<i>In vivo</i>
 dermoscopic and confocal microscopy multistep algorithm to detect <i>in situ</i>
 melanomas

Borsari, Stefania; Pampena, Riccardo; Benati, Elisa; Bombonato, Caterina; Kyrgidis, Athanassios; Moscarella, Elvira; Lallas, Aimilios; Argenziano, Giuseppe; Pellacani, Giovanni; Longo, Caterina

doi:10.1111/bjd.16364

Cited by 39 publications

(56 citation statements)

References 38 publications

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“…Concerning confocal criteria, only those taken into consideration in the four scores were evaluated. A specific description of the considered confocal criteria was previously reported elsewhere …”

Section: Methodsmentioning

confidence: 99%

“…two cut‐offs were reported, namely ≥−1 and ≥0, with sensitivity and specificity levels reported in the original study of 100.0% and 57.1% for ≥−1 cut‐off and 86.1% and 95.3% for the ≥0 cut‐off. For the score by Borsari et al . only one cut‐off was defined in the original study (≥2), showing 92.5% sensitivity and 61.0% specificity levels.…”

Section: Methodsmentioning

confidence: 99%

“…Concerning melanocytic lesions, RCM is currently considered as a second‐level diagnostic tool and demonstrated to significantly improve the number needed to excise as compared to clinical and dermoscopic evaluation alone . Numerous confocal criteria have been described with high level of correlation with histopathological features and different scores and algorithms have been created by the combination of these criteria to help dermatologists in melanoma diagnosis . In particular, the first confocal score was created in 2005 by Pellacani et al ., followed in 2009 by Segura et al .…”

Section: Introductionmentioning

confidence: 99%

“…allowing to differentiate dysplastic nevi from melanoma. Finally, in 2018 Borsari et al . created a mixed dermoscopic/confocal score for the diagnosis of in situ melanoma, starting from the assumption that in everyday clinical practice, RCM cannot be considered as a stand‐alone technique, because it is always used in combination with dermoscopy .…”

Section: Introductionmentioning

confidence: 99%

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External validation and comparison of four confocal microscopic scores for melanoma diagnosis on a retrospective series of highly suspicious melanocytic lesions

Pampena

Borsari

Lai

et al. 2019

Acad Dermatol Venereol

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Background In vivo reflectance confocal microscopy significantly improves melanoma diagnosis as compared to clinical/dermoscopic examination alone. Several confocal criteria have been described allowing to differentiate melanoma from nevi; by combining different criteria, three pure confocal scores (Pellacani 2005, Segura 2009 and Pellacani 2012) and one mixed dermoscopic/confocal score (Borsari 2018) were constructed. Objective Our aim was to externally validate and compare the performance of these confocal scores. Methods We retrospectively enrolled excised melanocytic lesions which underwent confocal examination in a 2‐year period. Lesions located on the face and acral sites were excluded. Both dermoscopic and confocal criteria considered in the four scores were evaluated by experts. Subsequently, specificity and sensitivity levels for each score were calculated, together with the positive and negative predictive values and likelihood ratios; also, receiver operating characteristic curves were constructed. Results A total of 389 patients with 422 lesions were retrospectively enrolled, of which 162 (38.4%) were melanomas and 260 (61.6%) were nevi (189 common and 71 Spitz/Reed nevi). The highest sensitivity levels were recorded for Segura 2009 with cut‐off ≥−1 (92.0%), while Pellacani 2005 with cut‐off ≥5 achieved the highest specificity (69.6%). The score by Borsari et al. showed the highest levels of positive and negative predictive values (59.8% and 91.5%) and likelihood ratios (2.4 and 0.1) as well as the highest area under the curve values (0.76; 95% CI 0.72–0.81; P < 0.001). Conclusions High levels of accuracy were found for each of the four considered scores. No differences were found among scores in confirming melanoma diagnosis when positive; however, the score by Borsari 2018 was the best in excluding melanoma diagnosis when negative.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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External validation and comparison of four confocal microscopic scores for melanoma diagnosis on a retrospective series of highly suspicious melanocytic lesions

