Differentiation between balanitis and carcinoma in situ using reflectance confocal microscopy

Area of Science:

• Dermatology
• In vivo imaging
• Oncology

Background:

• Zoon plasma cell balanitis is a benign inflammatory condition of genital skin.
• Distinguishing balanitis from carcinoma in situ (CIS) can be challenging, often necessitating biopsies.
• Reflectance confocal microscopy (RCM) offers non-invasive, in vivo imaging of skin architecture and cellular morphology.

Purpose of the Study:

• To assess the efficacy of RCM in differentiating between balanitis and CIS.
• To compare RCM findings with gold-standard histopathologic diagnoses.
• To evaluate RCM's potential to reduce the need for biopsies in diagnosing genital skin conditions.

Main Methods:

• An observer-blinded study conducted at a referral center.
• Involved 15 patients diagnosed with balanitis or CIS.
• Utilized Vivascope 1500 for RCM imaging, alongside clinical and histopathologic assessments.

Main Results:

• Histopathology confirmed 12 cases of balanitis and 3 cases of CIS, diagnoses corroborated by RCM.
• RCM identified distinct criteria for CIS (atypical honeycomb, disarranged epidermis, round nucleated cells) and balanitis (nucleated honeycomb, vermicular vessels).
• Normal adjacent skin exhibited a typical honeycomb pattern and round papillary vessels.

Conclusions:

• RCM successfully differentiated between balanitis and CIS.
• Reflectance confocal microscopy shows promise in avoiding biopsies at sensitive genital sites.
• This non-invasive imaging modality can aid in the accurate diagnosis of genital skin lesions.