By Kate Griesmann

Finding an odd mole can be scary, and the steps needed to investigate it are equally anxiety inducing: A visit to a dermatologist and maybe a biopsy, which can mean days of waiting to learn what is happening in your skin.

What if, instead, you could find out about your mole with one visit -- without the invasive biopsy and without the waiting. That’s the goal behind research into the confocal microscope, a laser light source that penetrates the skin and allows physicians to see what is happening inside, rather than just on top.

Duke dermatologist Kelly Nelson, MD, has been working with the confocal microscope for two years and believes it offers the opportunity to improve patient care by not only offering a noninvasive approach to diagnosis, but by also providing more information about moles and cancerous lesions.

Improving Diagnostic Testing

Current dermatology diagnostic methods include dermoscopy, where a magnifying lens is used to give dermatologists a look at what is happening on the skin’s surface. The confocal microscope provides deeper insight.

“The confocal microscope is unique in that you can actually see the cells, you can actually see the blood vessels,” said Nelson. “You get an additional layer of information beyond what you can capture with dermoscopy, where you’re just seeing a magnified picture of what’s on the skin surface.”

An examination with the confocal microscope is a painless process that takes about four minutes to complete. To start, a circular disc the size of a quarter is affixed to the patient’s body and the microscope is fitted onto the disc.

The machine then takes a series of images that are displayed on a computer screen, revealing the inner workings of the skin. By manipulating the laser, the physician can zoom in and capture still or moving images of certain areas.

Developing Technology to Improve Patient Care

The confocal microscope is currently FDA approved only for research purposes in the United States, but it has become a popular diagnostic tool in Europe. Duke’s microscope is one of only about 15 being used the United States.

Nelson’s patients have been receptive to the new technology, which can let them see parts of their body in a whole new way.

“It’s an opportunity to see underneath your own skin, which most people never experience,” said Nelson. “I try to be very up front with them that it’s still very much in the information-gathering stage, and that if I do see anything of concern we’re still going to take it off of them.”

Eventually, Nelson hopes, the confocal microscope will reduce the need for biopsies for undiagnosed lesions.

“Unfortunately, when we do encounter a skin cancer we still need to get tissue to confirm that diagnosis,” Nelson said. “But for things that are a little bit harder to differentiate whether there’s something of concern or not, the confocal does hold the potential to get another layer of information that may let you avoid an unnecessary biopsy.”

Providing a New View for Melanoma Treatment

Nelson has also been using the microscope to further research in understanding melanoma, which is the cause of 79 percent of all skin cancer deaths.

Because confocal microscopy provides such an intimate view of the skin without destroying the tissue, it is now possible to monitor a site over time. Physicians can compare images of the same area before and after treatment to see what effect -- if any -- the treatment had.

“When some people’s melanoma spreads, it spreads to their lymph nodes or their internal organs. Other people’s tumors -- for reasons that we don’t entirely understand -- spread more to their skin,” Nelson said.

With the confocal microscope, Nelson and her research team are starting to tackle some big questions about the relationship between this kind of melanoma and blood vessels, which are integrally related to cancer spreading. Along the way, they are learning many new things about melanoma, and hope to use that knowledge to improve patient care. “It’s opened up many new questions, which is what good research does,” said Nelson.