[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-453075-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-453075-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","diagnostic-accuracy-of-reflectance-confocal-microscopy-for-acral-lentiginous-melanoma-case-report","Diagnostic accuracy of reflectance confocal microscopy for acral lentiginous melanoma - Case report","","Reflectance confocal microscopy (RCM) was evaluated for diagnostic guidance in a 51-year-old patient presenting with an evolving brown plantar heel patch previously yielding inconclusive shave and subsequent punch biopsy results suggesting lentigo. RCM revealed focal collections of atypical melanocytes with bright, pleomorphic nuclei at the dermal–epidermal junction, consistent with melanoma. Targeted rebiopsy using RCM imaging confirmed acral lentiginous melanoma in situ. The case highlights how RCM can improve detection of malignant transformation and optimize biopsy site selection in clinically heterogeneous acral lesions where sampling can delay diagnosis.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/diagnostic-accuracy-of-reflectance-confocal-microscopy-for-acral-lentiginous-melanoma-case-report/453075/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/diagnostic-accuracy-of-reflectance-confocal-microscopy-for-acral-lentiginous-melanoma-case-report/453075.png","ImageObject",300,407,{"name":42,"@type":43},"Finn","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-09","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why were repeat biopsies considered in this case?","Question",{"text":63,"@type":64},"Initial shave and punch biopsies produced inconclusive or limited sampling results. Because of persistent diagnostic uncertainty and an atypical evolving lesion, repeat biopsy targeting was recommended.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What did RCM show that prompted concern for melanoma?",{"text":68,"@type":64},"RCM demonstrated focal collections of atypical melanocytes with bright, pleomorphic nuclei at the dermal–epidermal junction, a pattern consistent with melanoma.",{"name":70,"@type":61,"acceptedAnswer":71},"How did histopathology confirm the RCM findings?",{"text":72,"@type":64},"Broader biopsies targeting RCM-identified atypical areas confirmed acral lentiginous melanoma in situ on histopathologic examination.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},453075,1790815307,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":111,"preview_page_count":4},34359740700684,"https://ap-avatar.wpscdn.com/avatar/1f400023980c374ae676?_k=1777273430885731487","CONFOCAL MICROSCOPY  \nDiagnostic accuracy of reflectance confocal microscopy for acral lentiginous melanoma  \nUna Milovanovic, BS,a Adrianne Pan, MD,b Jennifer Laborada, MD,b Lucy Lam, MS, BSN,b Patrick Ottuso, MD,c  \nSairekha Ravichandran, MD,b and Lilia Correa-Selm, MDb ,d  \nKey words: acral lentiginous melanoma; confocal microscopy; diagnostic accuracy; histology correlation;  \nnoninvasive imaging; pigmented acral lesion; targeted biopsy.  \nCLINICAL PRESENTATION  \nA 51-year-old Caucasian woman with a history of melanoma presented with a brown patch on the right heel. The patient described its onset 10 years ago and reported that the lesion had been changing in size and color in the recent years (Fig 1) . Following an initialshave biopsy that was inconclusive, a punch biopsy was subsequently performed. The results suggested lentigo with negative staining for Preferentially Expressed Antigen in Melanoma. An independent dermatopathology review was obtained, which supported the initial findings. However, due to the small sample size, a repeat biopsy was recommended to achieve a more accurate representation of the larger lesion. Given the persistent diagnostic uncertainty and the lesion’s atypical and evolving characteristics, the patient was referred to for reflectance confocal microscopy (RCM) evaluation to have abetter assessment of the lesion.  \nCONFOCAL MICROSCOPY APPEARANCE  \nRCM of the lesion was obtained using a VivaScope 1500 (Caliber Imaging and Diagnostics) . The real-time, high-resolution imaging revealed focal collections of atypical melanocytes with bright, pleomorphic nuclei at the dermal—epidermal junction, findings consistent with melanoma (Fig 2) .  \nFrom the Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Floridaa; Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani, Tampa, Floridab; Advanced Dermatology and Cosmetic Surgery, Vero Beach, Floridac; and Cutaneous  \nOncology Department, Moffitt Cancer Center, Tampa, Florida.d Funding sources: None.  \nPatient consent: The authors attest that they have obtained written consent from patient/s, their legal guardian/s or person/s with legal authority, for their photographs and medical information to be published in print and online and with the understanding that this information may be publicly available. Patient consent forms were not provided to the journal but are retained by the authors to be made available upon request.  \nIRB approval status: Not applicable.  \nAbbreviations used:  \nALM: acral lentiginous melanoma  \nRCM: reflectance confocal microscopy  \nFig 1. A 3.5 3 2.3 cm gray-brown macule with irregular borders is seen on the plantar aspect of the right heel.  \nThis manuscript has not been previously published, nor is it under consideration elsewhere. The information in this manuscript was presented as a poster titled ‘‘Diagnostic Accuracy of Reflectance Confocal Microscopy for Acral Lentiginous Melanoma’’ at the 2025 American Academy of Dermatology conference.  \nCorrespondence to: Lilia Correa-Selm, MD, Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani, 13220 USF Laurel Drive, 5th Floor, Tampa, FL 33612-4742. E-mail: [lcorrea1@usf.edu](lcorrea1@usf.edu).  \nJAAD Case Reports 2026;67:209-11.  \n2352-5126  \n© 2025 The Author(s) . Published by Elsevier Inc. on behalf of the American Academy of Dermatology, Inc. This is an open access article under the CC BY license ([http://creativecommons.org/](http://creativecommons.org/)[ ](http://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) .  \n[https://doi.org/10.1016/j.jdcr.2025.1](https://doi.org/10.1016/j.jdcr.2025.1)1.007  \n210 Milovanovic et al JAAD CASE REPORTS JANUARY 2026  \nFig 2. A, Stratum spinosum of the epidermis showing a normal honeycomb pattern formed by keratinocytes. B, Nucleated melanocytes (yellow square) and multiple lymphocytes representing inflammation (red arrow) . C, Upp","cbCaiusx6ciDUDhE","https://ap.wps.com/l/cbCaiusx6ciDUDhE","pdf",5368180,"English","# Clinical presentation\n# Confocal microscopy appearance\n# Histological diagnosis\n# Key message","[{\"question\":\"Why were repeat biopsies considered in this case?\",\"answer\":\"Initial shave and punch biopsies produced inconclusive or limited sampling results. Because of persistent diagnostic uncertainty and an atypical evolving lesion, repeat biopsy targeting was recommended.\"},{\"question\":\"What did RCM show that prompted concern for melanoma?\",\"answer\":\"RCM demonstrated focal collections of atypical melanocytes with bright, pleomorphic nuclei at the dermal–epidermal junction, a pattern consistent with melanoma.\"},{\"question\":\"How did histopathology confirm the RCM findings?\",\"answer\":\"Broader biopsies targeting RCM-identified atypical areas confirmed acral lentiginous melanoma in situ on histopathologic examination.\"}]","Diagnostic accuracy of reflectance confocal microscopy for acral lentiginous melanoma - Case report | PDF",1790738198]