The reflectance confocal microscopy — lights and shadows: A case series
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Abstract
Reflectance confocal microscopy (RCM) is a non-invasive in vivo diagnostic method that increases the sensitivity and specificity of melanoma diagnosis when used complementarily with dermoscopy. There are benign and malignant melanocytic lesions in the so-called grey zone of non-invasive diagnostics, whose dermoscopic patterns overlap, and RCM examination shows only minor abnormalities. An increasing number of studies indicate the need to include many factors during the skin examination, some of which are unrelated to the diagnostic method used, such as the patient’s age, skin phototype, location and size of the skin lesion, personal/family history of melanoma/skin cancers, or the “ugly duckling” sign. In the example of three cases evaluated with dermoscopy, the iDScore 2021 algorithm and RCM, the authors illustrated the need for a complementary approach to diagnosing melanocytic lesions, despite patients’ differentiated risk of melanoma.
Keywords: melanomareflectance confocal microscopydermoscopy
References
- Yélamos O, Manubens E, Jain M, et al. Improvement of diagnostic confidence and management of equivocal skin lesions by integration of reflectance confocal microscopy in daily practice: Prospective study in 2 referral skin cancer centers. J Am Acad Dermatol. 2020; 83(4): 1057–1063.
- Xiong YD, Ma S, Li X, et al. A meta-analysis of reflectance confocal microscopy for the diagnosis of malignant skin tumours. J Eur Acad Dermatol Venereol. 2016; 30(8): 1295–1302.
- Pellacani G, Pepe P, Casari A, et al. Reflectance confocal microscopy as a second-level examination in skin oncology improves diagnostic accuracy and saves unnecessary excisions: a longitudinal prospective study. Br J Dermatol. 2014; 171(5): 1044–1051.
- Alarcon I, Carrera C, Palou J, et al. Impact of in vivo reflectance confocal microscopy on the number needed to treat melanoma in doubtful lesions. Br J Dermatol. 2014; 170(4): 802–808.
- Stanganelli I, Longo C, Mazzoni L, et al. Integration of reflectance confocal microscopy in sequential dermoscopy follow-up improves melanoma detection accuracy. Br J Dermatol. 2015; 172(2): 365–371.
- Longhitano S, Pampena R, Guida S, et al. In vivo confocal microscopy: The role of comparative approach in patients with multiple atypical nevi. Exp Dermatol. 2020; 29(10): 945–952.
- Condorelli AG, Farnetani F, Ciardo S, et al. Dynamic dermoscopic and reflectance confocal microscopic changes of melanocytic lesions excised during follow up. J Am Acad Dermatol. 2022; 86(5): 1049–1057.
- Que SK, Grant-Kels JM, Longo C, et al. Basics of confocal microscopy and the complexity of diagnosing skin tumors: New imaging tools in clinical practice, diagnostic workflows, cost-estimate, and new trends. Dermatol Clin. 2016; 34(4): 367–375.
- Shahriari N, Grant-Kels JM, Rabinovitz H, et al. Reflectance confocal microscopy: Diagnostic criteria of common benign and malignant neoplasms, dermoscopic and histopathologic correlates of key confocal criteria, and diagnostic algorithms. J Am Acad Dermatol. 2021; 84(1): 17–31.
- Tognetti L, Cartocci A, Bertello M, et al. An updated algorithm integrated with patient data for the differentiation of atypical nevi from early melanomas: The idScore 2021. Dermatol Pract Concept. 2022; 12(3): e2022134.
- Ferrari B, Pupelli G, Farnetani F, et al. Dermoscopic difficult lesions: an objective evaluation of reflectance confocal microscopy impact for accurate diagnosis. J Eur Acad Dermatol Venereol. 2015; 29(6): 1135–1140.
- Pizzichetta MA, Polesel J, Perrot JL, et al. Amelanotic/hypomelanotic lentigo maligna: Dermoscopic and confocal features predicting diagnosis. J Eur Acad Dermatol Venereol. 2023; 37(2): 303–310.
- Agozzino M, Ferrari A, Cota C, et al. Reflectance confocal microscopy analysis of equivocal melanocytic lesions with severe regression. Skin Res Technol. 2018; 24(1): 9–15.
- Bayan CAY, Khanna T, Rotemberg V, et al. A review of non-invasive imaging in extramammary Paget's disease. J Eur Acad Dermatol Venereol. 2018; 32(11): 1862–1873.
- Lampitelli S, Cantisani C, Rega F, et al. Identification of novel dermoscopic patterns for “featureless melanoma”: clinical-pathological correlation. Dermatol Pract Concept. 2023 [Epub ahead of print]; 13(2): e2023080.
- Lallas A, Zalaudek I, Apalla Z, et al. Management rules to detect melanoma. Dermatology. 2013; 226(1): 52–60.
