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Confocal Microscopy of Challenging Dermoscopic Diagnoses

Margaret I. Sanchez, MD; Harold S. Rabinovitz, MD; Margaret C. Oliverio, ARNP; George W. Elgart, MD; James M. Grichnik, MD, PhD
Arch Dermatol. 2012;148(10):1224. doi:10.1001/archdermatol.2012.2538.
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Dermoscopic evaluation has been shown to reduce unnecessary biopsies and to increase the accuracy of melanoma diagnosis. However, some lesions remain dermoscopically challenging, as in the 3 paired malignant and benign cases shown in the Figure: A and B reveal a disorganized reticular pattern and a moth-eaten border; C and D reveal structureless areas and areas of gray and asymmetrical dots; and E and F reveal a disorganized reticular pattern, structureless areas, and areas of gray and moth-eaten borders. Reflectance confocal microscopy provides additional information that can serve to facilitate the correct diagnosis. View the confocal features and diagnosis for each of these cases (here). Confocal microscopy also reveals some lesion structural details that are not readily appreciated by standard histopathology. This is particularly evident for the extension of melanocytic dendrites and for the presence of retractile (presumably melanocytic) cells in the papillary dermis residing under some histologically diagnosed in situ melanomas.

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