Confocal microscopy and optical coherence tomography for skin (VivaScope, VivoSight, deepLive)
Devices that look beneath the skin surface without cutting: one scans cells with a laser at microscope resolution, another builds a cross-section with infrared light. Both help decide whether a suspicious mole or patch needs a biopsy, and which edge to cut to.
Overview
Dermoscopy magnifies the skin surface; these instruments image below it. Reflectance confocal microscopy (Caliber Imaging and Diagnostics' VivaScope 1500 and the handheld 3000) scans a near-infrared laser through a pinhole to produce horizontal sections at cellular resolution to a depth of about a quarter of a millimetre, enough to see melanocytes at the junction, and it has reimbursement codes in the United States for lesion assessment; studies show it reduces unnecessary excisions of equivocal lesions and helps map basal cell carcinoma margins before Mohs surgery. Optical coherence tomography (Michelson Diagnostics' VivoSight) uses interferometry with infrared light to produce vertical cross-sections a millimetre or two deep at lower resolution, suited to diagnosing basal cell carcinoma, measuring its depth and monitoring non-surgical treatment; line-field confocal OCT (DAMAE Medical's deepLive) combines vertical and horizontal views at near-cellular resolution. Total-body photography systems such as Canfield's VECTRA WB360 and FotoFinder's ATBM sit upstream, tracking every mole over time so that changing lesions are chosen for these examinations or for dermoscopy and AI analysis.
All of these are adjuncts to expert examination and histology: imaging depth stops at the upper dermis, reading requires specific training, the devices are costly for a dermatology clinic, and randomised evidence is limited to the confocal excision-reduction trials in a few referral centres.
- NIR camera + excitation
- Fluorescent tumour margin
How it works
Reflectance confocal microscopy rejects out-of-focus light with a pinhole to image cellular structures in horizontal planes; optical coherence tomography uses low-coherence interferometry to build vertical cross-sections from backscattered infrared light; line-field confocal OCT combines both.
- Cellular-level view without biopsy
- Fewer unnecessary excisions in trials
- Margin mapping before surgery
- Imaging depth limited to the upper dermis
- Specialist training to read
- High device cost for a clinic
Latest papers
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