Conflict of interest Christi Alessi-Fox is an employee of Lucid, Inc., the manufacturer of the VivaScopes and is a minority shareholder of the Company.
Reflectance confocal microscopy for diagnosis of mammary and extramammary Paget’s disease
Article first published online: 3 JAN 2012
© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology
Volume 27, Issue 1, pages e24–e29, January 2013
How to Cite
Guitera, P., Scolyer, R.A., Gill, M., Akita, H., Arima, M., Yokoyama, Y., Matsunaga, K., Longo, C., Bassoli, S., Bencini, P.L., Giannotti, R., Pellacani, G., Alessi-Fox, C. and Dalrymple, C. (2013), Reflectance confocal microscopy for diagnosis of mammary and extramammary Paget’s disease. Journal of the European Academy of Dermatology and Venereology, 27: e24–e29. doi: 10.1111/j.1468-3083.2011.04423.x
Financial disclosure Relationships relevant to this manuscript: none reported.
- Issue published online: 18 DEC 2012
- Article first published online: 3 JAN 2012
- Received: 1 September 2011; Accepted: 7 December 2011
Background Paget’s disease is an intraepidermal adenocarcinoma that is difficult to diagnose clinically as it mimics inflammatory or infectious diseases. As a consequence, it may be clinically misdiagnosed resulting in a delay in appropriate management. Reflectance confocal microscopy allows the visualization of the upper layers of the skin and mucosa at cellular resolution. Paget’s disease is characterized histologically by the presence of neoplastic cells scattered throughout all layers of the epidermis in a pattern similar to that also observed in melanoma (and termed Pagetoid spread).
Objective In vivo confocal microscopy is an excellent diagnostic tool for detecting Pagetoid spread and for diagnosing melanoma. We therefore hypothesized that it may also assist in the diagnosis of Paget’s disease.
Methods In this study, we describe the confocal features of nine cases of extramammary Paget’s disease and one case of mammary one.
Results Large atypical Pagetoid cells were present singly and in clusters in all 10 cases and were readily visualized on ex vivo and in vivo confocal microscopy. The presence of Pagetoid spread and other confocal features, in the appropriate clinical context, is suggestive Paget’s disease and should allow distinction from other inflammatory diseases that may appear similar clinically.
Conclusion The use of confocal microscopy is likely to facilitate earlier diagnosis of Paget’s disease and the instigation of appropriate management with concomitant improvement in clinical outcomes.