Cutaneous Atlas of Ex Vivo Confocal Microscopy

Section I. Basics of Ex Vivo Confocal Microscopy.- Roles and Applications of Ex Vivo Confocal Microscopy.- Principles of Ex Vivo Confocal Microscopy.- Hands-On Guide for Ex Vivo Confocal Imaging.- Section II. Normal Skin.- Normal Skin on Ex Vivo Confocal Microscopy: Patterns and Histopathologic Correlation.- Section III. Benign Skin Tumours.- Features of Benign Epidermal Nonmelanocytic Lesions on Ex Vivo Confocal Microscopy and Histopathologic Correlation.- Features of Benign Nonmelanocytic Dermal and Subcutaneous Lesions on Ex Vivo Confocal Microscopy and Histopathologic Correlation.- Section IV. Malignant Keratinocyte Neoplasms.- Morphological Features of Basal Cell Carcinoma on Ex Vivo Confocal Imaging and Histopathologic Correlation.- Squamous Cell Carcinoma Features on Ex Vivo Confocal Imaging and Histopathologic Correlation.- Section V. Melanocytic Lesions.- Normal Nevi: Junctional, Compound, and Dermal.- Dysplastic Nevi.- Melanoma.- Section VI. Inflammatory Lesions.- Features of Lichen Planus and Psoriasis on Ex Vivo Confocal Imaging and Histopathologic Correlation.- Eczema: Features on FCM, Digital H&E, and Corresponding Conventional H&E.- Fluorescence Confocal Microscope for Identification of Discoid Lupus Erythematosus Histologic Features.- Immunofluorescence with Confocal Microscopy: Pemphigoid, Pemphigus, Cutaneous Vasculitis, Lichen Planus, and Cutaneous Lupus Erythematosus.- Section VII. Future of Ex Vivo Confocal Microscopy.- Advances in Technology, Staining Protocol, and Flattening Devices in Ex Vivo Confocal Microscopy.- Epidermal Reconstruction During Ex Vivo Confocal Microscopy for Detection of Superficial Basal Cell Carcinoma with 3D-mosaicking and Intensity Projection.

This atlas provides a detailed overview of the novel technique of ex vivo confocal microscopy for rapid imaging of excised tissues in dermatological practice. It features an extensive collection of ex vivo images acquired from normal skin structures and from a variety of neoplastic lesions (benign and malignant) and inflammatory lesions. Each chapter contains several image types of a particular disorder, including gray-scale, digital purple-pink images (DHE) and hematoxylin and eosin (H&E) correlations to assist the acquisition of diagnostic skills. Guidance on how to use techniques for tissue preparation, staining, handling and image acquisition are also provided enabling the reader to develop confidence in integrating this technique into their day-to-day practices. Furthermore, this atlas also provides an update on the ongoing latest advances in the field.

Cutaneous Atlas of Ex Vivo Confocal Microscopy covers how to apply these techniques into dermatological practice, especially in Mohs surgery for the evaluation of keratinocytic neoplasm and in dermatopathology for rapid evaluation of varied skin lesions. It is therefore a valuable resource for trainee, residents, practicing dermatologists and dermatopathologists who are seeking a resource to assist in developing their knowledge and skills of utilizing these methodologies. 

Dr. Manu Jain is an Assistant Attending and an optical imaging specialist in the Department of Dermatology at Memorial Sloan Kettering Cancer Center (MSKCC). She has over 10 years of experience working in the field of optical imaging (i.e., in vivo/ex vivo microscopy) that includes technologies such as reflectance confocal microscopy (RCM), fluorescence confocal microscopy (FCM), multiphoton microscopy (MPM), and optical coherence tomography (OCT). At MSKCC, Dr. Jain is leading the clinical, research, and teaching program for RCM in dermatology. She also collaborates with a team of engineers and computational analysts for computer-aided diagnosis of confocal images of skin. She is the Vice President of American Confocal Group and Past-Secretary of the International Tele-Dermatology Society (ITDS). She also created and directs the Annual CME accredited Confocal Course at MSK. Dr. Jain has published many peer-reviewed articles in reputed journals and co-authored several book chapters. She has been an invited speaker at multiple national and international meetings.

Dr. Anthony Rossi is a dermatologist who specializes in Mohs micrographic surgery specialist in the Department of Dermatology at MSKCC. He has significant experience in using reflectance confocal microscopy to help delineate borders of lentigo maligna melanoma and nonmelanoma skin cancers prior to surgery, and is working on research to expand the application of this technology to other aspects of skin cancer management. Dr. Rossi has published numerous journal articles and book chapters and has received presidential service awards from the American Academy of Dermatology, the American Society for Dermatologic Surgery, as well as the American Society for Lasers in Surgery and Medicine.
Dr. Kishwer Nehal the Director of Mohs and Dermatologic Surgery in the Department of Dermatology at MSKCC. She conducts clinical research on noninvasive imaging techniques, such as confocal microscopy and has published the first dedicated book on lentigo maligna melanoma. She works with the National Comprehensive Cancer Network to develop guidelines on managing skin cancers. Besides, she helped the American Joint Committee on Cancer to develop staging criteria for squamous cell carcinomas. She has shared her expertise at national and international meetings and written numerous journal articles and book chapters.

Dr. Mercedes Sendín Martín is a physician in the Department of Dermatology at Hospital Universitario Virgen del Rocío (Seville, Spain), where she works on research related to new optical imaging techniques during her residency program. She is specially focus on confocal imaging research, and published last year an alternative technique for obtaining colored ex vivo confocal images.