Determinação dos padrões da microscopia confocal in vivo no melanoma cutaneo e nevo melanocítico comum: comparacao com a dermatoscopia e histopatologia em cortes perpendiculares e transversais

O melanoma cutâneo e uma neoplasia que acomete individuos jovens e apresenta comportamento agressivo quando diagnosticado tardiamente. Sendo assim, novos metodos diagnosticos auxiliares ao exame clinico, como a dermatoscopia e a microscopia confocal in vivo (MC), tem sido desenvolvidos com o objetivo de melhorar a acuracia diagnostica desse tumor. Semelhante a dermatoscopia, a MC revela detalhes morfologicos da arquitetura tecidual no plano paralelo a pele e, alem disso, fornece imagens instantâneas com alta magnificacao e resolucao celular. A realizacao de cortes histologicos transversais (mesmo plano da dermatoscopia e MC) poderia contribuir para melhor caracterizar os achados observados tanto na dermatoscopia quanto na MC. Nao existem relatos na literatura medica comparando as caracteristicas dermatoscopicas, a MC e os achados histopatologicos em cortes transversais. O objetivo deste estudo foi descrever a tecnica para realizacao dos cortes histologicos transversais e comparar as principais caracteristicas dermatoscopicas do melanoma cutâneo a MC e a histopatologia em cortes perpendiculares e transversais, no intuito de oferecer uma interpretacao mais precisa dos achados celulares e arquiteturais observados in vivo. Foram avaliadas 65 lesoes com diagnostico dermatoscopico de melanoma cutâneo de 63 pacientes recrutados no Nucleo de Câncer de Pele e Dermatologia do A.C. Camargo Cancer Center no periodo de junho de 2011 a abril de 2013. Uma forma facil, segura e confiavel para a realizacao dos cortes histologicos transversais foi apresentada. Os aspectos celulares e arquiteturais no exame de MC das principais caracteristicas dermatoscopicas do melanoma cutâneo foram determinados e comparados aos achados histopatologicos nos cortes transversais e perpendiculares...(AU) Cutaneous melanoma is a cancer that affects young individuals and shows aggressive behavior when diagnosed lately. Therefore, new diagnostic tools to unaided eye, such as dermoscopy and in vivo reflectance confocal microscopy (RCM), have been developed with the aim of improving the diagnostic accuracy of this tumor. Similarly to dermoscopy, RCM reveals morphological details of tissue architecture in parallel plane to the skin and, moreover, provides instant images with high magnification and cellular level resolution. The performance of transverse histopathological sections (same plane of dermoscopy and RCM) could help to better characterize the features observed in both dermoscopy and RCM. There are no reports in the medical literature comparing dermoscopic, RCM and histopathological features in transverse sections. The purpose of this study was to describe the technique for acquiring the transverse sections and compare the main dermoscopic features of cutaneous melanoma to the RCM and histopathology in perpendicular and transverse sections, in order to offer a more precise interpretation of the cellular and architectural features observed in vivo. This study included 65 lesions with dermoscopic diagnosis of cutaneous melanoma in 63 patients recruited at the Dermatology Center of the AC Camargo Cancer Center from June 2011 to April 2013. An easy, safe and reliable way for handle the transverse sections was presented. The RCM cellular and architectural aspects of the main melanoma dermoscopic features were determined and compared to histopathological findings in the transverse and perpendicular sections. We described a new structure called “papillae in mitochondria” which may represent an additional clue for the melanoma in situ diagnosis. The transverse sections allowed a more precise interpretation of the main RCM features in cutaneous melanoma...(AU)