Biopsy is currently the gold standard for diagnosis of suspicious skin lesions even in cases that are not ideal. Such cases include but are not limited to patients with numerous atypical lesions, lesions at aesthetically significant sites, and children. These sensitive cases now have an alternative non-invasive diagnostic approach providing valuable information to guide management decisions. Current non-invasive technology includes a dermatoscope, which permits visualization of subsurface structures that are otherwise not visible to the naked eye. The most novel technology, reflectance confocal microscopy allows clinicians to visualize the cellular details of the skin without surgical intervention.
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About Us

NIDIskin is an educational forum dedicated to Non-Invasive Diagnostic Imaging of the Skin. This platform is created to expose and educate patients and practitioners regarding the existence and utilization of non-invasive diagnostic tools to improve patient care. Although there are numerous non-invasive technologies available, there are two that are novel to clinical practice, which currently include, Dermoscopy and Reflectance Confocal Microscopy. The aforementioned non-invasive tools are instrumental in making diagnoses and directing management decisions, including lesions that require a biopsy. As innovative diagnostic technology and methods emerge, NIDIskin is committed to serving as a vital source for exploration and distribution of knowledge regarding innovative non-invasive technologies.
NIDIskin has been a major platform to expand and educate on Reflectance Confocal Microscopy. Through this platform we organize two symposiums yearly, one during the spring on the east coast and another during the fall on the west coast. We also have a dedicated teaching portal online for the convenience of learning and sharing knowledge. Our team of educators includes world-renowned pioneers in reflectance confocal microscopy. Currently, our lead educators are Dr. Babar Rao and Dr. Pellacani. Additional faculty includes Dr. Stephen Hammond, Dr. John Durcan, and Dr. Manu Jain. We continue to expand our team with upcoming confocal specialists within the United States to continue to train individuals worldwide. Our team is dedicated to teach emerging in-vivo and ex-vivo technologies.
Dr. Babar Rao is a board certified Physician in both Dermatology and Dermatopathology and is a leading authority on pigmented lesions. His continued effort with non-invasive technology has allowed him to be a pioneer in Dermoscopy and Confocal Microscopy. Dr. Rao completed his Dermatology Residency at Weill Cornell Medical School and has previously trained at the University of London, UT Southwestern, New York University, and Rutgers University. He is currently Professor of Dermatology and Pathology at Rutgers University and Associate Clinical Professor at Weill Cornell Medical School. To learn more about Dr. Rao go to

Dr. Giovanni Pellacani is an esteemed Physician of Dermatology. He is currently the Dean of the Faculty of Medicine and the Chairman of Dermatology at University of Modena and Reggio Emilia in Modena, Italy.


Dermoscopy is a non-invasive diagnostic technique that uses a magnifier and a polarizing light to examine skin lesions in vivo. This hand-held device allows for visualization of subsurface structures that are otherwise not visible with the naked eye. In the 1980s dermoscopy was first established as useful in the diagnosis of pigmented skin lesions. Over the last three decades, dermoscopy has become wide spread with approximately 60% of dermatologists reporting regular use of dermoscopy in recent national surveys. Dermoscopy decreases the frequency of biopsy for benign lesions, thereby improves patient care.

Many diagnostic algorithms have been established to interpret dermoscopic images of pigmented lesions, including pattern analysis, the ABCD rule, the Menzies method, the 7-point checklist and the CASH algorithm. Our approach to dermoscopy is called ASAP: A Simple and Practical Approach to Dermoscopy. Instead of utilizing scoring systems, like the previously mentioned algorithms, the ASAP method uses simple patterns to determine whether or not a lesion should be biopsied. The dermoscopist identifies known benign patterns, known malignant patterns and suspicious features in an otherwise benign pattern. Lesions with known benign patterns are not biopsied. Lesions with known malignant patterns, suspicious features or unknown patterns are biopsied. This approach will be described in further detail in the dermoscopy tutorials.

Confocal microscopy

Confocal microscopy (CFM) is a diagnostic tool for cutaneous conditions that allows clinicians to visualize cellular details of the skin without the need for an invasive procedure. The microscope uses a laser to illuminate a small area of skin. Light is reflected back to the detector through a pinhole, which permits passage of light from the in-focus field only. With this input, a computer generates a two-dimensional grayscale image that corresponds to a transverse tissue section (ie. parallel to the skin surface). The contrast visualized by CFM is determined by the differential reflectance capability of various skin structures. The end result is a high-resolution image of the epidermis and superficial dermis that is obtained non-invasively and in real time.

The confocal microscope was first conceptualized by Marvin Minsky in 1957. As early as 1995, CFM was used in dermatology, as a tool used for clinical dermatology and in Moh’s research at the Wellman Laboratories of Photomedicine at Massachusetts General Hospital in Boston. By the early 2000’s, researchers from prestigious academic centers including Memorial Sloan-Kettering Cancer Center (New York, NY), Loma Linda University (Loma Linda, California), the Sydney Melanoma Unit (Sydney, Australia), University of Modena and Reggio Emilia (Modena, Italy), the Charite (Berlin, Germany) and University of Graz (Graz, Austria) were using CFM routinely, both as a research tool and a clinical diagnostic imaging device.

Today, confocal is widely used by dermatologists and researchers around the world to study and diagnose skin cancers, including melanoma, basal cell carcinoma and squamous cell carcinoma, along with a variety of other skin diseases, including psoriasis, actinic keratosis and seborrheic keratosis. Confocal microscopy has already had an impact on patient care and we imagine that this impact will continue and expand in the future.
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