Diagnostic impact of reflectance confocal microscopy as a second‐level examination for facial skin lesions

Abstract

SummaryBackground and objectiveBenign and malignant facial skin lesions may be difficult to differentiate clinically and with dermoscopy. The present study aimed to evaluate the potential utility of in vivo reflectance confocal microscopy (RCM) as a second‐level examination for facial skin neoplasms.Patients and MethodsRetrospective and blinded evaluation of 160 consecutive facial lesions was carried out in two separate steps. Clinical and dermoscopic images were assessed first, followed by combined evaluation of clinical/dermoscopic and RCM images. Our study included 60 % malignant lesions, comprising 43 % melanomas, 9 % basal cell carcinomas, 5 % in situ squamous cell carcinomas and 3 % lymphomas.ResultsAncillary RCM significantly improved diagnostic specificity for the detection of malignancy compared to clinical/dermoscopic evaluation alone (58 % vs 28 %). However, sensitivity was slightly lower for RCM‐based image evaluation (93 % vs 95 %) due to misclassification of one in situ SCC and one lymphoma. In terms of melanoma diagnosis, RCM‐based image evaluation was generally superior; sensitivity was only slightly increased (88 % vs 87 %), but melanoma specificity was significantly higher (84 % vs 58 %).ConclusionRCM is a valuable diagnostic adjunct for facial skin lesions; unnecessary biopsies in this cosmetically sensitive area could be reduced by one third without missing a melanoma.

Folliculotropism in head and neck lentigo maligna and lentigo maligna melanoma

“…In those areas with a functional and esthetic impact, reflectance confocal microscopy (RCM) is a good option in adjunct to clinical and dermatoscopic evaluations. Reflectance confocal microscopy is a second-level non-invasive diagnostic option shown to be highly accurate in the diagnosis of pigmented lesions, though one of its drawbacks is the longer examination duration [7].…”

Monitoring vulvar melanoma response to combined immunotherapy and radiotherapy with in vivo reflectance confocal microscopy

“…Cristian Navarrete-Dechent 1,2 , Miguel Cordova 2 , Saud Aleissa 2 , Alexander Shoushtari 3 , Travis J. Hollmann 4 , Mario M. Leitao Jr 5 , Anthony M. Rossi 2,6…”

“…These alternatives may fail to detect changes in cutaneous disease due to its limited cellular resolution. Reflectance confocal microscopy (RCM) is a non-invasive, quasi-histological imaging tool that emerges as a promising instrument for diagnosing and monitoring melanoma patients on systemic therapies [4][5][6].…”

Follikulotropismus bei Lentigo maligna und Lentigo‐maligna‐Melanom im Kopf‐Hals‐Bereich

“…Die konfokale Laserscanmikroskopie ist eine nicht‐invasive Methode der zweiten Stufe, mit der sich pigmentierte Läsionen sehr akkurat diagnostizieren lassen. Ein Nachteil liegt allerdings in der längeren Untersuchungsdauer [7].…”