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In vivo usage

Confocal laser scanning microscopy is used for in vivo and ex vivo medical applications

This non-invasive technology enables the physician to optimize diagnose and optimize treatment of different skin disease fields compared with traditional diagnostic procedures and technologies. Confocal laser scannig microscopy is also used for progress monitoring.

More than 800 publications in medical journals and feature articles testify to the diverse application possibilities of confocal laser scanning microscopy.

Vivascope-pub website (external link)

In vivo applications

Confocal laser scanning microscopy is pain free because it is a non-invasive examination and is used for in vivo applications with living organisms.

It is possible to depict cellular microstructures of skin in thin layers. The examination of unprepared skin directly on the patient yields quick findings and results compared with biopsies. This means waiting times for examination and diagnostics results are significantly reduced. This also potentially eliminates any unnecessary biopsies.

Melanocytic Lesions

Melanocytes - pigment cells in skin - are responsible for the mostly brownish discoloration. This discoloration often is nothing more than a benign mole (nevus) or a so-called "age spot" that are frequently found in great numbers over the entire body. However, if such a spot develops into a malignant melanoma, a quick response is indicated.

Physicians utilizing images produced by confocal laser scanning microscopy can achieve an accuracy of up to 95% in the diagnosis and analysis of malignant melanomas and other malignant skin tumors. Unnecessary scars and excisions are avoided which means the unchanged tissue is still available for subsequent accurate analyses.

Non Melanocytic Lesions

In vivo examinations with CLSM enable dermatologists to diagnose basal cell carcinomas promptly, non-invasively, and accurately.

Pigmented basal cell carcinomas or difficult to define keratosis are reliably distinguished from melanocytic lesions, squamous cell carcinoma and different stages of actinic keratosis are also detected reliably by physicians while yielding the same detection rate as traditional methods without changing or destroying tissue - which can be use for subsequent examinations or diagnoses.

Inflammatory Diseases

CLSM provides a safe and pain free method to analyse different types of inflammatory skin conditions. For example CLSM can be used to distinguish between allergic and irritant contact dermatitis. Furthermore, CLSM also allows a non-invasive examination of psoriasis, discoid lupus erythematosus, lichen planus and seborrheic dermatitis as a very good correlation to histology has been shown.

Burns

Previously used visual diagnoses by an experienced plastic surgeon are estimated at an accuracy of approx. 50% - the rate of incorrect assessments at the expense of the patient is accordingly high.

The use of CLSM makes it possible to qualitatively and quantitatively distinguish between superficial burns (second degree) and severe wounds on the verge of third degree burns and therefore requiring immediate medical treatment.

Additional Therapeutic Indications

The range of applications of confocal laser scanning microscopy is continually expanding. See Vivascope website for additional information and references.


Ex vivo applications

The confocal laser scan microscope for ex vivo use may make it possible to dermahistopatholocially visualize tissue samples immediately after excision with minimal tissue preparation.

Examination / Diagnostics

  • Mohs Surgery
  • Breast Cancer

Within the scope of these applications, CLSM potentially enables the physician to analyze tissue such as from the breast or knee during surgery to yield a result much faster. This means surgeons can potentially make on-the-spot decisions whether to continue surgery, remove additional tissue, or successfully conclude the procedure.

Mohs Surgery

In Mohs surgery up to now, each excision must be accompanied by frozen cross-sections of the excised material, which are complex to prepare and take approx. 20 to 45 minutes per cross-section.

Especially basal cell or squamous cell carcinomas frequently exhibit additional growth under the skin which is not visible on the surface of the skin. This means an entire series of excisions may therefore be needed to remove the tumor completely. Since the use of frozen cross-section must accompany the procedure, large and complicated tumors may require several hours of surgery.

Confocal laser scanning microscopy may be able to eliminate the need for frozen cross-sections by making it possible to assess fresh skin excisions quickly and precisely. A precise indication of the tumor margin may then be possible in approximately only nine minutes per excised tissue sample, which significantly reduces the time of the surgical procedure.

Breast Cancer

When a mammary carcinoma is suspected, core biopsies have been established as the standard method to identify malignant tumors. Up to now, fixation and embedding of the tissue cylinders is required before microtome cross-sections can be prepared, which are then examined by an expert. Patients have to wait four to five days for the finding, even longer if the diagnosis is ambiguous.

CLSM will allow the direct and immediate examination of the tissue specimen after extraction - ex vivo. Delays due to the time needed to prepare the specimen ideally would be completely eliminated. As a result, it may be possible to begin time-critical treatments, such as neoadjuvant chemotherapy, sooner.

If a surgeon were to utilize CLSM during the excision of a tumor, it may be possible to detect and control the margins of the carcinoma precisely, and a second surgery might even be avoidable. Preliminary work indicates that this method does not interfere with subsequent standard histological methods (H&E) for analyses.

General Definitions

  • In vivo
    The term in vivo is derived from the Latin "vivus" ("living"): the term in vivo is applied to processes with living organisms.
  • Ex vivo
    The term ex vivo comes from the Latin "ex" meaning outside and "vivus" meaning living or alive; ex vivo means outside of living tissue: using this technique it is possible to dermahistopatholocially visualize tissue samples immediately after excision with minimal tissue preparation.
  • Melanocytic Lesions
    The dermatological term melanocytic lesion is used to describe a region of skin that differs in color from the surrounding area.
  • Non-Melanocytic Lesions
    The term non-melanocytic lesion is used to describe changes of the epidermis due to various factors. Especially chronic light damage or infections with certain viruses are the primary causes. In contrast with melanocytic lesions, non-melanocytic lesions are defined in a multiphase process. Frequent non-melanocytic lesions are, for example, actinic keratosis or morbus bowen, a preliminary stage of the squamous cell carcinoma.
  • Mohs Surgery
    Micrographic surgery (3D-histology) according to Dr. Frederic Mohs is a highly effective procedure to excise various skin tumors. This method's greatest advantage is the complete removal of the tumor with minimal loss of surrounding healthy tissue and only a small, barely visible wound. Even in case of recurrences, it is possible to achieve a cure rate of up to 98 percent, which however usually requires several excisions.

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