Non‐invasive diagnosis of pink basal cell carcinoma: how much can we rely on dermoscopy and reflectance confocal microscopy?

Witkowski, Alexander; Łudzik, Joanna; deCarvalho, N.; Ciardo, Silvana; Longo, Caterina; DiNardo, Anna; Pellacani, Giovanni

doi:10.1111/srt.12254

Cited by 25 publications

(21 citation statements)

References 46 publications

(96 reference statements)

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“…In the naevi category (excluding spitz naevi) both of these features were present in low but notable frequencies demonstrating their presence in selected groups of melanocytic naevi, particularly those that are congenital, traumatized and/or dysplastic [ 34 , 35 ]. Additionally, the frequencies of BCC tumor islands and/or cords in the BCC population (89.1%) and dyskeratosis in the SCC population (58.3%) were also consistent with literature highlighting their presence as specific for BCC and common in SCC [ 36 – 38 ].…”

Section: Discussionsupporting

confidence: 87%

Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases

et al. 2017

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BackgroundReflectance confocal microscopy (RCM) is an imaging device that permits non-invasive visualization of cellular morphology and has been shown to improve diagnostic accuracy of dermoscopically equivocal cutaneous lesions. The application of double reader concordance evaluation of dermoscopy-RCM image sets in retrospective settings and its potential application to telemedicine evaluation has not been tested in a large study population.ObjectiveTo improve diagnostic sensitivity of RCM image diagnosis using a double reader concordance evaluation approach; to reduce mismanagement of equivocal cutaneous lesions in retrospective consultation and telemedicine settings.Methods1000 combined dermoscopy-RCM image sets were evaluated in blind by 10 readers with advanced training and internship in dermoscopy and RCM evaluation. We compared sensitivity and specificity of single reader evaluation versus double reader concordance evaluation as well as the effect of diagnostic confidence on lesion management in a retrospective setting.ResultsSingle reader evaluation resulted in an overall sensitivity of 95.2% and specificity of 76.3%, with misdiagnosis of 8 melanomas, 4 basal cell carcinomas and 2 squamous cell carcinomas. Combined double reader evaluation resulted in an overall sensitivity of 98.3% and specificity of 65.5%, with misdiagnosis of 1 in-situ melanoma and 2 basal cell carcinomas.ConclusionEvaluation of dermoscopy-RCM image sets of cutaneous lesions by single reader evaluation in retrospective settings is limited by sensitivity levels that may result in potential mismanagement of malignant lesions. Double reader blind concordance evaluation may improve the sensitivity of diagnosis and management safety. The use of a second check can be implemented in telemedicine settings where expert consultation and second opinions may be required.

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Section: Discussionsupporting

confidence: 87%

Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases

et al. 2017

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“…The combination of dermoscopy-reflectance confocal microscopy image evaluation has been found to significantly improve the accuracy and safety threshold in equivocal "pink" cutaneous lesions in the differential diagnosis of BCC. 23 So that, considering that SBCC is a distinct entity from other subtypes of BCC and its delayed diagnosis has a negative clinical outcome, we suggest that more accurate diagnostic tools apart from dermatoscopy are required to reach the goal of an early-stage diagnosis of SBCC.…”

Section: Discusionmentioning

confidence: 98%

Sclerodermiform basal cell carcinoma: how much can we rely on dermatoscopy to differentiate from non-aggressive basal cell carcinomas? Analysis of 1256 cases

Husein‐ElAhmed¹

2018

An. Bras. Dermatol.

