Confocal microscopy (CFM) is a diagnostic tool for cutaneous conditions that allows clinicians to visualize cellular details of the skin without the need for an invasive procedure. The microscope uses a laser to illuminate a small area of skin. Light is reflected back to the detector through a pinhole, which permits passage of light from the in-focus field only. With this input, a computer generates a two-dimensional grayscale image that corresponds to a transverse tissue section (ie. parallel to the skin surface). The contrast visualized by CFM is determined by the differential reflectance capability of various skin structures. The end result is a high-resolution image of the epidermis and superficial dermis that is obtained non-invasively and in real time. The confocal microscope was first conceptualized by Marvin Minsky in 1957. As early as 1995, CFM was used in dermatology, as a tool used for clinical dermatology and in Moh’s research at the Wellman Laboratories of Photomedicine at Massachusetts General Hospital in Boston. By the early 2000’s, researchers from prestigious academic centers including Memorial Sloan-Kettering Cancer Center (New York, NY), Loma Linda University (Loma Linda, California), the Sydney Melanoma Unit (Sydney, Australia), University of Modena and Reggio Emilia (Modena, Italy), the Charite (Berlin, Germany) and University of Graz (Graz, Austria) were using CFM routinely, both as a research tool and a clinical diagnostic imaging device. Today, confocal is widely used by dermatologists and researchers around the world to study and diagnose skin cancers, including melanoma, basal cell carcinoma and squamous cell carcinoma, along with a variety of other skin diseases, including psoriasis, actinic keratosis and seborrheic keratosis. Confocal microscopy has already had an impact on patient care and we imagine that this impact will continue and expand in the future.
No. NIDI does not scratch, puncture, or injure the skin in any way, and there is no anesthesia involved. Confocal Microscopy may require the patient to remain motionless and in the same position for up to 10 minutes, but otherwise does not cause any discomfort.
Anyone can be a candidate for NIDI, but most candidates fall into three main categories:
1. A patient who has a suspicious lesion on an aesthetically important site, such as the face or neck.
2. A patient with many irregular lesions that would otherwise require numerous biopsies.
3. Children, on whom we avoid surgery whenever possible.
No. A skin biopsy is still the gold standard when it comes to diagnosing any skin condition. However, NIDI can be used to determine whether a biopsy is necessary with much more certainty.
NIDI has been extensively studied around the world in a variety of settings, including major academic medical centers. Tens of thousands of patients have all been imaged without any reported side effects.
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The NIDI Teaching Portal will be available from 12:00 PM to 12:00 AM Eastern Time (New York) on weekdays only.
Click on the stack of squares on the leftmost part of the screen to open up confocal block and stack images.
Use your mouse or the plus (+) and minus (-) signs on the bottom right-hand corner to zoom in and out of images.
After viewing the images, scroll down to answer the quiz.
