Handheld reflectance confocal microscopy: Personalized and accurate presurgical delineation of lentigo maligna (melanoma)

Abstract

Background The surgical treatment of lentigo maligna melanoma is associated with high rates of local recurrence. Handheld reflectance confocal microscopy (HH‐RCM) allows for in vivo presurgical detection of subclinical lentigo maligna (melanoma) (LM/LMM). Methods A single‐center retrospective study from December 2015 to July 2017. Frequency and extent of negative surgical margins, and the diagnostic accuracy of presurgical mapping by HH‐RCM was determined. Results Twenty‐six consecutive patients with LM/LMM were included. In 45.8%, HH‐RCM detected subclinical LM with a sensitivity of 0.90 and specificity of 0.86. The management was changed in two (7.7%) patients. Of the 24 remaining lesions, 95.8% were excised with negative margins with a mean histological margin of 3.1 and 5.3 mm for LM and LMM, respectively. At a mean follow‐up of 36.7 months, there was one (4.8%) confirmed recurrence. Conclusions Our method of presurgical delineation by HH‐RCM appears to provide a reliable method for the surgical treatment of LM/LMM with a limited rate of overtreatment.

Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

“…A 10 mm surgical margin resulted in negative histological margins in 78% (40/51) following WLE or SE with partial margin assessment. 42,52,53 Similar to LM, this percentage decreased (55%; 144/260) in the case of SE or MMS with complete margin assessment. 39,56,63 The weighted mean ± SD (range) surgical margin necessary for negative histological margins was 9.3 ± 2.6 mm (6.3-13.0) (n = 405).…”

“…A 5 mm surgical margin resulted in negative histological margins in 83% (950/1100) following WLE or SE with partial margin assessment (i.e. bread loaf or radial sectioning) 36,37,39,51–55 . When the complete histological margin was assessed (e.g.…”

“…2 Even though the sample size of reported 181 HH-RCM mapped patients was limited, all five studies showed a reduced rate of positive histological margins, a reduction in necessary stages and less local recurrences, even in patients treated by WLE. 13,52,58,64,67 This might indicate a beneficial effect of presurgical mapping by HH-RCM combined with any surgical technique. Nonetheless, these data should be…”

“…bread loaf or radial sectioning). 36,37,39,[51][52][53][54][55] When the complete histological margin was assessed (e.g. SE or MMS), the margins were more often found to be involved, with a 5 mm surgical margin resulting in negative margins in 59% (350/598).…”

“…The use of HH-RCM mapping before WLE, resulted in a 2% (2/84) local recurrence rate at a weighted mean ± SD (range) follow-up of 51.3 ± 11.3 (36.7-60) months. 52,64 In the single study using arm-mounted RCM, the recurrence rate of 27% (4/15). 2 No local recurrences (0/97) were reported following HH-RCM usage before SE with complete margin assessment, a weighted mean ± SD (range) follow-up of 33.1 ± 15.9 (10-44) months, 58,67 compared to 2% (29/1270) without the use of HH-RCM.…”