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BackgroundThe behaviour of each basal cell carcinoma is known to be different according to the histological growth pattern. Among these aggressive lesions, sclerodermiform basal cell carcinomas are the most common type. This is a challenging-to-treat lesion due to its deep tissue invasion, rapid growth, risk of metastasis and overall poor prognosis if not diagnosed in early stages.ObjectiveTo investigate if sclerodermiform basal cell carcinomas are diagnosed later compared to non-sclerodermiform basal cell carcinoma Method: All lesions excised from 2000 to 2010 were included. A pathologist classified the lesions in two cohorts: one with specimens of non-aggressive basal cell carcinoma (superficial, nodular and pigmented), and other with sclerodermiform basal cell carcinoma. For each lesion, we collected patient's information from digital medical records regarding: gender, age when first attending the clinic and the tumor location.Results1256 lesions were included, out of which 296 (23.6%) corresponded to sclerodermiform basal cell carcinoma, whereas 960 (76.4%) were non-aggressive subtypes of basal cell carcinoma. The age of diagnosis was: 72.78±12.31 years for sclerodermiform basal cell and 69.26±13.87 years for non-aggressive basal cell carcinoma (P<.0001). Sclerodermiform basal cell carcinomas are diagnosed on average 3.52 years later than non-aggressive basal cell carcinomas. Sclerodermiform basal cell carcinomas were diagnosed 3.40 years and 2.34 years later than non-aggressive basal cell carcinomas in younger and older patients respectively (P=.002 and P=.03, respectively).Study limitationsretrospective design.ConclusionThe diagnostic accuracy and primary clinic conjecture of sclerodermiform basal cell carcinomas is quite low compared to other forms of basal cell carcinoma such as nodular, superficial and pigmented. The dermoscopic vascular patterns, which is the basis for the diagnosis of non-melanocytic nonpigmented skin tumors, may not be particularly useful in identifying sclerodermiform basal cell carcinomas in early stages. As a distinct entity, sclerodermiform basal cell carcinomas show a lack of early diagnosis compared to less-aggressive subtypes of BCC, and thus, more accurate diagnostic tools apart from dermatoscopy are required to reach the goal of early-stage diagnosis of sclerodermiform basal cell carcinomas.

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“…The Vivascope 3000 ® can be handled and placed directly on the skin, but, in contrast to the 1500 ® system, it allows visualization only of the point it is focusing on and cannot provide a map or mosaic of a specific skin area. The 3000 ® system is therefore more appropriate for diagnosis of lentigo maligna and freckles on the face (32-34), BCC (35)(36)(37)(38)(39)(40)(41)(42), inflammatory diseases (43), and for cosmetology applications (44)(45)(46)(47).…”

Section: Confocal Microscopy: Non-invasive Imaging Of the Skin With Cmentioning

confidence: 99%

Dermoscopy, Confocal Microscopy and other Non-invasive Tools for the Diagnosis of Non-Melanoma Skin Cancers and Other Skin Conditions

Malvehy

Pellacani²

2017

Acta Derm Venerol

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Non-melanoma skin cancer (NMSC), including basal cell and squamous cell carcinomas, is the most common form of neoplasm. The incidence of NMSC is increasing worldwide. The cure rate is high with early detection and appropriate treatment. Visual examination is the first screening tool used by clinicians, but it is sometimes not sufficient to discriminate benign from malignant lesions. Skin biopsy with histopathology is the gold standard for differential diagnosis; however, this procedure is invasive and occasionally painful. Repeated tissue sampling is not possible in patients with several suspicious lesions and various clinical presentations that are challenging to identify. There are several medical imaging tools for non-invasive in-depth skin examination that can be used to guide clinical diagnosis: dermoscopy, confocal microscopy, cross-polarized light and fluorescence photography, optical coherence tomography and high-frequency ultrasound. These tools are discussed along with their clinical applications. These techniques provide valuable morphological information for better identification, confident diagnosis and treatment monitoring of NMSC.

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Non‐invasive diagnosis of pink basal cell carcinoma: how much can we rely on dermoscopy and reflectance confocal microscopy?

Abstract: The combination of dermoscopy-RCM evaluation significantly improves the accuracy and safety threshold in equivocal 'pink' cutaneous lesions in the differential diagnosis of basal cell carcinoma.

Cited by 25 publications

References 46 publications

Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases

Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases

Sclerodermiform basal cell carcinoma: how much can we rely on dermatoscopy to differentiate from non-aggressive basal cell carcinomas? Analysis of 1256 cases

Dermoscopy, Confocal Microscopy and other Non-invasive Tools for the Diagnosis of Non-Melanoma Skin Cancers and Other Skin Conditions

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