Reflectance Confocal Microscopy as an Aid to Dermoscopy to Improve Diagnosis on Equivocal Lesions: Evaluation of Three Bluish Nodules
Figure 1
Forearm of a 54-year-old man. A hard blue asymptomatic nodule (a). Dermoscopically, the lesion showed a purple-bluish hue (white arrow), with a whitish veil and chrysalis structures (black arrow) ((b) 30x magnification). The confocal images show thick hyporeflective fibers of collagen in the dermis (yellow asterisks). Among these, hyperreflective dotted particles (white arrow heads) and several large multinucleated cells, plump and refractile, were seen (yellow arrow) ((c), (d) details m). Histology revealed a fibrous hystiocytoma, with spindled fibro-hystiocytes, blood extravasation (black arrow) and numerous siderophages ((e) HH 20x magnification): in particular, plump bright multinucleated cells were identified as haemosiderophages, clearly visible in the upper portion of the dermis (yellow arrow). The flattening of the dermal-epidermal junction is highlighted by a red asterisk.
