Pigmented lesion on the face: which is the chance of being melanoma using reflectance confocal microscopy features?

Mendes, Fernanda Berti Rocha; Braga, Juliana Casagrande Tavoloni; Pinto, Clóvis Antônio Lopes; Macêdo, Mariana Petaccia de; Habinovitz, Harold; Rezze, Gisele Gargantini

doi:10.1007/s00403-021-02263-6

Cited by 2 publications

(5 citation statements)

References 26 publications

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“…The confounding RCM feature in AK was the frequent detection of intraepidermal Langherans dendritic cells, which can be challenging to differentiate from melanocytic dendritic cells, one of the relevant criteria for melanoma diagnosis. 12 This could explain why it may be difficult to differentiate AHLM/LMM from AK in RCM. Dermoscopically, early LM may be difficult to identify because it may share similar features with actinic keratosis or solar lentigo 8 ; differentiating AHLM/LMMs from actinic keratosis or solar lentigo on dermoscopy may be challenging (Figure 2a).…”

Section: Discussionmentioning

confidence: 99%

“…The high level of confidence with dermoscopy plus RCM in the diagnosis of AHLM/LMMs versus AKs was lower (70.8%) than in the diagnosis of AHLM/LMMs versus AHBLs (76.6%). The confounding RCM feature in AK was the frequent detection of intraepidermal Langherans dendritic cells, which can be challenging to differentiate from melanocytic dendritic cells, one of the relevant criteria for melanoma diagnosis 12 . This could explain why it may be difficult to differentiate AHLM/LMM from AK in RCM.…”

Section: Discussionmentioning

confidence: 99%

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The combination of dermoscopy and reflectance confocal microscopy increases the diagnostic confidence of amelanotic/hypomelanotic lentigo maligna

Pizzichetta,

Polesel,

Perrot

et al. 2024

The Journal of Dermatology

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The dermoscopic diagnosis of amelanotic/hypomelanotic lentigo maligna/lentigo maligna melanoma (AHLM/LMM) may be very difficult in its early stages because of lack of pigment. Reflectance confocal microscopy (RCM) is an imaging technique that is especially helpful for the diagnosis of lentigo maligna. To determine the diagnostic performances of dermoscopy and RCM in the diagnosis of AHLM/LMMs we evaluated dermoscopic and RCM images of consecutive cases of histopathologically confirmed AHLM/LMMs, amelanotic/hypomelanotic basal cell carcinoma and squamous cell carcinoma (AHBCCs/AHSCCs), amelanotic/hypomelanotic benign lesions (AHBLs), and actinic keratoses (AKs) from five participating centers. Sensitivity, specificity, accuracy, predictive values, and level of diagnosis confidence were calculated for both diagnostic procedures. Both dermoscopy and RCM showed diagnostic performance >97% in the diagnosis of AHLM/LMMs versus AHBCC/AHSCCs and their combination slightly improved diagnostic performance, with accuracy increasing from 98.0% to 99.1%. Similarly, RCM in combination with dermoscopy showed a tiny increase in the diagnostic performance in the diagnosis of AHLM/LMMs versus AHBLs (accuracy increased from 87.2% to 88.8%) and versus AKs (accuracy increased from 91.4% to 93.4%). Although the increase in diagnostic performance due to RCM was modest, the combination of dermoscopy and RCM greatly increased the level of confidence; high confidence in the diagnosis of AHLM/LMMs versus AHBLs increased from 36.2% with dermoscopy alone to 76.6% with dermoscopy plus RMC. Based on our results, dermoscopy and RCM should be complementary to improve not only diagnostic accuracy but also the level of diagnostic certainty in the diagnosis of AHLM/LMMs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The combination of dermoscopy and reflectance confocal microscopy increases the diagnostic confidence of amelanotic/hypomelanotic lentigo maligna

