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Objective @#To explore the clinical application value of reflectance confocal microscopy(RCM) in the diagnosis of actinic cheilitis(AC).@*Methods@#After approval by the hospital ethics committee and informed consent given by the patients, from October 2020 to July 2022, 17 patients who were diagnosed with actinic cheilitis in the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The white keratotic lesions of the lips were scanned with reflectance confocal microscopy, and the image characteristics were summarized and analyzed, including epithelial hyperplasia/atrophy, hyperkeratosis, inflammatory cell infiltration, blood vessel dilatation, solar elastosis, atypical keratinocytes, widening of intercellular spaces, degeneration of basal cell layer, and pigmentation. We used the sample compliance rate to measure the correlation between RCM parameters and histopathological diagnostic criteria for AC and kappa concordance analysis to calculate the concordance between RCM and pathological diagnosis. @* Results@# Under RCM, the sample correct rates for epithelial hyperplasia/atrophy, hyperkeratosis, inflammatory cell infiltration, vasodilation, and solar elastosis were 76.5%, 100%, 100%, 64.7%, and 70.6%, the sample accuracy compared with pathological diagnosis was 82.4%, 47.1%, 94.1%, 88.2% and 76.5%, respectively. We also observed that 100%, 88.2%, 76.5%, and 88.2% of AC patients showed RCM features of atypical keratinocytes, widening of intercellular spaces, degeneration of the basal cell layer, and pigmentation, respectively. The kappa value of hyperkeratosis and inflammatory cell infiltration was 1. The kappa value of blood vessel dilatation was 0.645. @* Conclusion @#Reflectance confocal microscopy is noninvasive and versatile and has clinical application value in the diagnosis of actinic cheilitis.
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Objective To summarize the clinical characteristics of patients with occupational melanosis. Methods Diagnostic data of 69 patients with occupational melanosis was analyzed using retrospective analysis. Results The main occupational hazards for the 69 patients with occupational melanosis were coal tar, petroleum and its fractionated products, pigments and dyes and their intermediates, rubber additives and rubber products. The median length of occupational exposure and disease latency were 8.0 and 6.0 years, respectively, with a highly positive correlation between them (Spearman correlation coefficients=0.962, P<0.01). Skin lesions were mainly found on exposed areas such as the face-to-neck and limbs, prevalence of 94.2% and 75.4% respectively. And 78.3% of patients had skin lesion on more than two sites. The lesions were mostly in the form of irregular flakes (59.4%), with a gray-black color (44.9%). About 43.5% of patients experienced skin itching. Complete blood count, liver function, and kidney function were all within normal ranges. Skin biopsy results showed that epidermal hyperkeratosis, thinning of the spinous layer, liquefaction degeneration of basal cells, increased superficial dermal melanocytes, and infiltration of lymphocytes, histiocytes, and melanocytes around the blood vessels. Reflectance confocal microscopy (RCM) detection showed focal liquefaction degeneration of basal cells in the lesions, with a significant infiltration of melanocytes and inflammatory cells in the dermal papillae and superficial layers. Conclusion The primary target organ of occupational melanocytes is the skin, and no damage to other organs was identified thus far. Results from skin biopsies and RCM examinations can be used for differential diagnosis.
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Skin photoaging not only affects the appearance, but also is associated with skin tumors. It is very important to objectively and effectively evaluate photoaging. Histopathological examination is the gold standard for the diagnosis of photoaging, but it can not be used repeatedly because of its invasiveness, and is not suitable for dynamic monitoring and evaluation of photoaging. Skin imaging technologies can realize in vivo, real-time and non-invasive two- or three-dimensional image analysis, which facilitate the visual assessment of skin photoaging. This review summarizes research progress in dermoscopy, reflectance confocal microscopy, high-frequency ultrasound and optical coherence tomography in evaluation of photoaging.
