• M Venturini, R Sala, S Gonzàlez, and P G Calzavara-Pinton.
• Department of Dermatology, University of Brescia, Spedali Civili Hospital, Brescia, Italy. marina.venturini@med.unibs.it
• Br. J. Dermatol. 2013 Jan 1; 168 (1): 99-105.

BackgroundPhotodynamic therapy (PDT) with methyl aminolaevulinate (MAL) is an approved noninvasive treatment option for basal cell carcinoma (BCC). In vivo reflectance confocal microscopy (RCM) is a noninvasive imaging technique that has proved useful for in vivo real-time cytomorphological analysis of BCC cells infiltrating the epidermis.Objectives  To investigate the use of in vivo RCM to assess the persistence of BCC cells surviving MAL-PDT.MethodsIn vivo  RCM images of 20 biopsy-proven BCCs were taken before patients underwent a treatment cycle with MAL-PDT. Follow-up after 3months was performed using clinical examination, RCM and conventional dermoscopy. Treated areas also underwent a targeted 3-mm punch biopsy for standard haematoxylin and eosin histology stain to establish the clinical and instrumental correlation of the treatment outcome.Results  Three months after PDT, clinical examination established that two out of 20 BCCs were persistent; dermoscopy found three out of 20 residual BCCs, but RCM showed that one of these lesions was a false positive, and showed persistent BCC foci in five out of 20 lesions. Histological analysis of targeted biopsies confirmed these results.Conclusions  RCM provided noninvasive, early detection of incipient recurrences of BCC after MAL-PDT. RCM findings steered targeted biopsies and surgical removal, or a new MAL-PDT, of these subclinical recurrences with minimal invasiveness.© 2012 The Authors. BJD © 2012 British Association of Dermatologists.

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