In vivo Reflectance Confocal Microscopy
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In order to define a glossary of descriptors in melanocytic tumors, a list of parameters has been elaborated based on a critical review of the scientific literature. Independent investigators are invited to: 1) visualize the on-line tutorial describing the parameters, 2) evaluate a set of training images with real time feedback, and 3) access the evaluation area with the actual study images.
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Confocal scanning laser microscopy

Reflectance-mode Confocal Scanning Laser Microscopy represents a novel approach for the in-vivo study of the skin enabling the visualization of the epidermis and superficial dermis at a nearly histologic resolution, with a cellular-level resolution to a depth limited to the papillary dermis in normal skin.

A low power laser beam illuminates a point inside the object. Reflectance-mode confocal microscopy works by detecting single back-scattered photon from the illuminated in-focus section through a pinhole-sized filter and rejecting light reflected from out-of-focus portions of the object. Laser beam is then scanned on the horizontal plane producing 2-dimensional pictures representing parallel sections of the skin.

Confocal Scanning Laser Microscopy enables the non invasive imaging of skin structures with cellular-level resolution (0.5-1.0 μm in the lateral dimension and 4-5 μm in the axial ones) to a depth limited to 200 to 300 μm, in relation to the wavelength of the employed laser-light, corresponding to the level of papillary dermis in normal skin.

In reflectance-mode Confocal Scanning Laser Microscopy, contrast is provided by differences in refraction index of organelles and other microstructures, that are bright, contrasting with the background. Melanin and melanosomes are a strong source of contrast rendering melanocytic cells particularly evident by means of this technique.

Confocal Scanning Laser Microscopy was applied for imaging physiological and pathological conditions of the skin. Since pigment melanin and melanosomes are among the strongest sources of contrast in Confocal Scanning Laser Microscopy, this technique seems to be particularly indicated for the study of melanocytic lesions.

The cytological and architectural aspects observable within the epidermis and the superficial dermis described identifying features characteristic of common nevi, atypical nevi and malignant melanomas. Characterization of Confocal Scanning Laser Microscopy features of melanocytic lesions improve diagnostic accuracy in dermatological oncology, together with knowledge on their biology.

The evaluation of consistency and reproducibility of basic parameters introduced in the previous publications is needed. The aim of this study is the elaboration of a glossary of terms and definitions and the evaluation of the reproducibility by the analyses of the inter and intra observer agreement.

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