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Richard G. B. Langley, Capital District Health Authority, Halifax, NS Bone marrow transplants are currently the only potential cure for patients suffering from both cancerous and non-cancerous blood disorders. Graft-versus-host disease (GVHD) is a common and potentially life-threatening complication of bone marrow transplants occurring in 20 to 80% of patients who have undergone this procedure. The skin is the earliest and most frequent target for acute GVHD. Early recognition and treatment are essential for managing this complication of bone marrow transplants, to reduce both the morbidity and mortality associated with GVHD. Skin biopsy is currently the most common and successful method of diagnosing cutaneous GVHD however, due to the time required for processing tissue, the diagnosis may be delayed several weeks. The confocal scanning laser microscope (CSLM) is a non-invasive tool which provides instantaneous, in vivo, high resolution images of the skin. It is hypothesized that imaging GVHD lesions with CSLM at the bed-side will allow visualization of features commonly seen in histopathology of these lesions, and facilitate a timely diagnosis and prompt institution of treatment. The specific aims of this study include: (1) quantification of the cellular and morphological features of the skin-associated symptoms of GVHD in patients who have received a bone marrow transplant and (2) to correlate the observations made with CSLM analysis of GVHD lesions, with the results obtained from conventional biopsy and pathology. Peer Reviewed Publications Supported by the Canadian Dermatology Foundation Humphrey S, Walsh NM, Delaney L,Propperova I, Langley R. Prognostic Significance of Vascularity of Cutaneous Melanoma using CSLM. Journal of Cutaneous Medicine and Surgery 2006 10:122-127 Langley RG, Burton E, Walsh N, Propperova I, Murray SJ. In vivo confocal scanning laser microscopy of benign lentigines: comparison to conventional histology and in vivo characteristics of lentigo maligna. J Am Acad Dermatol. 2006 Jul;55(1):88-97. Langley RG, Walsh N, Sutherland AE, Propperova I, Delaney L, Morris S, Gallant C. The diagnostic accuracy of in vivo confocal scanning laser microscopy compared to dermoscopy of benign and malignant melanocytic lesions: a prospective study. Dermatol 2007; 215: 365-72. Scope A, Benvenuto-Andrade C, Agero AL, Malvehy J, Puig S, Rajadhyaksha M, Busam KJ, Marra DE, Torres A, Propperova I, Langley RG, Marghoob AA, Pellacani G, Seidenari S, Halpern AC, Gonzalez S. In vivo reflectance confocal microscopy imaging of melanocytic skin lesions: consensus terminology glossary and illustrative images. J Am Acad Dermatol. 2007 Oct;57(4):644-58. Epub 2007 Jul 16. Propperova I, Langley RG. Reflectance-mode confocal microscopy for the diagnosis of sebaceous hyperplasia in vivo. Arch Dermatol. 2007 Jan;143(1):134. ©2008 |
