Original article
The role of in vivo confocal microscopy in the diagnosis of eyelid margin tumors: 47 cases

https://doi.org/10.1016/j.jaad.2014.05.060Get rights and content

Background

Handheld in vivo reflectance confocal microscopy (IVCM) is a new imaging method that allows noninvasive diagnosis of cutaneous tumors but to date it has not been used in the study of eyelid tumors.

Objective

We sought to evaluate the suitability of IVCM for eyelid margin tumors.

Methods

We prospectively evaluated the IVCM features of 47 eyelid margin lesions, clinically suspicious of malignancy; 35 of these were excised whereas the other 12, with no IVCM malignant features, were followed up for at least 1 year. Clinical, IVCM, and histologic diagnoses were compared.

Results

IVCM showed sensitivity and specificity of 100% and 69.2%, respectively, for malignancy (basal cell carcinoma, squamous cell carcinoma, and melanoma). The follow-up of the 12 nonexcised lesions did not show any clinical progression.

Limitations

The lesions showing neither clinical nor IVCM features for malignancies were not biopsied in view of the potential functional and aesthetic consequences of eyelid margin surgery.

Conclusion

Used with a handheld dermatology-specific microscope, IVCM can play a role in the noninvasive diagnosis of eyelid margin lesions. Further studies are needed to better define diagnostic criteria of eyelid tumors and improve the specificity of this technique.

Section snippets

Methods

A total of 45 consecutive patients (19 female, 36 male; average age 64 years, range 13-94 years) presenting with a total of 47 eyelid margin tumor lesions were recruited at the Department of Dermatology, University Hospital of Saint-Étienne, France, between January 2011 and June 2013. Clinical and IVCM diagnoses were established by a team of 3 dermatologists (E. C., J. L. P., B. L.) and 2 ophthalmologists (D. G., M. E.).

IVCM examination was carried out with a handheld microscope for skin

Results

IVCM features of the tumor-free mucosa varied according to the area of the eyelid margin. Three main different areas were identified: the cutaneous outer part, the mucous intermediate part, and the inner tarsal conjunctiva. Although the first resembled normal-appearing skin, the mucous intermediate part was characterized by: (1) the absence of stratum corneum and stratum granulosum, (2) the absence of papillae, and (3) prominent chorion capillaries. The same features were evident in the tarsal

Discussion

Our study showed that skin-specific handheld IVCM can be a new tool for the noninvasive diagnosis of eyelid margin tumors. Two IVCMs are currently available to explore the eye surface: a 4-slit scanning confocal microscope (Confoscan, Nidek, Gamagori, Japan) and a laser-scanning confocal microscope (Heidelberg Retina Tomograph,5, 6 Heidelberg Engineering GmbH, Heidelberg, Germany). Because of their limited ease of handling, both these microscopes are mostly used to view the cornea and more

References (13)

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Funding sources: None.

Reprints not available from the authors.

Conflicts of interest: None declared.

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