In vivo Reflectance Confocal Microscopy
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This tutorial is provided to describe the unifying concept of confocal microscopy with complete definitions of the parameters and example images. Afer completion, please proceed to the training area, where a set with 45 images is available for the refinement and final elaboration of the list. All tutorial set images cover an area of 470x350 μm.
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RCM features description

Upper dermis

Melanocytic nest features

The presence of clusters of refractive cells forming oval to roundish structures immediately below the basal cell layer, corresponding to melanocytic nests, is reported. According to their aspect, cellular clusters are divided into 4 different types:

Dense clusters correspond to compact aggregates with sharp margin and similar cells in morphology and refractivity (Fig. 47-49).

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Figure 47. Dense clusters: compact aggregates of polygonal cells

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Figure 48. Dense clusters: compact aggregates of polygonal cells

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Figure 49. Dense clusters: compact aggregates of polygonal cells

Dense and sparse clusters (dishomogeneous clusters) correspond to compact aggregates with sharp and regular margins and non homogeneity in cell morphology and refractivity, with the presence of evident cells not tightly aggregated within the nest (Fig. 50,51).

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Figure 50. Dense and sparse clusters: dishomogeneously aggregated cells. It shows the contemporary presence of cells aggregated in clusters and evident bright cells apparently not aggregated

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Figure 51. Dense and sparse clusters

Sparse cell clusters correspond to irregularly aggregated and sparse cells, usually irregular in morphology and refractivity confined within a darker well-demarcated area (Fig. 52-54).

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Figure 52. Sparse cell clusters: irregularly aggregated and isolated cells within a sharply demarcated dark area

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Figure 53. Sparse cell clusters

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Figure 54. Sparse cell clusters

Cerebriform clusters correspond to cellular clusters consisting of confluent amorphous aggregates of low reflecting cells exhibiting granular cytoplasm without evident nuclei and ill defined borders, being the aggregates brain-like in appearance, showing a fine hyporeflective «fissure» like appearance (Fig. 55,57).

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Figure 55. Cerebriform clusters: confluent aggregates of small low reflecting cells separated by hyporeflective fissure-like appearance

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Figure 57. Cerebriform clusters

Isolated cells within upper dermis

The presence of non aggregated cells inside dermal papillae is reported:

Nucleated cells correspond to round to oval or triangular cells with well-demarcated refractive cytoplasm and well-demarcated dark nucleus infiltrating dermal papilla. These cells are clearly separated in between (Fig. 58,59).

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Figure 58. Nucleated cells within the dermal papilla the cell is large, with bright reflective and well demarcated cytoplasm

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Figure 59. Numerous nucleated cells within the dermis

Bright Spots and small bright cells are small hyperefractive dots and small cells with very bright cytoplasm and small nuclei sometimes visible (Fig. 60,61).

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Figure 60. Small hyper-reflecting particles and cells with bright cytoplasm and sometimes visible nuclei. Compared with «nucleated cells», they are markedly smaller

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Figure 61. Small hyper-reflecting particles and cells

Plump bright cells are described as plump irregularly shaped bright cells with ill-defined borders and usually no visible nucleus. Sometimes they are crowded within the papilla (Fig. 62-64).

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Figure 62. Plump bright cells appears as irregularly shaped and with ill-defined borders

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Figure 63. Plump bright cells appears as irregularly shaped and with ill-defined borders

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Figure 64. Plump bright cells appears as irregularly shaped and with ill-defined borders

Collagen structures

Collagen could be seen as amorphous or fibrillar structures which distribution could be:

Reticulated, forming a web-like structures inside the dermal papillae or the dermis (Fig. 66-67b).

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Figure 66. Reticulated collagen forming web-like structures

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Figure 67. Reticulated collagen forming web-like structures

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Figure 67b. Reticulated collagen forming web-like structures

In boundles, gathered into large fasciae (Fig. 68).

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Figure 68. Collagen gathered into large bundles

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 All images are propriety of G. Pellacani and protected by copyright. Reproduction is not permitted without permission.