Reflectance confocal microscopy criteria for squamous cell carcinomas and actinic keratoses

Ayelet Rishpon, Nancy Kim, Alon Scope, Leeor Porges, Margaret C. Oliviero, Ralph P. Braun, Ashfaq A. Marghoob, Christi Alessi Fox, Harold S. Rabinovitz

Research output: Contribution to journalArticlepeer-review

153 Scopus citations


Objective: To identify criteria for the diagnosis of squamous cell carcinoma (SCC) and actinic keratosis (AK) by in vivo reflectance confocal microscopy (RCM). Design: Prospective RCM imaging of lesions suspected clinically and/or dermoscopically to be SCC or AK, followed by RCM assessment of the biopsy-proven SCCs and AKs. Setting: Private skin cancer clinic, Plantation, Florida. Patients: A total of 38 lesions in 24 patients were assessed, including 7 AKs, 25 SCCs in situ, 3 invasive SCCs, and 3 keratoacanthomas. Interventions: Prior to undergoing biopsy, all lesions were assessed by RCM. Results: Mosaic RCM images at the stratum corneum level revealed scale in 29 SCCs (95%) and in all 7 AKs. Polygonal nucleated cells at the stratum corneum were seen in 3 SCCs (10%) and 1 AK (14%). All 38 cases displayed an atypical honeycomb and/or a disarranged pattern of the spinous-granular layer of the epidermis; round nucleated cells were seen in the spinous-granular layer in 20 SCCs (65%) and 1AK(14%). Round blood vessels in the superficial dermis were seen in 28 SCCs (90%) and 5 AKs (72%). Conclusions: An increasing frequency of abnormal RCM features can be observed across the spectrum of keratinocytic neoplasias. The presence of an atypical honeycomb or a disarranged pattern of the spinous-granular layer, round nucleated cells at the spinous-granular layer, and round blood vessels traversing through the dermal papilla are the key RCM features of SCC.

Original languageEnglish (US)
Pages (from-to)766-772
Number of pages7
JournalArchives of Dermatology
Issue number7
StatePublished - Jul 2009
Externally publishedYes

ASJC Scopus subject areas

  • Dermatology


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