Surgical Margin Mapping of Melanoma In Situ Using In Vivo Reflectance Confocal Microscopy Mosaics

Abstract

BACKGROUNDMelanoma in situ (MIS) can have poorly defined borders and subclinical extension that makes margin control challenging. Reflectance confocal microscopy (RCM) is a promising noninvasive technique that can be used to assess subclinical spread.OBJECTIVETo optimize surgical margins of histology-proven MIS using RCM mosaics.MATERIALS AND METHODSProspective review of 22 patients with histology-proven MIS who underwent RCM margin mapping prior to staged excision, between August 1, 2018, and August 13, 2020, at the Department of Dermatology, University of New Mexico, School of Medicine.RESULTSTwenty patients (91%) had tumor clearance on the first stage using a 3-mm surgical margin after confocal margin mapping.CONCLUSIONReflectance confocal microscopy margin mapping using the mosaic device tends to clear MIS in one stage, and the use of the handheld device may improve the accuracy for difficult anatomic areas. Current Procedural Terminology codes for RCM do not reflect the time required and complexity of the procedure. Reflectance confocal microscopy margin mapping prior to excision has the potential to decrease the number of stages needed for melanoma removal, reduce treatment time, and cost.

Lentigo maligna (melanoma): A systematic review and meta‐analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

“…The available full texts of 145 studies were screened according to our eligibility criteria, and 92 studies did not meet our inclusion criteria. Several additional studies were excluded because no distinction was made between MIS of the superficial spreading melanoma type or MIS of the LM type (n = 9) [22][23][24][25][26][27][28][29][30] or reported on the same patient population as more recent publications (n = 3). [31][32][33]…”

Skin Cancer Pathobiology at a Glance: A Focus on Imaging Techniques and Their Potential for Improved Diagnosis and Surveillance in Clinical Cohorts

“…RCM enables the repetitive examination of the same skin area without causing any damage and proved useful in monitoring disease progression, tumor-associated vasculature, and inflammation in skin cancer patients [ 362 ]. Furthermore, RCM allows for the assessment of the entire lesion and may be employed to guide biopsies and define tumor margins before surgical excision [ 66 ] or other types of therapies [ 68 ]. Finally, RCM diagnostic features may help differentiate between the various histologic subtypes of skin tumors and guide the therapeutic decisions in the affected patients [ 71 ].…”

“…However, the most significant advantage comes from coupling RCM with dermatoscopy, as this procedure reduced by half the number of biopsies needed to diagnose melanocytic tumors compared to dermoscopy alone [ 64 , 65 ]. Last but not least, it should be noted that RCM can be used in CM for the evaluation of surgical margins [ 66 ] but also for non-invasive monitoring purposes in patients treated with systemic [ 67 ], radiation, or topical therapies [ 68 ]. According to the latest scientific reports, the sensitivity of RCM in estimating the risk of recurrence of CM is higher than that of dermoscopy [ 69 ].…”

Looking into the Skin in Health and Disease: From Microscopy Imaging Techniques to Molecular Analysis

“…It has been shown that CLSM is able to identify key features in different types of skin malignancies or premalignant lesions, being a performant, non-invasive diagnostic tool [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ] with increased accuracy as compared to previous non-invasive approaches [ 41 , 42 , 43 , 44 , 45 , 46 ]. Moreover, it is helpful for identification of distinct tumor subtypes with specific malignant behavior [ 47 , 48 , 49 ]; CLSM can also be used for the evaluation of tumor edges and surgical margins [ 50 , 51 ], and offers the advantage of non-invasive monitoring of the therapeutic response [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. Furthermore, the major advances in molecular imaging techniques, such as single photon emission computed tomography (SPECT/CT) and positron emission tomography (PET), and the recent burst in artificial intelligence research, have expanded the boundaries for the investigation of skin cancer, and are proven to be valuable tools for its detection and monitoring [ 61 , 62 , 63 ].…”