Langerhans cells and melanocytes share similar morphologic features under in vivo reflectance confocal microscopy: A challenge for melanoma diagnosis Journal Article


Authors: Hashemi, P.; Pulitzer, M. P.; Scope, A.; Kovalyshyn, I.; Halpern, A. C.; Marghoob, A. A.
Article Title: Langerhans cells and melanocytes share similar morphologic features under in vivo reflectance confocal microscopy: A challenge for melanoma diagnosis
Abstract: Background: Intraepidermal Langerhans cells (ILC) are difficult to differentiate from melanocytes under reflectance confocal microscopy (RCM) and their presence may simulate pagetoid spread of melanocytes on RCM images. Objective: We sought to correlate bright round and dendritic cells in a pagetoid pattern identified on RCM with findings of conventional histopathology and immunohistochemistry for lesions that were falsely diagnosed as melanoma by RCM. Methods: This retrospective study included histopathologically proven nevi, imaged by RCM, which displayed bright cells in a pagetoid pattern (BCPP) under RCM, resulting in the incorrect RCM diagnosis of melanoma. Morphological comparisons were made between RCM images of nevi showing BCPP, histopathologically proven melanomas displaying BCPP, and biopsy-proven nevi without BCPP. Results: We identified 24 nevi that were falsely diagnosed as melanoma by RCM because of the presence of BCPP. These pagetoid cells on RCM corresponded on histopathology to ILC with a high density in 23 of the 24 nevi (95%) and to melanocytes in 7 of the 24 nevi (29%). Among 6 melanomas displaying BCPP on RCM, ILC with high density were observed histopathologically in 5 of the 6 cases (83%) and pagetoid melanocytes were seen in all 6 cases (100%). Limitations: The results cannot be generalized to clinically banal-appearing nevi. Conclusions: Although the finding of BCPP is a useful RCM feature for the diagnosis of melanoma, it does not always imply the presence of pagetoid melanocytes but may at times represent ILC. © 2011 by the American Academy of Dermatology, Inc.
Keywords: immunohistochemistry; adult; clinical article; histopathology; cancer diagnosis; cell structure; melanoma; reflectance confocal microscopy; confocal microscopy; skin biopsy; nevus; dendritic cell; melanocyte; in vivo study; retrospective study; density; langerhans cell; langerhans cells; cd1a; melan-a; pagetoid melanocytes; pagetoid pattern
Journal Title: Journal of the American Academy of Dermatology
Volume: 66
Issue: 3
ISSN: 0190-9622
Publisher: Mosby Elsevier  
Date Published: 2012-03-01
Start Page: 452
End Page: 462
Language: English
DOI: 10.1016/j.jaad.2011.02.033
PROVIDER: scopus
PMCID: PMC3264757
PUBMED: 21798622
DOI/URL:
Notes: --- - "Export Date: 2 April 2012" - "CODEN: JAADD" - "Source: Scopus"
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  1. Allan C Halpern
    396 Halpern
  2. Melissa P Pulitzer
    205 Pulitzer
  3. Alon Scope
    125 Scope
  4. Ashfaq A Marghoob
    534 Marghoob