In Vivo Reflectance Confocal Microscopy (RCM)

 

What is Confocal Imaging?

In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging procedure that allows real-time viewing of cells, resulting in virtual biopsies.

In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging technique that produces virtual biopsies in real time.

RCM uses a laser diode as the source of the light. An operator positions the RCM unit while light passes through optics and illuminates a small area of tissue. Light reflected back through the lens, at a given focal point, is recorded digitally. The wavelength of the light does not cause injury and is only slightly warm to the patient.

The operator can control the depth of the images and can record video, stacks of images, or mosaics, as they view a screen showing the patient’s cell structure in real-time. Since RCM is noninvasive, it can allow the same area to be reviewed over time without impacting the tissue.

There are two main types of RCM units: stationary and handheld. While dozens of dermatologists in the U.S. utilize confocal microscopy, only a select few have access to handheld units and the specialized training required to accurately identify extramammary Paget’s disease (EMPD). Most confocal systems are stationary, which restricts their use to areas where a larger, fixed device can be accommodated. In contrast, handheld units can be effectively used on almost all accessible surface areas, except for the soles of the feet, palms, fingernails, and toenails, making them a versatile tool for dermatological examinations, particularly in the assessment of extramammary Paget’s disease (EMPD).

Handheld in vivo reflectance confocal microscopy (RCM) allows viewing of the epidermis down to the papillary dermis. RCM allows physicians to cover a larger area than other techniques and without any pain to the patient. RCM can also record images in difficult to reach or sensitive locations. One drawback of the process is that handheld RCM requires a highly trained and skilled operator, often a dermatopathologist. This is because the operator must interpret real-time images on a screen to accurately position the handheld wand.

The confocal microscope was invented in the 1950’s but it took until the 1990’s for the technology to mature to a point were portability and digital recording of images was possible.

RCM works well as an adjunct to traditional scouting biopsies in extramammary Paget's disease (EMPD) treatment and diagnostics. However, since RCM has a small field of view and limited depth it does have limitations in some applications. 

In vivo reflectance confocal microscopy was approved by the FDA for EMPD diagnosis in the United States in 2018. Memorial Sloan Kettering Cancer Center was one of the first medical institutions in the United States to use handheld RCM in an EMPD diagnostic program. Since then, other organizations have been adding RCM capability. Extramammary Paget's disease (EMPD) patients report the use of RCM, as part of their EMPD assessments, at the following organizations*:

Other unique imaging procedures are also being used in a variety of healthcare situations. One such procedure includes Full-Field Optical Coherence Tomography (FFOCT). In vivo FFOCT is a non-invasive and non-destructive technique that captures in-depth, high-resolution tissue imaging at the cellular level. Pathologists have used the technology with various skin cancers including extramammary Paget’s disease (EMPD). FFOCT can reach tissue depths of hundreds of microns. However the nuclei in the individual cells are not always visible in FFOCT, which can be limiting to a pathologist's determination of EMPD.

Since EMPD cases vary widely, it is important to work with your physician to determine the best treatment plan for your situation. This information is not intended as a substitute for professional medical care.

* Information regarding reflectance confocal microscopy (RCM) locations, for EMPD treatment and diagnosis, have been shared by EMPD patients and medical institutions. If you are aware of locations using reflectance confocal microscopy with EMPD patients, please let us know.

The content presented on this website, encompassing both textual material and visual media, serves educational and informational purposes aimed at aiding individuals affected by extramammary Paget’s disease (EMPD) and their families in comprehending the complexities associated with EMPD. It is imperative to note that the website is not designed to serve as a replacement for professional medical advice, diagnosis, or treatment. Furthermore, the website does not advocate for or endorse any specific treatments, tests, physicians, procedures, or products. Should you suspect that you are experiencing symptoms of EMPD, we strongly advise you to seek guidance from your healthcare provider.

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