In Vivo Reflectance Confocal Microscopy (RCM) 


What is Confocal Imaging?

In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging procedure that allows real-time viewing of tissue, resulting in virtual biopsies.

RCM uses a laser diode as the source of the light. An operator uses a hand-held wand while light passes through optics and illuminates a small area of tissue. Light reflected back through the lens, at a given focal point, is recorded digitally. The wavelength of the light does not cause injury and is only slightly warm to the patient.

In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging technique that produces virtual biopsies in real time.

The operator can control the depth of the images and can record video or stacks of images as they view a screen showing the patient’s cell structure in real-time. Since RCM is noninvasive, it can allow the same area to be reviewed over time without impacting the tissue.

RCM allows viewing of the epidermis down to the papillary dermis. RCM allows physicians to cover a larger area than other techniques and without any pain to the patient. RCM can also record images in difficult to reach or sensitive locations. The downside of the process is that RCM requires a highly trained and skilled pathologist as the operator must view a screen in real-time to determine where the wand should be placed. 

The confocal microscope was invented in the 1950’s but it took until the 1990’s for the technology to mature to a point were portability and digital recording of images was possible.

In vivo reflectance confocal microscopy has not been approved for general use in all countries and as such its availability is limited. There are several institutions in the United States that have been using RCM in limited ways. One of those facilities is Memorial Sloan Kettering Cancer Center in New York.

RCM has been tested on a number skin cancers including extramammary Paget’s disease (EMPD).