Pizzichetta,

Polesel,

Perrot

et al. 2024

The Journal of Dermatology

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“…Reflectance confocal microscopy images were collected with Vivascope 1500® and Vivascope 3000® (MAVIG GmbH). RCM criteria included previously described features at the epidermis: atypical cells (presence, type, shape [dendritic or roundish] and distribution [focal or widespread]), folliculotropism (presence or absence); at the dermal‐epidermal junction (DEJ) atypical cells, medusa head‐like structures, sheet‐like structures, junctional nests, bulging around the follicle and polycyclic papillary contours; and at the dermis: dermal nests, nucleated cells within the papillae and inflammation 9,11,12,16 …”

Section: Methodsmentioning

confidence: 99%

“…Other non‐invasive diagnostic tools have been applied to improve the identification accuracy of malignant lesions, including reflectance confocal microscopy (RCM) 9–11 . RCM patterns for LM/LMM include atypical cells at different skin layers, folliculotropism, medusa head‐like structures, sheet‐like structures, bulging around the follicle, junctional or dermal nests, nucleated cells within the papillae and inflammation (melanophages) 12–15 …”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] RCM patterns for LM/LMM include atypical cells at different skin layers, folliculotropism, medusa head-like structures, sheetlike structures, bulging around the follicle, junctional or dermal nests, nucleated cells within the papillae and inflammation (melanophages). [12][13][14][15] However, non-invasive diagnostic criteria to differentiate LM from LMM have been rarely reported for dermoscopy 7 and are currently lacking for RCM. 16,17 As partial or incisional biopsies may be preferred in these aesthetically sensitive areas, identifying non-invasive predictors of invasive disease can assist in determining an adequate biopsy strategy for the correct final histopathological diagnosis.…”

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confidence: 99%

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Lentigo maligna and lentigo maligna melanoma in vivo differentiation with dermoscopy and reflectance confocal microscopy: A retrospective, multicentre study

Guida

Alma

Fiorito

et al. 2023

Acad Dermatol Venereol

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IntroductionDermoscopic predictors of lentigo maligna (LM) and lentigo maligna melanoma (LMM) have been recently reported, but these have not been reported in reflectance confocal microscopy (RCM).Objectives(i) To validate dermoscopic predictors for LM/LMM, (ii) to identify RCM patterns in LM and LMM, and (iii) correlations between dermoscopic and RCM features in LM and LMM.Materials and MethodsA retrospective, multicentre study of consecutive lesions with histologically proven LM or LMM subtypes of the head and face, with complete sets of dermoscopic and RCM images.ResultsA total of 180 lesions were included (n = 40 LMM). Previously reported differential dermoscopic features for LM subtypes were confirmed. Other features significantly associated with LMM diagnosis included irregular hyperpigmented areas, shiny white streaks, atypical vessels and light brown colour at dermoscopy and medusa head‐like structures, dermal nests and nucleated cells within the papillae at RCM (p < 0.05). Correlations among LM lesions between dermoscopic and RCM features included brown to‐grey dots and atypical cells (epidermis), grey colour and inflammation and obliterated follicles and medusa head‐like structures. Among LMM lesions, significant correlations included obliterated follicles with folliculotropism, both irregular hyperpigmented areas and irregular blotches with widespread atypical cell distribution (epidermis), dermal nests and nucleated cells within the papillae (dermis). Irregular blotches were also associated with medusa head‐like structures (dermal epidermal junction [DEJ]).ConclusionsDermoscopic and RCM features can assist in the in vivo identification of LM and LMM and many are correlated. RCM three‐dimensional analysis of skin layers allows the identification of invasive components in the DEJ and dermis.

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Pigmented lesion on the face: which is the chance of being melanoma using reflectance confocal microscopy features?

Cited by 2 publications

References 26 publications

The combination of dermoscopy and reflectance confocal microscopy increases the diagnostic confidence of amelanotic/hypomelanotic lentigo maligna

The combination of dermoscopy and reflectance confocal microscopy increases the diagnostic confidence of amelanotic/hypomelanotic lentigo maligna

Lentigo maligna and lentigo maligna melanoma in vivo differentiation with dermoscopy and reflectance confocal microscopy: A retrospective, multicentre study

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