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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.
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