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Background: Mycosis fungoides (MF), a T-cell lymphoma, is the most common variant of primary cutaneous lymphomas. The discrete clinical aspect of the early patch-stage and an overlapping clinical presentation with other erythematosquamous skin diseases make the diagnosis of MF challenging. Histopathology is the gold standard for the diagnosis of MF. However, in early stages, MF can simulate inflammatory diseases, presenting reactive lymphocytes and absence of lymphocytic cytologic atypia. Consecutive biopsies are often necessary from several clinically suspect sites. Previous studies evaluated Reflectance Confocal Microscopy (RCM) as a promising tool for MF diagnosis because it offers the opportunity to analyze skin structures non-invasively at a 'quasi-histopathologic' resolution and to guide the most representative site for biopsy. Case presentation: We present a 76 years-old woman with a 5-year history of erythematous plaques and patches. She had had 5 previous skin biopsies with a pattern suggestive of nummular eczema. The history and the clinical presentation led to the suspicion of MF. RCM examination was performed and two lesions were marked for biopsy. The histopathology exam confirmed the diagnosis of MF. The patient was submitted to topical treatment with total remission of the lesions. Conclusions: The mean time from onset of symptoms to diagnosis is 6 years and the delay in diagnosis results in delay for adequate therapy. Therefore, the selection of the biopsy site is crucial to avoid unrepresentative samples. Mancebo et al. recently published the largest cohort of cutaneous T.cell lymphoma examined with RCM. 83 lesions were evaluated, and the authors confirmed that this image technique was effective in to guide the most representative site for the biopsy. We believe that further and larger studies will clarify it and defining a diagnostic algorithm for the RCM diagnosis of MF.
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Humans , Female , Aged , Lymphoma, T-Cell , Mycosis Fungoides/pathology , Microscopy, Confocal/instrumentation , Early DiagnosisABSTRACT
Objective:To verify the effect of ozone on Staphylococcus aureus (S.aureus) colonization in patients with atopic dermatitis (AD) and its correlation with the patient's status.Methods:A total of 12 patients with moderate or severe AD,aged from 6 to 65 years,were recruited from outpatient of the Third Xiangya Hospital.The treatment sides were showered with ozonated water and smeared with ozonated oil for 7 days (twice a day),while the control sides were washed with warm running water and smeared with base oil.At different time points,the severity scoring ofatopic dermatitis (SCORAD) scores,sleep and pruritus scores were assessed and compared between the two sides.Meanwhile,plate cultivation was used to quantitatively detect the changes ofS.aureus colonization in skin lesions.Results:After 7 days treatment,erythema and pimples were decreased in the treatment sides.The clear skin texture,smooth skin,improved skin lesions were also observed by dermoscopic examination.The results of reflectance confocal microscopy (RCM) demonstrated that the parakeratosis was improved,the structures were clearer,and the inflammatory cells infiltration was reduced after ozone treatment for 7 days.After ozone treatment for 3 and 7 days,the S.aureus colonization in the treatment sides decreased by (75.55±21.81)％ and (97.24±2.64)％ respectively.Compared to that of control sides,the percentage of S.aureus colony after ozone treatment for 7 days decreased significantly (P＜0.01).After ozone treatment for 7 days,the SCORAD scores,sleep and pruritus scores were significantly decreased (all P＜0.01).There was a linear correlation between the decreasing percentage of S.aureus colony and the declining percentage of SCORAD scores in AD patients.Conclusion:Topical ozone therapy can effectively reduce S.aureus colony in skin lesions and alleviate the severity of AD patients with moderate to severe degree.
