Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,
Dermatology. 2019;235(2):150-155. doi: 10.1159/000495034. Epub 2018 Dec 14.
Reflectance confocal microscopy (RCM) is a noninvasive technique that provides real-time in vivo images of the epidermal layer. Imiquimod has been recommended as an alternative treatment in lentigo maligna (LM) when surgical excision is not the treatment of choice. In the present study we compare the results of in vivo RCM to the histopathological examination before and after treatment of LM with topical imiquimod.
Thirty-four patients with confirmed LM were included. Imiquimod 5% was applied until a weeping erosion appeared in the LM-affected skin. Evaluation was performed by clinical examination, dermatoscopy, histopathology and RCM.
During the follow-up, 27 of 34 patients (79.42%) demonstrated a total tumor clearance by imiquimod treatment. In the treated area, a significant decrease of atypical cells was detected using RCM (p < 0.0001). Furthermore, a significant positive correlation in the detected atypical cells was shown using confocal microscopy and histology (p = 0.0001, r = 0.7335, respectively).
In patients not suitable for surgical intervention imiquimod treatment is an appropriate treatment alternative. Thereby, in vivo RCM was demonstrated to be an excellent examining device, which not only allows diagnosis of LM, but also therapy and follow-up examinations. An important benefit of RCM, in contrast to conventional histopathology, is the simple handling with in vivo examination of epidermal skin without any pain for the patient.
反射共聚焦显微镜（RCM）是一种非侵入性技术，可提供表皮层的实时体内图像。当手术切除不是首选治疗方法时，咪喹莫特已被推荐作为恶性雀斑样痣（LM）的替代治疗方法。在本研究中，我们比较了局部应用咪喹莫特治疗 LM 前后的活体 RCM 结果与组织病理学检查结果。
纳入 34 例经证实的 LM 患者。在 LM 受累皮肤出现渗出性糜烂时，给予咪喹莫特 5%外用。通过临床检查、皮肤镜检查、组织病理学和 RCM 进行评估。
在随访期间，34 例患者中有 27 例（79.42%）通过咪喹莫特治疗实现了完全肿瘤清除。在治疗区域，使用 RCM 检测到异常细胞数量显著减少（p < 0.0001）。此外，使用共聚焦显微镜和组织学检测到异常细胞的数量呈显著正相关（p = 0.0001，r = 0.7335）。
对于不适合手术干预的患者，咪喹莫特治疗是一种合适的替代治疗方法。因此，活体 RCM 被证明是一种出色的检查设备，不仅可以诊断 LM，还可以进行治疗和随访检查。与传统组织病理学相比，RCM 的一个重要优势是可以简单地对表皮进行活体检查，而无需患者承受任何痛苦。
