| الملخص: | Background and Design: There are few reports on the in vivo reflectance confocal microscopy (RCM) features of clear cell acanthoma (CCA). This study aimed to evaluate the diagnostic ability of RCM in CCAs that are difficult to diagnose clinically and to compare the RCM findings with those observed in squamous cell carcinoma in situ (SCCIS) lesions, which exhibit similar clinical morphology.
Materials and Methods: We searched our database and identified three cases of CCA with atypical features and three cases of SCCIS with common morphological features. We described the clinical, dermoscopic, RCM, and histopathological characteristics of these cases.
Results: Both lesion groups showed prominent epidermal hyperplasia on RCM; however, atypia in epidermal cells in CCAs was not as pronounced as that in SCCISs. The general architecture was preserved in the CCAs. In SCCISs, epidermal basal cells were increased in size, and prominent pleomorphism and atypia were observed in the full-thickness epidermis, whereas basal cells in CCAs were normal in pattern and appearance.
Conclusion: We suggest that differentiating CCA from SCCIS on RCM is possible, even in atypical cases, by careful evaluation of the general architecture of the tumor and determination of the degree of epidermal disarray, nuclear features of the epidermal cells, presence of uniformity or pleomorphism of the epidermal cells, and features of the basal cells. A comparison of normal skin and tumor areas may also help in better evaluation.
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