摘要： Background: Basal cell carcinoma (BCC) treatment modalities can be strati?ed by tumor subtype and recurrence risk. The main limitation of nonsurgical treatment modalities is the lack of histopathologic con?rmation. Re?ectance confocal microscopy (RCM) is a noninvasive imaging device that provides quasihistologic images. Objective: To evaluate the feasibility and ef?cacy of RCM-guided carbon dioxide (CO2) laser ablation of low-risk BCCs. Methods: Prospective study with biopsy specimeneproven low-risk BCCs imaged with RCM. RCM was performed on these sites before and after ablation. If residual tumor was found, a new series of laser passes were performed. The patients were then monitored for recurrence clinically and with RCM. Results: Twenty-two tumor sites in 9 patients (5 men, 4 women) were imaged and treated. Median age was 59 6 12.9 years (range, 30-74 years). Mean tumor size was 7.7 mm (range, 5-10 mm). Residual tumor was identi?ed in 5 of 22 cases (22.7%) under RCM on immediate ?rst-pass postablation sites, prompting additional laser passes. Median follow-up was 28.5 months (range, 22-32 months) with no recurrences found. Conclusions: Addition of RCM to laser ablation work?ow can detect subclinical persistent tumor after initial ablation and may serve as an aid to increase the ef?cacy of laser ablation.