Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study

Navarrete‐Dechent, Cristián; Córdova, Miguel; Aleissa, Saud; Liopyris, Konstantinos; Dusza, Stephen W.; Kose, Katsumi; Busam, Klaus J.; Lezcano, Cecilia; Pulitzer, Melissa; Chen, Chih-Shan J.; Lee, Erica H.; Rossi, Anthony; Nehal, Kishwer S.

doi:10.1016/j.jaad.2019.11.058

Cited by 32 publications

(23 citation statements)

References 35 publications

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“…In addition to mapping margins of primary LM/LMM, RCM may be used for the evaluation of patients with incompletely excised LM/LMM. RCM can provide with in vivo , real‐time, non‐invasive assessment of the complete scar area.…”

Section: Discussionmentioning

confidence: 99%

“…Non‐randomized studies suggest lower recurrence rates of LM/LMM when treated with circumferential margin assessment, possibly explained by comprehensive evaluation of margins . RCM emerges as a novel, non‐invasive tool to aid in the presurgical mapping of LM/LMM detecting subclinical extension …”

Section: Discussionmentioning

confidence: 99%

“…Reflectance confocal microscopy (RCM) is a non‐invasive imaging tool that uses a near‐infrared laser and provides with quasi‐histological views in vivo . RCM has been used as a diagnostic tool for both primary and recurrent melanomas, as well as to map melanomas of the LM/LMM type prior to surgical excision and to monitor non‐surgical treatment modalities . Studies have not specifically evaluated this clinical–pathological scenario and the role of RCM in the evaluation of incompletely excised LM/LMM.…”

Section: Introductionmentioning

confidence: 99%

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Incompletely excised lentigo maligna melanoma is associated with unpredictable residual disease: clinical features and the emerging role of reflectance confocal microscopy

Navarrete‐Dechent

Aleissa

Córdova

et al. 2020

Acad Dermatol Venereol

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Background Lentigo maligna/lentigo maligna melanoma (LM/LMM) poses a treatment and surgical challenge given unpredictable subclinical extension resulting in incomplete excision. Objectives To describe the demographic, clinical and pathologic characteristics of incompletely excised LM/LMM. To evaluate the potential role of reflectance confocal microscopy (RCM). Patients and methods A retrospective review of a melanoma database at a tertiary cancer centre for patients referred with 'incompletely excised LM/LMM' or 'incompletely excised melanoma' between October 2006 and July 2017. We recorded clinical and pathological data and surgical margins needed to clear the residual LM/LMM. The second part consisted of a prospective cohort of patients in which RCM was performed when presenting with incompletely excised LM/LMM. Results We included a total of 67 patients (retrospective + prospective cohort); mean age was 64.9 (standard deviation: 11.3) years and 52.2% were males. For the retrospective cohort (n = 53), the mean scar size was 3.4 cm. The average initial margins excised prior to presentation were 4.8 mm (range 3-7 mm). The average additional margin needed to clear the residual, incompletely excised LM/LMM was 7.8 mm. For the prospective cohort (n = 14), there were no differences in age, gender or size when compared to the retrospective cohort. RCM had a diagnostic accuracy of 78.6%, a sensitivity of 90.9%, a specificity of 33.3% and a positive predictive value of 83.3% for the detection of incompletely excised LM/LMM. Conclusions Incompletely excised LM/LMM is a poorly characterized clinical-pathological scenario that may require considerable extra margins for microscopic clearance. RCM may emerge as a valuable tool for the evaluation of patients with incompletely excised LM/LMM.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incompletely excised lentigo maligna melanoma is associated with unpredictable residual disease: clinical features and the emerging role of reflectance confocal microscopy

Navarrete‐Dechent

Aleissa

Córdova

et al. 2020

Acad Dermatol Venereol

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“…A prospective study evaluating the correlation of LM/LMM subclinical extension defined by RCM compared to the gold standard histopathology showed an overall agreement of 85.9% between RCM imaging and histopathology of staged excision margins. 70 Diagnostic accuracy for detection of residual melanoma in the tumor debulking (after biopsy) had a sensitivity of 96.7% and a specificity of 66.7% when compared to the histopathology.…”

Section: Reflectance Confocal Microscopymentioning

confidence: 93%

<p>Lentigo Maligna: Clinical Presentation and Appropriate Management</p>

Iznardo¹,

Garcia‐Melendo²,

Yélamos³

2020

CCID

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“…A comparison of several classification models on full-size images was then carried out to estimate the relevance of these methods. Also, this study will employ the term "lentigo maligna" instead of the term "melanoma in situ type lentigo maligna" as it was used by the last RCM clinical studies [23][24][25][26] and for the sake of simplicity.…”

Section: Introductionmentioning

confidence: 99%

Classification of Lentigo Maligna at Patient-Level by Means of Reflectance Confocal Microscopy Data

et al. 2020

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Reflectance confocal microscopy is an appropriate tool for the diagnosis of lentigo maligna. Compared with dermoscopy, this device can provide abundant information as a mosaic and/or a stack of images. In this particular context, the number of images per patient varied between 2 and 833 images and the objective, ultimately, is to be able to discern between benign and malignant classes. First, this paper evaluated classification at the image level, with the help of handcrafted methods derived from the literature and transfer learning methods. The transfer learning feature extraction methods outperformed the handcrafted feature extraction methods from literature, with a F 1 score value of 0.82. Secondly, this work proposed patient-level supervised methods based on image decisions and a comparison of these with multi-instance learning methods. This study achieved comparable results to those of the dermatologists, with an auc score of 0.87 for supervised patient diagnosis and an auc score of 0.88 for multi-instance learning patient diagnosis. According to these results, computer-aided diagnosis methods presented in this paper could be easily used in a clinical context to save time or confirm a diagnosis and can be oriented to detect images of interest. Also, this methodology can be used to serve future works based on multimodality.

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Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study

Cited by 32 publications

References 35 publications

Incompletely excised lentigo maligna melanoma is associated with unpredictable residual disease: clinical features and the emerging role of reflectance confocal microscopy

Incompletely excised lentigo maligna melanoma is associated with unpredictable residual disease: clinical features and the emerging role of reflectance confocal microscopy

<p>Lentigo Maligna: Clinical Presentation and Appropriate Management</p>

Classification of Lentigo Maligna at Patient-Level by Means of Reflectance Confocal Microscopy Data

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