New prospects in dermatology: Fiber-based confocal scanning laser microscopy

Confocal scanning laser microscopy (CSLM) constitutes an optical, noninvasive method providing visualization of tissue architecture with resolution similar to that of light microscopy. In dermatology, confocal imaging enables in vivo measurements of surface and subsurface skin microstructures. Skin annexes, as well as cutaneous cells from different epidermal layers, can be easily distinguished; their change in morphology from skin surface to the papillary dermis can be observed. Therefore, CSLM possesses a high potential for diagnostical purposes and dermatological research. The aspect of normal skin in contrast to the pathogenic state can be exposed. In our studies, we used in vivo fluorescence CSLM for morphometric analysis of healthy human skin and for imaging a number of clinically relevant inflammatory, proliferative, and neoplastic skin disorders. We report the ability to produce high-resolution histoimages of normal and pathological epidermis using this nondestructive visualization technique. Changes in keratinocyte size, shape, and morphology, as well as changes in the distribution pattern of the fluorescent emission of the dye, can be detected. Furthermore, novel fiber optic elements support a flexible handling of the rigid microscopic gadgetry. Four clinical examples of implementation were elected and instanced for demonstration.