In Vivo Reflectance Confocal Microscopy of Basal Cell Carcinoma: Feasibility of Preoperative Mapping of Cancer Margins

The incidence of basal cell carcinoma (BCC) is steadily increasing in most countries, accounting for approximately 80% of all nonmelanoma skin cancers.1 Mohs micrographic surgery (MMS) has been shown to be the most efficacious technique for removal of aggressive high-risk BCC located on the mid-face and ears,2,3 but the technique is labor intensive and time consuming, so there is a need for effective tools for improving and facilitating accurate tumour demarcation in patients with these aggressive skin tumors. In vivo reflectance confocal microscopy (RCM) enables the noninvasive imaging of superficial layers of the skin with high resolution that provides cellular detail.4 RCM has previously been reported to be useful in the in vivo evaluation of skin tumors such as BCC, squamous cell carcinoma,5 and malignant melanoma.6 The ability to use RCM to perform noninvasive evaluation of skin lesions means that it has the potential to define lesion margins before surgical therapy. It has been demonstrated recently that it is possible to examine nonmelanoma skin cancers in ex vivo tissue during Mohs micrographic surgery without frozen sections.7 The purpose of this study was to investigate the potential of RCM to define margins of BCC before surgery.