The role of reflectance confocal microscopy in differentiating melanoma in situ from dysplastic nevi with severe atypia: A cross-sectional study

Fraga‐Braghiroli, Naiara; Grant‐Kels, Jane M.; Oliviero, Margaret; Rabinovitz, Harold; Ferenczi, Katalin; Scope, Alon

doi:10.1016/j.jaad.2020.05.071

Cited by 12 publications

(12 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that an irregular honeycombed pattern, the presence of pagetoid spread, and the absence of dermal nests are the most important criteria to discriminate a melanoma from a nevus in LC-OCT. These findings are very similar to studies with RCM [29][30][31]. We were surprised that no criteria related to the DEJ could be detected here, but this can be explained by the fact that many superficial spreading melanomas have a well-defined DEJ, which were the majority of the melanomas in our study.…”

Section: Discussionsupporting

confidence: 91%

Line-Field Confocal Optical Coherence Tomography: A New Tool for the Differentiation between Nevi and Melanomas?

Schuh

Ruini

Perwein

et al. 2022

Cancers

View full text Add to dashboard Cite

Until now, the clinical differentiation between a nevus and a melanoma is still challenging in some cases. Line-field confocal optical coherence tomography (LC-OCT) is a new tool with the aim to change that. The aim of the study was to evaluate LC-OCT for the discrimination between nevi and melanomas. A total of 84 melanocytic lesions were examined with LC-OCT and 36 were also imaged with RCM. The observers recorded the diagnoses, and the presence or absence of the 18 most common imaging parameters for melanocytic lesions, nevi, and melanomas in the LC-OCT images. Their confidence in diagnosis and the image quality of LC-OCT and RCM were evaluated. The most useful criteria, the sensitivity and specificity of LC-OCT vs. RCM vs. histology, to differentiate a (dysplastic) nevus from a melanoma were analyzed. Good image quality correlated with better diagnostic performance (Spearman correlation: 0.4). LC-OCT had a 93% sensitivity and 100% specificity compared to RCM (93% sensitivity, 95% specificity) for diagnosing a melanoma (vs. all types of nevi). No difference in performance between RCM and LC-OCT was observed (McNemar’s p value = 1). Both devices falsely diagnosed dysplastic nevi as non-dysplastic (43% sensitivity for dysplastic nevus diagnosis). The most significant criteria for diagnosing a melanoma with LC-OCT were irregular honeycombed patterns (92% occurrence rate; 31.7 odds ratio (OR)), the presence of pagetoid spread (89% occurrence rate; 23.6 OR) and the absence of dermal nests (23% occurrence rate, 0.02 OR). In conclusion LC-OCT is useful for the discrimination between melanomas and nevi.

show abstract

Section: Discussionsupporting

confidence: 91%

Line-Field Confocal Optical Coherence Tomography: A New Tool for the Differentiation between Nevi and Melanomas?

Schuh

Ruini

Perwein

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“…Previous literature has reported overlap in the ABCDE criteria between NOSS and melanoma. 1,2 NOSS in this study tended to have an atypical clinical appearance including large size (>5 mm), multiple colors, history of evolution, irregularity, etc., with the most common reason for biopsy being “suspected malignancy.” Although dermoscopy 28–30 or advanced imaging technologies 31 may be able to better differentiate these lesions clinically, biopsy remains the gold standard. In our cohort, only one reviewed case was upgraded to early melanoma in situ (1/115%, 0.009%) during histologic re-examination.…”

Section: Discussionmentioning

confidence: 99%

A Single-Institution Cohort Study With Nevi of Special Site: Recurrence, Progression to Melanoma, and Patterns of Management

