Cutaneous Melanoma Systematic Diagnostic Workflows and Integrated Reflectance Confocal Microscopy Assessed with a Retrospective, Comparative Longitudinal (2009–2018) Study

Abstract

Background: The increasing global burden of melanoma demands efficient health services. Accurate early melanoma diagnosis improves prognosis. Objectives: To assess melanoma prevention strategies and a systematic diagnostic-therapeutical workflow (improved patient access and high-performance technology integration) and estimate cost savings. Methods: Retrospective analysis of epidemiological data of an entire province over a 10-year period of all excised lesions suspicious for melanoma (melanoma or benign), registered according to excision location: reference hospital (DP) or other (NDP). A systematic diagnostic-therapeutical workflow, including direct patient access, primary care physician education and high-performance technology (reflectance confocal microscopy (RCM)) integration, was implemented. Impact was assessed with the number of lesions needed to excise (NNE). Results: From 40,832 suspicious lesions excised, 7.5% (n = 3054) were melanoma. There was a 279% increase in the number of melanomas excised (n = 203 (2009) to n = 567 (2018)). Identification precision improved more than 100% (5.1% in 2009 to 12.0% in 2018). After RCM implementation, NNE decreased almost 3-fold at DP and by half at NDP. Overall NNE for DP was significantly lower (NNE = 8) than for NDP (NNE = 20), p < 0.001. Cost savings amounted to EUR 1,476,392.00. Conclusions: Melanoma prevention strategies combined with systematic diagnostic-therapeutical workflow reduced the ratio of nevi excised to identify each melanoma. Total costs may be reduced by as much as 37%.

Concordance between reflectance confocal microscopy and histopathology for the diagnosis of acral lentiginous melanoma

“…Many studies have explored the RCM characteristics of MM, 1 , 4 , 5 including melanoma in specific locations such as lentigo maligna melanoma. 6 , 7 , 8 However, monitoring acral skin using RCM is challenging because of the thick stratum corneum of the extremities; there are few reports describing the RCM characteristics of acral melanoma.…”

Clinical, Dermoscopic, and Histological Characteristics of Melanoma Patients According to the Age Groups: A Retrospective Observational Study

“…Dermoscopy is one of the most important pillars of the secondary prevention of melanomas [ 18 , 19 , 20 , 21 ]. It enables their diagnosis at an early stage and thus contributes to a reduction in melanoma mortality [ 18 , 19 , 20 , 21 ].…”

Effect of Reflectance Confocal Microscopy for Suspect Lesions on Diagnostic Accuracy in Melanoma

“…Our group previously assessed the integration of RCM into a diagnostic-therapeutic workflow (with centralized and immediate assessment of suspect lesions) and specific education over a 10-year period in a single province, reporting improved precision in diagnosis of approximately 100%. Meta-analyses have reported estimates of improved specificity of RCM compared with dermoscopy. In 2020, Pezzini et al concluded that independent of study design, RCM has a high diagnostic power for melanoma detection (pooled sensitivity of 92%) and reduces unnecessary excisions (pooled specificity of 70%).…”

“…Data from this study are essential for the ongoing discussion regarding the applicability of advanced technologies in routine melanoma detection among equivocal lesions. Our group previously assessed the integration of RCM into a diagnostic-therapeutic workflow (with centralized and immediate assessment of suspect lesions) and specific education over a 10-year period in a single province, reporting improved precision in diagnosis of approximately 100% . Meta-analyses have reported estimates of improved specificity of RCM compared with dermoscopy.…”

“…The systematic application of RCM in the triage of high-risk patients should improve diagnostic accuracy and reduce unnecessary excisions for histopathological diagnostic confirmation, thereby reducing costs, surgical waiting lists, and delayed diagnoses. However, the clinical application of RCM has mainly been limited to retrospective and prospective observational studies producing hypothetical estimates of clinical applicability without intention to affect clinical and therapeutic patient pathways …”