Skin Cancer Diagnosis With Reflectance Confocal Microscopy

Farnetani, Francesca; Scope, Alon; Braun, Ralph P.; González, Salvador; Guitera, Pascale; Malvehy, Josep; Manfredini, Marco; Marghoob, Ashfaq A.; Moscarella, Elvira; Oliviero, Margaret; Puig, Susana; Rabinovitz, Harold; Stanganelli, Ignazio; Longo, Caterina; Malagoli, Carlotta; Vinceti, Marco; Pellacani, Giovanni

doi:10.1001/jamadermatol.2015.0810

Cited by 83 publications

(35 citation statements)

References 22 publications

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“…Specificity for pink naevi excluding spitz naevi (R2: 55.3%; R3: 58.9%) showed significant improvement over dermoscopy only evaluation (35.7%) verifying that RCM permits visualization of morphologic features providing more cellular information for the reader and therefore the potential to improve both diagnostic accuracy and confidence in this group of equivocal lesions. In the SK/SL/LPLK/AK category specificities (R2: 48.4%; R3: 36.4%) were acceptable and also in concordance with literature [10–13]. The low specificity for recognizing spitz naevi (R2: 25.0%; R3: 12.5%) confirms previously reported limitations of RCM application in this subset of lesions [23].…”

Section: Discussionsupporting

confidence: 87%

“…A recent study showed that sensitivity is higher for experienced RCM users versus those who are new to the field (91.0% vs. 84.8%), but that specificity is quite similar (80.0% vs. 77.9%) [13]. In our study single reader dermoscopy-RCM image set evaluation was comparable with recently published literature showing that RCM has a high overall sensitivity for pink cutaneous lesions (R2: 91.3%; R3: 96.5%) [10–12,14,15,23].…”

Section: Discussionmentioning

confidence: 99%

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Improving Diagnostic Accuracy of Dermoscopically Equivocal Pink Cutaneous Lesions with Reflectance Confocal Microscopy in Telemedicine Settings: Double Reader Concordance Evaluation of 316 Cases

et al. 2016

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BackgroundSolitary pink lesions in differential diagnosis with hypopigmented/amelanotic melanoma present a diagnostic challenge in daily practice and are regularly referred for second expert opinion. Reflectance confocal microscopy (RCM) has been shown to improve diagnostic accuracy of dermoscopically equivocal pink lesions. No studies have been performed to evaluate the effect of adding a second expert reader and automatic removal of lesions with discordant management recommendations and its potential effect on diagnostic sensitivity and final management of these lesions in retrospective or telemedicine settings.ObjectiveTo improve diagnostic accuracy and reduce potential mismanagement of dermoscopically equivocal pink cutaneous lesions by implementing double reader concordance evaluation of RCM images.Methods316 dermoscopically equivocal pink lesions with dermoscopy-RCM image sets were evaluated retrospectively. Accuracy of three readers was evaluated by single reader evaluation of dermoscopy only and dermoscopy-RCM image sets and finally by double reader evaluation of dermoscopy-RCM image sets. Lesions with discordant diagnosis between two readers were automatically recommended for excision.ResultsDermoscopy only evaluation resulted in an overall sensitivity of 95.9% and specificity of 33.6%, with 1 of 12 amelanotic melanomas mismanaged. Dermoscopy-RCM image set single reader evaluation resulted in an overall sensitivity of 93.9% and overall specificity of 54.2%, with 1 of 12 melanomas mismanaged. Dermoscopy-RCM image set double reader concordance evaluation resulted in an overall sensitivity of 98.3% and specificity of 42.7%, with no amelanotic melanoma mismanagement.ConclusionEvaluation of dermoscopy-RCM image sets of equivocal pink lesions by a single reader in telemedicine settings is limited by the potential for misdiagnosis of dangerous malignant lesions. Double reader concordance evaluation with automatic referral of lesions for removal in the case of discordant diagnosis improves the diagnostic sensitivity in this subset of lesions and reduce potential misdiagnosis in settings where a second expert opinion may be employed.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Improving Diagnostic Accuracy of Dermoscopically Equivocal Pink Cutaneous Lesions with Reflectance Confocal Microscopy in Telemedicine Settings: Double Reader Concordance Evaluation of 316 Cases

et al. 2016

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“…The RCM features included: cord-like structures, tumor nests, palisading, streaming, dark peri-tumoral rim (clefting), stroma with plump cells and bright dots, and horizontal vessels, 13,14,16,27–29 while OCT features were: hyporeflective/gray structures attached to the dermal-epidermal junction (DEJ), disruption of the DEJ, hyporeflective/gray ovoid structures in the dermis, dark peri-tumoral rim (clefting), hyper-reflective peritumoral stroma, hyper-reflective streaks and branched vessels. 12,30–32 …”

