Reflectance confocal microscopy and dermoscopy aid in evaluating repigmentation within or adjacent to lentigo maligna melanoma surgical scars

Abstract

Background: Determining whether repigmentation within or adjacent to lentigo maligna or lentigo maligna melanoma (LM/LMM) scars represents recurrence of melanoma is challenging. The use of reflectance confocal microscopy (RCM) and dermoscopy may aid in differentiating true melanoma recurrence from other causes of repigmentation.Objectives: To describe the characteristics of repigmentation within or adjacent to LM/LMM scars observable on RCM and dermoscopy. Methods:We retrospectively analysed patients who presented with new pigmentation within or adjacent to scars from surgically treated LM/LMM between January 2014 and December 2018. Clinical and demographic characteristics and time to recurrence were recorded. RCM was used to evaluate areas of pigmentation before biopsy. If available, dermoscopic images were evaluated.Results: In total, 30 confocal studies in 29 patients were included in the study cohort. Twentyone patients had biopsy-confirmed recurrent LM/LMM; the remainder had pigmented actinic keratosis (n=4) or hyperpigmentation/solar lentigo (n=5). RCM had sensitivity of 95.24%

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

“…After re‐reviewing the images, no RCM evidence of residual LM/LMM was found which could be explained by the presence of focal residual LM/LMM on final pathology. The present study also complements the current literature on the feasibility of RCM evaluation of previously biopsied/surgically treated tissue …”

“…We found that RCM was associated with a diagnostic accuracy of 78.6%, a sensitivity of 90.9% and a specificity of 33.3% for the detection of residual LM/LMM, when compared to histopathology. With a sensitivity of >90%, RCM has the potential to accurately locate the area of residual LM/LMM . Nevertheless, specificity in our study was relatively low (<50%).…”

“…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.…”

Late recurrence of melanoma after 10 years – Is the course of the disease different from early recurrences?

“…Reflectance confocal microscopy, biomarkers, liquid biopsies and the recognition of circulating tumour cells and cell-free DNAs/RNAs are promising methods for the early detection of recurrences which are still at the cellular level and which cannot be detected by conventional screening tools. [35][36][37] In conclusion after onset of metastases, the course of the disease is very similar in ER and LR, when early recurrence is defined up to 10 years and late recurrence after 10 years. Whereas immunological control may contribute to late onset of metastasis, once metastasis occurred it seems that the tumour escapes from immunological control.…”

Editorial for: Bertoni et al. ex vivo fluorescence confocal microscopy: prostatic and periprostatic tissues atlas and evaluation of the learning curve

“…Further examples are light reflectance spectroscopy [1], optical coherence tomography (OCT) [2], high wavenumber spectra (so called Raman spectrometry) [3] and video-rate multi-colored structured illumination microscopy [4,5], and also MRT-imaging with instruments that are in routine or research use for humans. An overview concerning alternative techniques to frozen sections is given by Eissa et al last year [6].…”