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Advances in Confocal Scanning Laser Microscopy

Confocal microscopy is a recently developed technique that allows optical sectioning of turbid objects and imaging of sections of human skin in vivo. In a 1995 report from Harvard Medical School, the Wellman Laboratories reported that nuclear and cellular skin detail was visualized without the need for biopsy or histologic processing. Since then, this group has improved the resolution, contrast, depth of imaging, and field of view of confocal images of human skin and has built a small portable and durable confocal microscope capable of imaging normal and abnormal skin morphology and dynamic processes in vivo. This report provides the details of these advances.

Confocal images of human skin were obtained with lateral resolution of 0.5 to 1.0 µm and axial resolution of 3 to 5 µm. These images compared favorably with light microscopic histology based on 5-µm sections. Visualization to the superficial reticular dermis is possible with confocal images to a maximum depth of 350 µm. Further modifications in confocal microscopy will focus on vertical sectioning, three-dimensional image reconstruction, increasing the field of view, and further decreasing the size of the device to perhaps as small as a hand-held unit.Comment: Confocal microscopy is noninvasive and void of visible artifacts because it does not involve tissue processing. Because this is an in vivo process, dynamic changes -- such as blood flow, the effects of light exposure, or even response to allergens, laser treatment, or inflammation -- can be monitored. The greatest challenge for dermatologists will be to learn to interpret and analyze confocal images and correlate them with histology. Although confocal images will not replace clinical expertise or the ability to create clinical pathological correlations, they could represent a breakthrough in the management of some skin diseases.

— JS Dover

Published in Journal Watch Dermatology December 1, 1999

Citation(s):

Rajadhyaksha N et al. In vivo confocal scanning laser microscopy of human skin II. J Invest Dermatol 1999 113 293-303.

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