Section: Methodsmentioning

confidence: 99%

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

et al. 2018

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IMPORTANCE The limited tissue sampling of a biopsy can lead to an incomplete assessment of basal cell carcinoma (BCC) subtypes and depth. Reflectance confocal microscopy (RCM) combined with optical coherence tomography (OCT) imaging may enable real-time, noninvasive, comprehensive three-dimensional sampling in vivo, which may improve the diagnostic accuracy and margin assessment of BCCs.OBJECTIVE To determine the accuracy of a combined RCM-OCT device for BCC detection and deep margin assessment. DESIGN, SETTING, AND PARTICIPANTSThis pilot study was carried out on 85 lesions from 55 patients referred for physician consultation or Mohs surgery at Memorial Sloan Kettering Skin Cancer Center in Hauppauge, New York. These patients were prospectively and consecutively enrolled in the study between January 1, 2017, and December 31, 2017. Patients underwent imaging, with the combined RCM-OCT probe, for previously biopsied, histopathologically confirmed BCCs and lesions clinically or dermoscopically suggestive of BCC. Only patients with available histopathologic examination after imaging were included. MAIN OUTCOMES AND MEASURESImprovements in sensitivity, specificity, and diagnostic accuracy for BCC using the combined RCM-OCT probe as well as the correlation between OCT-estimated depth and histopathologically measured depth were investigated. RESULTSIn total, 85 lesions from 55 patients (27 [49%] were female and 28 [51%] were male with a median [range] age of 59 [21-90] years) were imaged. Imaging was performed on 25 previously biopsied and histopathologically confirmed BCCs and 60 previously nonbiopsied but clinically or dermoscopically suspicious lesions. Normal skin and BCC features were correlated and validated with histopathologic examination. In previously biopsied lesions, residual tumors were detected in 12 of 25 (48%) lesions with 100% sensitivity (95% CI, 73.5%-100%) and 23.1% specificity (95% CI, 5.0%-53.8%) for combined RCM-OCT probe. In previously nonbiopsied and suspicious lesions, BCCs were diagnosed in 48 of 60 (80%) lesions with 100% sensitivity (95% CI, 92.6%-100%) and 75% specificity (95% CI, 42.8%-94.5%). Correlation was observed between depth estimated with OCT and depth measured with histopathologic examination: the coefficient of determination (R 2 ) was 0.75 (R = 0.86; P < .001) for all lesions, 0.73 (R = 0.85; P < .001) for lesions less than 500 μm deep, and 0.65 (R = 0.43; P < .001) for lesions greater than 500 μm deep. CONCLUSIONS AND RELEVANCECombined RCM-OCT imaging may be prospectively used to comprehensively diagnose lesions suggestive of BCC and triage for treatment. Further validation of this device must be performed on a larger cohort.

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“…Other studies have shown good correlation between RCM and histopathology for melanocytic pathologies under different circumstances, 9,17 but difficulties with correlation in the dermal layer. 18 Secondly, there was no guarantee that RCM images were taken from where the DM was identified histologically within the specimen. While this would be desirable in a prospective study design, because DM is rare, it may be difficult to undertake.…”

Section: Discussionmentioning

confidence: 99%

Detection of desmoplastic melanoma with dermoscopy and reflectance confocal microscopy

Maher

Solinas

Scolyer

et al. 2017

Acad Dermatol Venereol

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Background Desmoplastic melanoma (DM) is frequently misdiagnosed clinically and often associated with melanoma in situ (MIS). Objective To improve the detection of DM using dermoscopy and reflectance confocal microscopy (RCM). Methods A descriptive analysis of DM dermoscopy features and a case-control study within a melanoma population for RCM feature evaluation, performed blindly, using data obtained between 2005 and 2015. After retrospectively identifying all DM cases with RCM data over the study period (n=16), a control group of non-DM melanoma patients with RCM data, in a ratio of at least 3:1, was selected. The control group was matched by age and primary tumor site location, divided into non-DM invasive melanomas (n=27) and MIS (n=27). Invasive melanomas were selected according to the melanoma subtypes associated with the DM cases. The main outcomes were the frequency of melanoma-specific features on dermoscopy for DM; and the odds ratios of RCM features to distinguish DM from MIS and/or other invasive melanomas; or MIS from the combined invasive melanoma group. Results At least 1 of the 14 melanoma-specific features evaluated on dermoscopy were found in 100% of DMs (n=15 DM with dermoscopy). Known RCM melanoma predictors were commonly found in the DMs, such as pagetoid cells (100%) and cell atypia (100%). The RCM feature of spindle cells in the superficial dermis was more common in DM compared with the entire melanoma control group (OR 3.82, 95% CI 1.01–14.90), and particularly compared to MIS (OR 5.48, 95% CI 1.11–32.36). Nucleated cells in the dermis and the RCM correlate of dermal inflammation were also significant RCM features favouring DM over MIS, as well as invasive melanoma over MIS. Conclusion Dermoscopy and RCM may be useful tools for the identification of DM. Certain RCM features may help distinguish DM from MIS and other invasive melanomas. Larger studies are warranted.

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Skin Cancer Diagnosis With Reflectance Confocal Microscopy

Cited by 83 publications

References 22 publications

Improving Diagnostic Accuracy of Dermoscopically Equivocal Pink Cutaneous Lesions with Reflectance Confocal Microscopy in Telemedicine Settings: Double Reader Concordance Evaluation of 316 Cases

Improving Diagnostic Accuracy of Dermoscopically Equivocal Pink Cutaneous Lesions with Reflectance Confocal Microscopy in Telemedicine Settings: Double Reader Concordance Evaluation of 316 Cases

Evaluation of a Combined Reflectance Confocal Microscopy–Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma

Detection of desmoplastic melanoma with dermoscopy and reflectance confocal microscopy

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