The diagnostic accuracy of dermoscopy and reflectance confocal microscopy for amelanotic/hypomelanotic melanoma: a systematic review and meta‐analysis

Abstract

Summary Background Dermoscopy and reflectance confocal microscopy (RCM) are noninvasive techniques for the diagnosis of skin lesions. Their accuracy for amelanotic/hypomelanotic melanoma (AHM) has not been systematically studied. Objectives We aimed to investigate systematically the accuracy of dermoscopy and RCM and to compare the accuracy between them for diagnosing AHM. Methods We searched the PubMed, Web of Science, Embase and Cochrane Library databases for eligible studies about dermoscopy, RCM and AHM from inception to 31 June 2019. The quality of the studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool. The pooled results were calculated using a random effects model in Stata 14, Meta‐DiSc, RevMan 5·3 and SAS 9·4. We also explored the sources of heterogeneity by sensitivity analysis. Results Seven studies with a total of 1111 lesions were included. The pooled sensitivity and specificity of dermoscopy for the diagnosis of AHM were 61% [95% confidence interval (CI) 0·37–0·81] and 90% (95% CI 0·74–0·97), respectively. The corresponding respective values of RCM for the diagnosis of AHM were 67% (95% CI 0·51–0·81) and 89% (95% CI 0·86–0·92). In three studies including the performance of both RCM and dermoscopy, the relative diagnostic odds ratio of RCM over dermoscopy was 4·69 (95% CI 0·81–27·3) (P = 0·068). Conclusions Our study demonstrates that both dermoscopy and RCM offer good diagnostic accuracy with high specificity and moderate sensitivity in the diagnosis of AHM. RCM is more accurate than dermoscopy in diagnosing AHM but the comparison needs to be confirmed. What's already known about this topic? Amelanotic/hypomelanotic melanoma (AHM) is the most lethal skin cancer. The diagnosis of AHM is a great challenge because of its nonspecific clinical manifestation. Early diagnosis can improve the prognosis. Dermoscopy and reflectance confocal microscopy (RCM) have high diagnostic accuracy for pigmented melanoma. What does this study add? Both dermoscopy and RCM offer good diagnostic accuracy with high specificity and moderate sensitivity for AHM. RCM might be more accurate than dermoscopy for diagnosis of AHM. More research on the diagnostic accuracy of dermoscopy and RCM for AHM is required in support of these findings. Linked Comment: Chi. Br J Dermatol 2020; 183:197.

Efficacy and Safety of Laser‐Assisted Combination Chemotherapy: An Explorative Imaging‐Guided Treatment With 5‐Fluorouracil and Cisplatin for Basal Cell Carcinoma

“…Our specific aim was to evaluate tumor response, safety, and drug biodistribution in tumors and blood after AFL-assisted 5-FU + CIS treatment in patients with low-risk BCCs. As imaging-guided diagnosis is known to improve diagnostic accuracy, multiple established imaging modalities were used to guide tumor demarcation and treatment over the course of the study [24][25][26].…”

Dermoscopy and reflectance confocal microscopy for early diagnosis of amelanotic/hypomelanotic melanoma: still a long way to go?

“…Nevertheless, the data suggest that the performance of both dermoscopy and RCM in early diagnosis of AHM is unsatisfactory and they may miss one‐third or more of affected cases. On the other hand, the pooled specificities for diagnosing AHM were 0·90 (95% CI 0·74–0·97) and 0·89 (95% CI 0·88–0·92) for dermoscopy and RCM, respectively . The high specificities of dermoscopy and RCM could arguably prevent unnecessary biopsies; however, this may not always be true as biopsy may still be indicated to avoid missing AHM, given the aforementioned low sensitivity.…”

“…Seven studies on the diagnostic accuracy of dermoscopy and three on RCM were included. The pooled sensitivities for diagnosing AHM were 0·61 [95% confidence interval (CI) 0·37–0·81] and 0·67 (95% CI 0·51–0·81) for dermoscopy and RCM, respectively . High sensitivity of diagnostic tools is preferable for the purpose of screening for early cancer.…”

“…In this issue of the BJD , Lan et al . review the diagnostic accuracy of dermoscopy and reflectance confocal microscopy (RCM) in diagnosing AHM using histopathology as the gold standard . Seven studies on the diagnostic accuracy of dermoscopy and three on RCM were included.…”

“…Lan et al . also found limited evidence from three included studies that suggests a higher accuracy of RCM than dermoscopy in early diagnosis of AHM, but the difference did not reach statistical significance (relative pooled diagnostic odds ratio 4·69, 95% CI 0·81–27·3) . Even if there is adequate evidence confirming the superiority of RCM in early diagnosis of AHM, the current high costs, time consumption and limited access to RCM instruments may limit its feasibility in the real‐world setting.…”