Diagnostic accuracy of reflectance confocal microscopy for pigmented skin lesions presenting dermoscopic features of cutaneous melanoma

Abstract

Introduction The incidence and mortality of melanoma are rising rapidly. Despite ongoing research and the introduction of new therapeutic methods, advanced melanoma is still considered incurable. Early detection and surgical excision of the tumor increases patients’ survival. Since the diagnostic protocol includes surgical excision of all suspicious lesions, it is burdened with a high rate of unnecessary excisions that cause unwanted scarring. This is why the development of accurate diagnostic techniques is crucial. The most common diagnostic tool in early diagnosis of cutaneous melanoma is dermoscopy, though there are emerging new techniques, such as reflectance confocal microscopy and optical coherence tomography. Aim To evaluate diagnostic accuracy of reflectance confocal microscopy as a secondary examination in melanocytic lesions previously diagnosed as melanomas by means of dermoscopy. Material and methods Forty-six melanocytic lesions presenting dermoscopic features of cutaneous malignant melanoma were examined by means of reflectance confocal microscopy. Results The RCM evaluation showed sensitivity at the level of 100% and specificity at 62%. Conclusions It can be estimated that double evaluation of melanocytic lesions by dermoscopy and reflectance confocal microscopy may allow up to 62% of unnecessary excisions to be avoided.

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

“…The lateral resolution was 1.25 μm, and the axial resolution was 5 μm with a 30× water immersion objective lens. The criteria for the diagnosis of MM were described previously 2,3 . The two primary criteria were atypical cells (nests) at the dermal‐epidermal junction, and disordered epidermal structures along with the disappearance of papillary rings.…”

“…The criteria for the diagnosis of MM were described previously. 2 , 3 The two primary criteria were atypical cells (nests) at the dermal‐epidermal junction, and disordered epidermal structures along with the disappearance of papillary rings. Four secondary criteria were intraepidermal dendritic and spindle cells, scattered or widespread presence of round or oval Paget‐like cells, nests of anomalous tumor cells, and nucleated cells in the dermal papilla.…”

Reflectance confocal microscopy versus dermoscopy for the diagnosis of cutaneous melanoma: a head-to-head comparative meta-analysis

“…After thoroughly reviewing the full texts of the remaining 24 articles, another 10 were found to be ineligible due to missing data (true positives, false positives, false negatives, and true negatives) (n = 8) and the absence of head-to-head comparisons (n = 2). Eventually, 14 articles assessing the diagnostic performance of RCM and dermoscopy were included in the meta-analysis [16,[18][19][20][21][22][23][24][25][26][27][28][29][30]. The article selection process, as illustrated in the PRISMA flow diagram, is presented in Figure 1.…”