Elkeeb

Hopkins

Bolender

et al. 2022

The American Journal of Dermatopathology

View full text Add to dashboard Cite

Nevi of specialized sites (NOSS) occur on the scalp, ears, flexural, acral, and genital areas and display atypical clinical and histologic features. We assessed NOSS recurrence and progression to melanoma, management patterns, and associations between histologic features and treatment recommendations. We queried all histologic diagnoses of NOSS (n = 275) from 2012 to 2017 from a large U.S. academic medical center with reference dermatopathology laboratory and matched these to clinical records. A blinded panel of dermatopathologists re-evaluated lesions, catalogued histologic findings, and gave management recommendation. Associations with dermatopathologist decision and concordance between new and original recommendations were assessed. Of 117 cases with follow-up, 2 locally recurred (1.46%) and none eventuated in melanoma. Clinical features were not associated with original treatment recommendations. After histopathologic review, large melanocytes [odds ratio ratio (ORR) = 8.00, 95% CI, 1.35-47.4] and junctional mitotic figures (ORR = 65.0, 6.5-650) predicted excision recommendation. Likewise, accumulation of many (.9) high-risk features was associated with excision recommendation. Panel review changed treatment recommendation in 27% of cases. Fair concordance existed between original and panel recommendations (k = 0.29, 0.15-0.44). The low rate of recurrence and lack of melanoma occurrence suggest that despite an atypical clinical and histopathologic appearance, these nevi have limited potential for malignant transformation. Histopathologic findings seem to be principal drivers behind the recommendation for excision in this analysis. Variability existed in treatment recommendations; the panel's consensus recommendation tended to downgrade treatment. This highlights the importance of further outcomes-based studies to identify true high-risk features and refine management guidelines.

show abstract

“…[27][28][29][30] The progressive technological advances made in recent years in the non-invasive skin-imaging field have provided dermatologists with instruments such as RCM, HD-OCT and HRUS able to give new and unespected insight into skin morphology [27] (Table 1). In specific situation such as the diagnosis of skin cancer at delicate sites and the surgical definition of surgical margins, the request for RCM and/or OCT examination in specialized centers is every day increasing [33,34]. In this context, there is currently a growing interest in non-invasive diagnostic techniques in AIBDs manifestations, especially for external mucosae and delicate skin sites [8,[11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Line field confocal optical coherence tomography: An adjunctive tool in the diagnosis of autoimmune bullous diseases

Tognetti

Cinotti

Suppa

et al. 2021

Journal of Biophotonics

View full text Add to dashboard Cite

Autoimmune bullous diseases (AIBDs)still represent a considerable a source of morbidity and mortality: early identification of a specific AIBD is often difficult due to overlapping clinical and/or laboratory features and time-consuming invasive laboratory tests. We aimed to investigate the potential role of a new imaging technology, line-field confocal optical coherence tomography (LC-OCT), in the non-invasive diagnosis of AIBDs. LC-OCT was performed at lesional, perilesional and contralateral healthy sites in 30 patients, before histology and direct immunofluorescence. LC-OCT examination was able to identify the level of split (subcorneal/ suprabasal/subepidermal/sublamina densa), to provide detailed images of the bulla roof morphology and content (eg, erythrocytes/acantholytic cells/polymorphonucleates). Areas of intra/subepidermal detachment were also detected also at clinically normal perilesional skin sites. LC-OCT can support physicians, real time and at bed-site, in the differential diagnosis of various AIBDs and their mimickers. Moreover, it can be used for the identification of subclinical lesions and therapy tapering.

show abstract

The role of reflectance confocal microscopy in differentiating melanoma in situ from dysplastic nevi with severe atypia: A cross-sectional study

Cited by 12 publications

References 39 publications

Line-Field Confocal Optical Coherence Tomography: A New Tool for the Differentiation between Nevi and Melanomas?

Line-Field Confocal Optical Coherence Tomography: A New Tool for the Differentiation between Nevi and Melanomas?

A Single-Institution Cohort Study With Nevi of Special Site: Recurrence, Progression to Melanoma, and Patterns of Management

Line field confocal optical coherence tomography: An adjunctive tool in the diagnosis of autoimmune bullous diseases

Contact Info

Product

Resources

About