Dermoscopy-guided reflectance confocal microscopy of skin using high-NA objective lens with integrated wide-field color camera

Reflectance Confocal Microscopy, or RCM, is being increasingly used to guide diagnosis of skin lesions. The combination of widefield dermoscopy (WFD) with RCM is highly sensitive (~90%) and specific (~ 90%) for noninvasively detecting melanocytic and non-melanocytic skin lesions. The combined WFD and RCM approach is being implemented on patients to triage lesions into benign (with no biopsy) versus suspicious (followed by biopsy and pathology). Currently, however, WFD and RCM imaging are performed with separate instruments, while using an adhesive ring attached to the skin to sequentially image the same region and co-register the images. The latest small handheld RCM instruments offer no provision yet for a co-registered wide-field image. This paper describes an innovative solution that integrates an ultra-miniature dermoscopy camera into the RCM objective lens, providing simultaneous wide-field color images of the skin surface and RCM images of the subsurface cellular structure. The objective lens (0.9 NA) includes a hyperhemisphere lens and an ultra-miniature CMOS color camera, commanding a 4 mm wide dermoscopy view of the skin surface. The camera obscures the central portion of the aperture of the objective lens, but the resulting annular aperture provides excellent RCM optical sectioning and resolution. Preliminary testing on healthy volunteers showed the feasibility of combined WFD and RCM imaging to concurrently show the skin surface in wide-field and the underlying microscopic cellular-level detail. The paper describes this unique integrated dermoscopic WFD/RCM lens, and shows representative images. The potential for dermoscopy-guided RCM for skin cancer diagnosis is discussed.