Pampena

Borsari

Lai

et al. 2019

Acad Dermatol Venereol

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“…Instead, RCM can view in detail the superficial layers of the skin, containing subtle clues for in situ melanomas [63], which may not yet be obvious on dermoscopy. Interpretation of colors and patterns is key to dermoscopy and the absence of pigmentation increases the degree of difficulty of lesion assessment.…”

Section: Background: Reflectance Technologymentioning

confidence: 99%

Advances in the use of reflectance confocal microscopy in melanoma

Waddell

Star

Guitera

2018

Melanoma Management

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In vivo reflectance confocal microscopy (RCM) is a noninvasive high-resolution skin imaging tool that has become an important adjunct to clinical exam, dermoscopy and histopathology assessment, in the diagnosis and management of melanoma. RCM generates a horizontal view of the skin, whereby cellular and subcellular (e.g., nuclei, melanophages, collagen) structures, to the level of the upper dermis, are projected onto a screen at near-histological resolution. Morphologic descriptors, standardized terminology, and diagnostic algorithms are well established for the RCM assessment of melanoma, melanocytic, and nonmelanocytic lesions. Clinical applications of RCM in melanoma are broad and include diagnosis, assessment of large lesions on cosmetically sensitive areas, directing areas to biopsy, delineating margins prior to surgery, detecting response to treatment and assessing recurrence. This review will provide an overview of RCM technology, findings by melanoma subtype, clinical applications, as well as explore the accuracy of RCM for melanoma diagnosis, pitfalls and emerging uses of this technology ex vivo.

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Assessment of Diagnostic Accuracy of Dermoscopic Structures and Patterns Used in Melanoma Detection

et al. 2021

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IMPORTANCE Dermoscopy increases the diagnostic accuracy for melanoma. However, the accuracy of individual structures and patterns used in melanoma detection has not been systematically evaluated.OBJECTIVE To assess the diagnostic accuracy of individual dermoscopic structures and patterns used in melanoma detection.DATA SOURCES A search of Ovid Medline, Embase, Cochrane CENTRAL, Scopus, and Web of Science was conducted from inception to July 2020.STUDY SELECTION Studies evaluating the dermoscopic structures and patterns among melanomas in comparison with nonmelanoma lesions were included. Excluded were studies with fewer than 3 patients, studies in languages other than English or Spanish, studies not reporting dermoscopic structures per lesion type, and studies assessing only nail, mucosal, acral, facial, or metastatic melanomas or melanomas on chronically sun-damaged skin. Multiple reviewers applied these criteria, and 0.7% of studies met selection criteria. DATA EXTRACTION AND SYNTHESISThe Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline and Meta-analysis of Observational Studies in Epidemiology reporting guideline were followed. Guidelines were applied via independent extraction by multiple observers. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe prespecified outcome measures were diagnostic accuracy (sensitivity and specificity) and risk (odds ratio [OR]) of melanoma for the following dermoscopic structures/patterns: atypical dots/globules, atypical network, blue-white veil, negative network, off-centered blotch, peripheral-tan structureless areas, atypical vessels (eg, linear irregular, polymorphous), pseudopods, streaks, regression (ie, peppering, scarlike areas), shiny white structures, angulated lines, irregular pigmentation, and a multicomponent pattern. RESULTS A total of 40 studies including 22 796 skin lesions and 5736 melanomas were evaluated. The structures and patterns with the highest ORs were shiny white structures (OR,

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In vivo dermoscopic and confocal microscopy multistep algorithm to detect in situ melanomas

Abstract: An easy and reproducible multistep algorithm for in situ melanoma detection is suggested, that can be routinely used in tertiary centres.

Cited by 39 publications

References 38 publications

External validation and comparison of four confocal microscopic scores for melanoma diagnosis on a retrospective series of highly suspicious melanocytic lesions

External validation and comparison of four confocal microscopic scores for melanoma diagnosis on a retrospective series of highly suspicious melanocytic lesions

Advances in the use of reflectance confocal microscopy in melanoma

Assessment of Diagnostic Accuracy of Dermoscopic Structures and Patterns Used in Melanoma Detection

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