Challenging facial pigmented lesions: values and limits of confocal microscopy

Agozzino, Marina; Russo, Teresa; Ardigò, Marco; Piccolo, Vincenzo; Mascolo, Massimo; Staibano, Stefania; Alfano, Roberto; Argenziano, Giuseppe

doi:10.5826/dpc.0803a08

Cited by 3 publications

(1 citation statement)

References 3 publications

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“…RCM enables examination of the entire lesion, while confocal resolution and morphologic features are similar to histology [28]. This non-invasive imaging technique has been proven useful not only in the evaluation and follow-up of melanocytic [29,30] and non-melanocytic lesions [31,32,33,34,35,36,37], but also in the diagnosis of inflammatory skin diseases [38,39,40,41,42,43,44,45,46,47,48]. However, one fundamental risk of techniques such as RCM is that they rely on morphology-based analysis, thus being subject to interpretation bias.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Study of the Diagnostic Accuracy of In Vivo Reflectance Confocal Microscopy for Basal Cell Carcinoma Diagnosis and Subtyping

Lupu

Popa

Voiculescu

et al. 2019

JCM

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Current national and European guidelines recommend distinct management approaches for basal cell carcinoma (BCC) based on tumor location, size, and histopathological subtype. In vivo reflectance confocal microscopy (RCM) is a non-invasive skin imaging technique which may change the diagnostic pathway for BCC patients. This study aimed to determine the sensitivity and specificity of RCM for BCC diagnosis, assess the predictive values of several confocal criteria in correctly classifying BCC subtypes, and evaluate the intraobserver reliability of RCM diagnosis for BCC. We conducted a retrospective study in two tertiary care centers in Bucharest, Romania. We included adults with clinically and dermoscopic suspect BCCs who underwent RCM and histopathological examination of excision specimens. For RCM examinations, we used the VivaScope 1500 and histopathology of the surgical excision specimen was the reference standard. Of the 123 cases included in the analysis, BCC was confirmed in 104 and excluded in 19 cases. RCM showed both high sensitivity (97.1%, 95% CI (91.80, 99.40)) and specificity (78.95%, 95% CI (54.43, 93.95)) for detecting BCC. Several RCM criteria were highly predictive for BCC subtypes: cords connected to the epidermis for superficial BCC, big tumor islands, peritumoral collagen bundles and increased vascularization for nodular BCC, and hyporefractile silhouettes for aggressive BCC. Excellent intraobserver agreement (κ = 0.909, p < 0.001) was observed. This data suggests that RCM could be used for preoperative diagnosis and BCC subtype classification in patients with suspected BCCs seen in tertiary care centers.

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