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Abarzua-Araya A, Bañuls J, Cabo H, Carrera C, Gamo R, González S, Jaimes N, Navarrete-Dechent C, Pérez Anker J, Roldán-Marín R, Segura S, Yélamos O, Puig S, Malvehy J. [Translated article] Reflectance Confocal Microscopy Terminology in Spanish: A Delphi Consensus Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T258-T264. [PMID: 38244840 DOI: 10.1016/j.ad.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/09/2023] [Indexed: 01/22/2024] Open
Abstract
The terminology used to describe reflectance confocal microscopy (RCM) findings in both melanocytic and nonmelanocytic lesions has been standardized in English. We convened a panel of Spanish-speaking RCM experts and used the Delphi method to seek consensus on which Spanish terms best describe RCM findings in this setting. The experts agreed on 52 terms: 28 for melanocytic lesions and 24 for nonmelanocytic lesions. The resulting terminology will facilitate homogenization, leading to a better understanding of structures, more standardized descriptions in clinical registries, and easier interpretation of clinical reports exchanged between dermatologists.
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Affiliation(s)
- A Abarzua-Araya
- Melanoma Unit, Dermatology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; Dermatology Department, Hospital General Universitario de Alicante Dr. Balmis, ISABIAL, Alicante, Spain; Universidad de Buenos Aires, Buenos Aires, Argentina; Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J Bañuls
- Dermatology Department, Hospital General Universitario de Alicante Dr. Balmis, ISABIAL, Alicante, Spain
| | - H Cabo
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - C Carrera
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Hospital Fundación Alcorcón, Madrid, Spain; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, Spain; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), Spain; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - R Gamo
- Hospital Fundación Alcorcón, Madrid, Spain
| | - S González
- Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, Spain
| | - N Jaimes
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - C Navarrete-Dechent
- Melanoma Unit, Dermatology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Pérez Anker
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - R Roldán-Marín
- Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - S Segura
- Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), Spain
| | - O Yélamos
- Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Puig
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Hospital Fundación Alcorcón, Madrid, Spain; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, Spain; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), Spain; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain.
| | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Hospital Fundación Alcorcón, Madrid, Spain; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, Spain; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), Spain; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
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Abarzua-Araya A, Bañuls J, Cabo H, Carrera C, Gamo R, González S, Jaimes N, Navarrete-Dechent C, Pérez Anker J, Roldán-Marín R, Segura S, Yélamos O, Puig S, Malvehy J. Reflectance Confocal Microscopy Terminology in Spanish: A Delphi Consensus Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:258-264. [PMID: 37890615 DOI: 10.1016/j.ad.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
The terminology used to describe reflectance confocal microscopy (RCM) findings in both melanocytic and nonmelanocytic lesions has been standardized in English. We convened a panel of Spanish-speaking RCM experts and used the Delphi method to seek consensus on which Spanish terms best describe RCM findings in this setting. The experts agreed on 52 terms: 28 for melanocytic lesions and 24 for nonmelanocytic lesions. The resulting terminology will facilitate homogenization, leading to a better understanding of structures, more standardized descriptions in clinical registries, and easier interpretation of clinical reports exchanged between dermatologists.
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Affiliation(s)
- A Abarzua-Araya
- Melanoma Unit, Dermatology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; Dermatology Department, Hospital General Universitario de Alicante Dr. Balmis, ISABIAL, Alicante, España; Universidad de Buenos Aires, Buenos Aires, Argentina; Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - J Bañuls
- Dermatology Department, Hospital General Universitario de Alicante Dr. Balmis, ISABIAL, Alicante, España
| | - H Cabo
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - C Carrera
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Hospital Fundación Alcorcón, Madrid, España; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, España; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), España; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, España
| | - R Gamo
- Hospital Fundación Alcorcón, Madrid, España
| | - S González
- Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, España
| | - N Jaimes
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos
| | - C Navarrete-Dechent
- Melanoma Unit, Dermatology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Pérez Anker
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - R Roldán-Marín
- Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - S Segura
- Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), España
| | - O Yélamos
- Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, España
| | - S Puig
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Hospital Fundación Alcorcón, Madrid, España; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, España; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), España; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, España.
| | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Hospital Fundación Alcorcón, Madrid, España; Department of Medicine and Medical Specialties, Alcalá de Henares University, Madrid, España; Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, Estados Unidos; Clínica de Onco-dermatología, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Dermatology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Universitat de Vic-Universitat central de Catalunya (UVIC), España; Dermatology Department, Hospital de Santa Creu i Sant Pau de Barcelona, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, España
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Braga JCT, Barcaui CB, Pinheiro AM, Sortino AMF, Abdalla CMZ, Campos-do-Carmo G, Rezze GG, Piñeiro-Maceira J, Rocha LL, Maia M, Sá BCSD. Reflectance confocal microscopy - Consensus terminology glossary in Brazilian Portuguese for normal skin, melanocytic and non-melanocytic lesions. An Bras Dermatol 2024; 99:100-110. [PMID: 37777382 DOI: 10.1016/j.abd.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Currently, there is no uniform and official terminology in Portuguese for reflectance confocal microscopy analysis, despite the increasing number of Brazilian dermatologists using this new tool. OBJECTIVE To present the terminology in Brazilian Portuguese for the description of reflectance confocal microscopy and establish the first Brazilian consensus on terms related to normal skin and cutaneous tumors. METHODS 10 Brazilian specialists from different institutions and states of Brazil were selected to evaluate the best corresponding terms in Portuguese for normal skin, melanocytic and non-melanocytic tumors. The terms used were translated from international consensuses in the English language. The modified Delphi method was used to create the consensus in 3 steps. RESULTS The terms considered the most appropriate in the Portuguese language to describe the findings of normal skin, melanocytic and non-melanocytic lesions in the reflectance confocal microscopy analysis were presented. STUDY LIMITATIONS The limitations of the present study include the number of participants and limited regional representation (only two of the five Brazilian regions were represented). CONCLUSION This Brazilian consensus represents an opportunity for dermatologists and physicians specializing in cutaneous oncology to become familiar with reflectance confocal microscopy, propagating the technique in clinical and research environments to stimulate national and international publications on this subject.
