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Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that has been used to diagnose basal cell carcinoma (BCC). How accurate is RCM to predict whether a BCC is infiltrative or superficial?

The 2006 study {2} was inconclusive:

Limitations: The pigmented BCCs imaged in this study were predominantly nodular; a different set or additional criteria may be necessary for detection of infiltrative and metatypical BCCs.

The 2016 study {1} focused on superficial basal cell carcinoma (sBCC) but only looked at 3 cases.

Motivations:

  1. Understanding if RCM is a decent replacement for a biopsy to diagnose BCC.
  2. Superficial BCCs can be treated quite well with Imiquimod 5% cream (US brand: Aldara) but Imiquimod not doesn't work as well on infiltrative BCCs, which typically requires surgery (Mohs if cosmesis is important or old-fashioned excision).

References:

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    I'm afraid the answer may be currently unknown, the best review I found, which was most recent, shows the real need for larger blinded trials. Seems reasonable but not confirmed or validated at this point. Looking at FDA test submissions, that seems to be the trend there as well.
    – Atl LED
    Oct 12, 2023 at 2:46

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