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O câncer de mucosa oral é um problema de saúde pública, com maior incidência em homens acima de 50 anos. Uma das manifestações clínicas mais precoces do câncer da mucosa oral são as lesões leucoqueratósica. O aspecto clínico não homogêneo e o tamanho maior de 200mm2, em mucosa não queratinizada como a do assoalho da boca e ventre da língua, são aspectos que implicam na possibilidade de evolução da lesão. A dificuldade do diagnóstico das lesões precoces está na seleção do local a ser biopsiado principalmente frente a lesões extensas e heterogêneas. O objetivo desta pesquisa é avaliar se a utilização do exame clínico juntamente com os métodos auxiliares de diagnóstico das lesões leucoqueratósica da mucosa oral (VELscope®, Azul de toluidina e Solução de lugol) contribui para uma maior precisão do diagnóstico de displasias nestas lesões quando comparado ao histopatológico. E, identificar os padrões morfológicos destas lesões quando avaliadas por meio da microscopia confocal reflectante. Foram selecionados 30 pacientes, maiores de 18 anos, portadores de lesão clínica compatível com leucoplasia oral triados no ambulatório da disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo e que precisavam ser submetidos à biópsia para o estabelecimento do diagnóstico final. Foram realizados os testes de Azul de Toluidina, Solução de Lugol, VELscope®, microscopia confocal reflectante e posteriormente, a biópsia incisional para obtenção do diagnóstico final. Os pacientes incluídos possuíam média de idade 60,66 anos, sendo 70% (21/30) do gênero feminino e 30% (9/30) do gênero masculino. O tabagismo foi relatado por 16,7% (5/30) dos pacientes, sendo 60% (3/5) homens. A associação do tabagismo e etilismo foi relatada em 10% (3/30) dos pacientes, o tabagismo isoladamente por 6,6% (2/30) e o de etilismo por 3,3%(1/30)...
Cancer of the oral mucosa is a public health problem, with higher incidence in men above 50 years. One of the earliest manifestations of cancer of the oral mucosa lesions are leukokeratosis. The inhomogeneous clinical aspect and the larger size of 200mm2 in non-keratinized mucosa as the floor of the mouth and constipation of the tongue, are aspects that imply the possibility of evolution of the lesion. The difficulty of diagnosis of early lesions is in the selection of the site to be biopsied primarily against large and heterogeneous lesions. The objective of this research is to evaluate the use of clinical examination along with diagnostic aids leucoqueratósica of oral lesions (VELscope ®, Toluidine blue and Lugol solution) methods contributes to greater accuracy of diagnosis of dysplasia in these lesions when compared the histopathological. And identify the morphological patterns of these lesions when evaluated by reflectance confocal microscopy. 30 patients older than 18 years, with clinical lesion compatible with oral leukoplakia screened in the outpatient discipline of Clinical Dentistry, Faculty of Dentistry, University of São Paulo and that needed to be biopsied to establish the final diagnosis were selected. Tests toluidine blue, Lugol's solution, VELscope ®, reflectance confocal microscopy (RCM) and subsequently, incisional biopsy to obtain the final diagnosis were performed. Patients enrolled had a mean age 60.66 years, 70% (21/30) were female and 30% (9/30) were male. Smoking was reported by 16.7% (5/30) of patients, 60% (3/5) homens.A association of smoking and alcohol use was reported in 10% (3/30) of patients, smoking alone by 6.6% (2/30) and of alcoholism by 3.3% (1/30)...
Subject(s)
Humans , Male , Adult , Middle Aged , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/diagnosis , Diagnosis, Oral/methods , Epithelium , Leukoplakia, Oral/classification , Leukoplakia, Oral/complications , Leukoplakia, Oral/diagnosis , Odontodysplasia/complications , Odontodysplasia/diagnosisABSTRACT
La microscopia confocal de reflectancia (MCR) es una herramienta de imágenes no invasiva que permite la visualización in vivo y en tiempo real de estructuras microscópicas de la epidermis, unión dermo-epidérmica y dermis superficial con una resolución cuasi histológica. Ha sido utilizada en la evaluación de lesiones benignas y malignas, demostrando un gran potencial para aplicaciones en investigación básica y en dermatología clínica. En el presente trabajo se revisan conceptos acerca del desarrollo y principios básicos del funcionamiento de la MCR, así como de sus aplicaciones en la práctica clínica.
Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that allows in-vivo and realtimevisualization of microscopic structures of the epidermis, dermo-epidermal junction and superficialdermis with a quasi-histological resolution. It has been used in the evaluation of benignand malignant lesions, showing a great potential for applications in basic research and clinicaldermatology. This paper reviews concepts about the development and basic principles of the RCMand its applications in clinical practice.