Reflectance confocal microscopy evaluation of pigmented lesions on tattooed skin
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ORIGINAL ARTICLE
Reflectance confocal microscopy evaluation of pigmented lesions on tattooed skin Catherine Reilly 1
&
Nadiya Chuchvara 1,2 & Jennifer Cucalon 1 & Radhika Srivastava 1,2 & Babar K. Rao 1,2
Received: 16 May 2019 / Accepted: 27 September 2020 # Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract The evaluation of pigmented lesions on tattooed skin poses a diagnostic challenge for dermatologists, as a nevus may be partially or completely obscured by tattoo pigment. Because of incidences of melanoma arising from tattooed skin, the current gold standard is to biopsy these lesions. Reflectance confocal microscopy (RCM) is a noninvasive imaging modality used in the diagnosis and management of skin diseases that may allow for diagnosis, while preserving the tattoo design. Retrospective chart review was conducted to identify pigmented lesions on or near tattooed skin that were evaluated with RCM. Confocal characteristics and diagnoses were recorded and analyzed. Nineteen lesions from 15 patients were retrospectively reviewed. Tattoo pigment did not hinder evaluation and diagnosis of pigmented lesions on RCM. About 94.7% of lesions were diagnosed as benign melanocytic nevi by an expert confocal reader. One lesion was confocally diagnosed as melanocytic nevus with atypia but was found to be an inflamed melanocytic nevus on histology. Tattoo pigment particles were differentiated from other hyperrefractile entities by an expert confocal reader based on size, morphology, and clinical correlation. RCM may provide a solution to the diagnostic challenge of pigmented lesions on or near tattooed skin. Keywords Dermatology . Reflectance confocal microscopy . RCM . Pigmented lesions . Pediatric . Non-invasive . In vivo . Dermoscopy . Tattoo
Introduction Skin tattooing is an increasingly common practice, and it is estimated that 21–24% of adults in the USA have at least 1 tattoo [1]. Individuals desire and pursue skin tattoos for many reasons, including remembrance, enhancing appearance, and even just for fun [2]. Tattooed skin poses a challenge for dermatologists, especially in the evaluation of pigmented lesions. The tattoo may partially or completely obscure the lesion, and subsequently hinder clinical and dermoscopic evaluation of malignant features, especially with the use of darkly colored or black ink. Of concern, there have been over 30 reported cases of malignant melanoma arising on tattooed skin since * Catherine Reilly [email protected] 1
Rao Dermatology, 95 First Avenue, Atlantic Highlands, NJ 07716, USA
2
Center for Dermatology, Department of Pathology and Laboratory Science, Rutgers Robert Wood Johnson Medical School, 1 Worlds Fair Drive, Somerset, NJ 08873, USA
1938 [3]. Due to poor visualization, impaired evaluation, and fear of malignancy, it is the gold standard to pursue biopsy of pigmented lesions on tattooed skin, disfiguring the tattoo design. Dermoscopy and optical coherence topography (OCT) are two noninvasive evaluation methods currently used in dermatology. Cases de
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