Confocal microscopy-guided laser ablation for superficial and early nodular Basal cell carcinoma: a promising surgical alternative for superficial skin cancers.
Confocal microscopy-guided laser ablation for superficial and early nodular Basal cell carcinoma: a promising surgical alternative for superficial skin cancers.
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DOI：
10.1001/jamadermatol.2013.10225
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发表时间：
2014-09
期刊：
影响因子：
10.9
通讯作者：
Rajadhyaksha, Milind
中科院分区：
文献类型：
--
作者：
Chen, Chih-Shan Jason;Sierra, Heidy;Cordova, Miguel;Rajadhyaksha, Milind
激光消融术是一种治疗浅表皮肤癌的快速微创方法，但由于缺乏组织学边缘控制，疗效和可靠性各不相同。高分辨率反射共聚焦显微镜（RCM）可以提供一种直接检查患者边缘的方法。我们报告了2例成功消除浅表和早期结节性基底细胞癌（BCC）的病例，使用RCM成像指导Er-：YAG激光消融。三维（3-D）映射是可行的与RCM-，描绘肿瘤的侧边界和厚度。因此，外科医生可以通过局部控制来输送激光能量密度和通过，即，通过改变具有由BCC的3-D形貌控制的特异性的亚病变区域中的消融参数。我们进一步证明了在初始激光消融后的残余BCC的术中检测和通过额外的通过完全去除残余肿瘤。RCM成像和组织切片均证实BCC最终清除。共聚焦显微镜可以提高激光肿瘤消融的有效性和可靠性。该报告代表了RCM成像的一种新的翻译应用，当与消融激光相结合时，可能有一天会为BCC提供有效且具有成本效益的治疗。
Laser ablation is a rapid and minimally invasive approach for the treatment of superficial skin cancers, but efficacy and reliability vary owing to lack of histologic margin control. High-resolution reflectance confocal microscopy (RCM) may offer a means for examining margins directly on the patient. We report successful elimination of superficial and early nodular basal cell carcinoma (BCC) in 2 cases-, using RCM imaging to guide Er-:YAG laser ablation. Three-dimensional (3-D) mapping is feasible with RCM-, to delineate the lateral border and thickness of the tumor. Thus, the surgeon may deliver laser fluence and passes with localized control—ie, by varying the ablation parameters in sub-lesional areas with specificity that is governed by the 3-D topography of the BCC. We further demonstrate intra-operative detection of residual BCC after initial laser ablation and complete removal of remaining tumor by additional passes. Both RCM imaging and histologic sections confirm the final clearance of BCC. Confocal microscopy may enhance the efficacy and reliability of laser tumor ablation. This report represents a new translational application for RCM imaging, which, when combined with an ablative laser, may one day provide an efficient and cost-effective treatment for BCC.
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