Determination of the in vivo confocal microscopy patterns of the cutaneous neoplasms of the face and comparison to the dermoscopy and histophatology in transversal and convencional sections

Abstract

The skin is the organ that is most affected by cancer in both genders. The face, due to the constant exposure is the area at most risk for developing skin tumors. Of all skin cancers, about 80% are located on the face.The non-melanoma skin tumors can be locally aggressive and, on the face, provide important functional and morphological defects. Regarding to melanoma, the depth of the tumor at diagnosis is directly related to survival and the need for early diagnosis is indisputable.To facilitate the early diagnosis of skin cancer, dermoscopy has been a widely used, and can increase diagnostic accuracy by up to 20% when performed by an experienced examiner. On the face, the method has limitations in the evaluation of pigmented lesions, since the rectification of the epithelial cones in this region makes the structure of pigmented network different. The lesions of solar lentigo, seborrheic keratosis and lichen planus like keratosis are very similar to lentigo maligna lesions, complicating the clinical diagnosis. In non-pigmented lesions, the diagnosis may be suggested by the predominat typical dermatoscopic vascular pattern in the lesion, which often can not be found, or be confused with the underlying poikiloderma. Confocal laser microscopy appears today as the imaging method promising for the noninvasive diagnosis of skin lesions, with the potential to fill gaps in the examination of the skin. The method allows in vivo tests, is performed in real time and provides images with a resolution similar to the histology, in planes parallel to the epidermis. The intravascular blood flow can also be documented in vivo, providing valuable information about the conformation of the vessels in the dermis and the architecture of the various tumor cancers. This project aims to study and describe aspects of skin cancers on the face, comparing these findings with those of dermoscopy and histology of cross sections, based on the method for obtaining cross sections proposed by Rezze and co-workers. As the face is the region of the integument that is most exposed to ultraviolet radiation, preferred location of skin tumors and a place where invasive surgery has a great social impact, a more accurate diagnostic method and non-invasive can be a valuable tool. Understanding the potential impact of using this new method in clinical practice is also the target of this work. (AU)