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Maher N.G.,The Melanoma Institute Australia | Maher N.G.,University of Sydney | Solinas A.,Royal Prince Alfred Hospital | Scolyer R.A.,The Melanoma Institute Australia | And 5 more authors.
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology | Year: 2016

Objective: To improve prebiopsy diagnostic accuracy and surgical management of pigmented appearing lesions on the lips, particularly melanoma, using in,vivo reflectance confocal microscopy (RCM). Study Design: Prospective case series over a 12-month period between 2015 and 2016. The setting was two specialist dermatology referral centers with expertise in confocal microscopy. The study population was a consecutive sample of patients with pigmentation of the lip for which the cause was uncertain clinically, whose differential diagnosis included melanoma, and who had undergone both in,vivo RCM and subsequent biopsy. The outcome measures were RCM features, dermoscopy features, and histopathological diagnosis. Results were reported by descriptive analysis and correlations made between RCM features and histopathology. Results: Eight patients were recruited for the study. In,vivo RCM facilitated the targeting of small biopsies to identify two in situ oral melanoma recurrences and successfully mapped an in situ oral melanoma before wide excision. Suprabasal dendritic pagetoid cells and epidermal disarray on RCM were useful indicators for in situ melanoma of the lip. Previously described dermoscopy features for mucosal melanoma were not very helpful in diagnosing melanoma in our series. Challenges included evaluating inflamed lesions with pigment incontinence. Conclusions: RCM can assist in the diagnosis and management of pigmented lip lesions, but additional studies are required to further evaluate these initial observations. © 2016 Elsevier Inc.


Maher N.G.,The Melanoma Institute Australia | Maher N.G.,University of Sydney | Collgros H.,Hospital Universitario La Paz | Uribe P.,University of Santiago de Chile | And 7 more authors.
Oral Oncology | Year: 2015

Confocal microscopy (CM) has been shown to correlate with oral mucosal histopathology in vivo. The purposes of this review are to summarize what we know so far about in vivo CM applications for oral mucosal pathologies, to highlight some current developments with CM devices relevant for oral applications, and to formulate where in vivo CM could hold further application for oral mucosal diagnosis and management. Ovid Medline® and/or Google® searches were performed using the terms 'microscopy, confocal', 'mouth neoplasms', 'mouth mucosa', 'leukoplakia, oral', 'oral lichen planus', 'gingiva', 'cheilitis', 'taste', 'inflammatory oral confocal', 'mucosal confocal' and 'confocal squamous cell oral'. In summary, inclusion criteria were in vivo use of any type of CM for the human oral mucosa and studies on normal or pathological oral mucosa. Experimental studies attempting to identify proteins of interest and microorganisms were excluded. In total 25 relevant articles were found, covering 8 main topics, including normal oral mucosal features (n = 15), oral dysplasia or neoplasia (n = 7), inflamed oral mucosa (n = 3), taste impairment (n = 3), oral autoimmune conditions (n = 2), pigmented oral pathology/melanoma (n = 1), delayed type hypersensitivity (n = 1), and cheilitis glandularis (n = 1). The evidence for using in vivo CM in these conditions is poor, as it is limited to mainly small descriptive studies. Current device developments for oral CM include improved probe design. The authors propose that future applications for in vivo oral CM may include burning mouth syndrome, intra-operative mapping for cancer surgery, and monitoring and targeted biopsies within field cancerization. © 2016 Elsevier Ltd.

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