“At the start of my scientific internship in dermatology, I was given a new device: the reflection confocal microscope. Back when we had little experience with this device in the Netherlands, but the department saw opportunities in the assessment of potential melanomas. This device can help visualize the upper skin layers at a cellular level without the need of a tissue biopsy. Because of my fascination with this device, I eventually agreed to a PhD trajectory in addition to my work as a physician, and ultimately my training as a dermatologist.”
“In addition to assessing moles, the device was used to treat patients with lentigo maligna, a possible melanoma precursor that often occurs on the face. This precursor is a complex condition, because they tend to be relatively large in older patients. Ultimately, we treat them to prevent the development of melanoma. Ideally, we want to be able to predict who needs this intervention, and what the course of the disease will be for a patient. Now we can make educated guesses, but don’t always reach with the desired precision.”
“When we see patients with lentigo maligna, we first assess the entire area and determine its size using the confocal microscope. Before we had the microscope, we occasionally found a melanoma after surgery, having missed it in the initial diagnosis. Now we can detect 75% of these missed cases before surgery thanks to the confocal microscope. We previously kept finding that more tissue often had to be removed than expected. With the new handy device, we now know much better in advance what really needs to be removed, so that patients know more clearly what they can expect before they make a treatment choice. Now we can completely remove the melanomas in one operation.”
“The device is small and requires some skill. I have now examined thousands of potential skin cancers with it. I can count the number of people who didn’t want to participate in the study throughout the years on one hand. Despite the extra time and effort that participation costs, nearly all patients were interested. When patients see the images that we have made with this device, they often tell me that it reminds them of the surface of the moon. I still hear that every week, which is why I decided to put a moonscape on the cover of my thesis.”
Yannick Elshot has successfully defended his thesis on March 21, 2025 at 2:00 PM.
Research at the Netherlands Cancer Institute is financially supported by KWF Dutch Cancer Society.
Head and neck skin cancer: The clinical applications of reflectance confocal microscopy.
Prof. Dr. M.A. de Rie & Prof. Dr. M.W. Bekkenk
Prof. Dr. A.J.M. Balm & Dr. M.B. Crijns