Ex Vivo Confocal Microscopy: Revolution in Fast Pathology in Dermatology

J. Malvehy; J. Pérez-Anker; A. Toll; R. Pigem; A. Garcia; L.L. Alos; S. Puig


The British Journal of Dermatology. 2020;183(6):1011-1025. 

In This Article


Different forms of ex vivo CM with a range of lasers have been used in several studies.[14–17] However, only two systems for ex vivo CM used in clinical studies were available on the market at the time of this review: the Histolog Scanner (SamanTree Medical SA, Lausanne, Switzerland) and the VivaScope 2500M-G4 (MAVIG GmbH, Munich, Germany; Caliber Imaging and Diagnostics, Rochester, NY, USA) (Figure 1). Their technical characteristics are listed in Table 1. They have the great advantage of producing images of fresh tissue in a few minutes without interfering with the subsequent histopathological investigations and haematoxylin and eosin (H&E) or immunostaining processes (Figure 1). Comparison of ex vivo confocal laser microscopy and conventional histopathology is summarized in Table 2.

Figure 1.

Modern ex vivo confocal microscopy devices used in clinical studies. (a) VivaScope 2500M-G4. (a1) Details of the image capture: the fresh macro specimen is observed on the screen while the tissue is being scanned in real time. (b) Histolog Scanner.

The procedure for ex vivo CM includes the preparation of the tissue,[18,19] staining with different agents for RCM and FCM, mounting using different methods for flattening the skin sample,[20,21] and imaging with black and white images (RCM), green (FCM) or digital H&E (FCM + RCM). Different staining methods have been used to enhance the contrast of cell structures in ex vivo CM with no damage to conventional histopathology preparation (Table 3).[14,17,22–37]