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

Correlation of Ex Vivo Confocal Microscopy and Normal Skin Histology

Ex vivo confocal images allow a good correlation with conventional histology with H&E (Figure 2). In a recent study by Schüürmann et al.,[38] using the VivaScope V2500, they found that the following cutaneous and subcutaneous structures are excellently displayed in the images, with only minimal differences compared with H&E slides: every layer of the epidermis, collagen and elastic tissue; lymphatic and capillary vessels; hair follicles and other skin appendages; eccrine and sebaceous glands; subcutaneous fat; elastic cartilage and muscle fibres. The authors in that study, using acridine orange, found that, due to their intensive reflection, pigmented structures such as hair shafts, melanocytes and melanophages appear pink and blurred in digital-stained ex vivo CM images using this device. This is different from conventional H&E slides and, until now, is probably the major limitation of the technique that could be solved with modification of staining methods or software development.

Figure 2.

Image of normal skin obtained with the VivaScope 2500M-G4 device, stained with acetic acid and acridine orange, flattened with the magnet device. Black frame: detail of the normal skin and sebaceous gland. Blue arrowhead: solar elastosis beyond the epidermis. Red arrowhead: periglandular inflammation. Green arrowhead: all the epidermal layers can be observed because of the stain method applied.