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Affiliation(s)
| | - Carlos B Barcaui
- Service of Dermatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ana Maria Pinheiro
- Department of Dermatology, Universidade de Brasília, Brasília, DF, Brazil
| | | | | | - Gabriella Campos-do-Carmo
- Department of Dermatology, Instituto Nacional de Câncer, Gávea Medical Center, Rio de Janeiro, RJ, Brazil
| | - Gisele Gargantini Rezze
- Department of Dermatology, Hospital Clínic I Provincial da Universidade de Barcelona, Barcelona, Spain
| | - Juan Piñeiro-Maceira
- Service of Dermatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lilian Licarião Rocha
- Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcus Maia
- Dermatology Clinic, Santa Casa de Misericórdia São Paulo, São Paulo, SP, Brazil
| | - Bianca Costa Soares de Sá
- Department of Dermatology, Núcleo de Câncer de Pele, A.C. Camargo Câncer Center, São Paulo, SP, Brazil
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In vivo optical imaging-guided targeted sampling for precise diagnosis and molecular pathology. Sci Rep 2021; 11:23124. [PMID: 34848749 PMCID: PMC8633337 DOI: 10.1038/s41598-021-01447-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023] Open
Abstract
Conventional tissue sampling can lead to misdiagnoses and repeated biopsies. Additionally, tissue processed for histopathology suffers from poor nucleic acid quality and/or quantity for downstream molecular profiling. Targeted micro-sampling of tissue can ensure accurate diagnosis and molecular profiling in the presence of spatial heterogeneity, especially in tumors, and facilitate acquisition of fresh tissue for molecular analysis. In this study, we explored the feasibility of performing 1–2 mm precision biopsies guided by high-resolution reflectance confocal microscopy (RCM) and optical coherence tomography (OCT), and reflective metallic grids for accurate spatial targeting. Accurate sampling was confirmed with either histopathology or molecular profiling through next generation sequencing (NGS) in 9 skin cancers in 7 patients. Imaging-guided 1–2 mm biopsies enabled spatial targeting for in vivo diagnosis, feature correlation and depth assessment, which were confirmed with histopathology. In vivo 1-mm targeted biopsies achieved adequate quantity and high quality of DNA for next-generation sequencing. Subsequent mutational profiling was confirmed on 1 melanoma in situ and 2 invasive melanomas, using a 505-gene mutational panel called Memorial Sloan Kettering-Integrated mutational profiling of actionable cancer targets (MSK-IMPACT). Differential mutational landscapes, in terms of number and types of mutations, were found between invasive and in situ melanomas in a single patient. Our findings demonstrate feasibility of accurate sampling of regions of interest for downstream histopathological diagnoses and molecular pathology in both in vivo and ex vivo settings with broad diagnostic, therapeutic and research potential in cutaneous diseases accessible by RCM-OCT imaging.
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Scope A, Farnetani F, Haupt S, Schechtman E, Longo C, Pellacani G. Dermoscopic and clinical predictors of reflectance confocal microscopy patterns of typical nevi on the back and legs: A cross-sectional study. J Am Acad Dermatol 2020; 85:1240-1247. [PMID: 32534083 DOI: 10.1016/j.jaad.2020.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nevus phenotype is a marker of melanoma risk. In vivo prediction of microscopic pattern is needed to more precisely classify nevi. OBJECTIVE To identify dermoscopic and clinical predictors of microscopic patterns of typical nevi. METHODS We used reflectance confocal microscopy (RCM) to classify microscopic patterns of nevi. We prospectively accrued adults presenting for periodic skin screening and imaged, with dermoscopy and RCM, 3 randomly selected nevi from the upper and lower back and lower extremity. RCM patterns were classified into ring, clod, meshwork, and composite types. Logistic regression was used to identify best predictors of RCM pattern. RESULTS The study included 310 nevi from 112 participants (mean age 44 years; 51 women). Dermoscopic reticular pattern correlated most frequently (59.9%) with RCM ring pattern, dermoscopic globular with RCM composite (56.6%) and RCM clod (35.9%), dermoscopic complex with RCM composite (76.3%), and dermoscopic homogenous with RCM clod (50.8%). Integrating dermoscopic pattern with contour, diameter, color, and anatomic location of nevi improved prediction of microscopic patterns beyond dermoscopy alone. The dermoscopic clinical regression model correctly classified lesions to RCM ring versus RCM clod in 90% and to RCM ring versus RCM composite patterns in 81%. LIMITATIONS The study was restricted to adults, back and lower extremities, and typical nevi. CONCLUSIONS Integrating dermoscopic patterns with clinical attributes may improve prediction of microscopic patterns of nevi.
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Affiliation(s)
- Alon Scope
- Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara Haupt
- Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edna Schechtman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Azienda Unità Sanitaria Locale-Istituto Di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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Navarrete-Dechent C, Liopyris K, Monnier J, Aleissa S, Boyce LM, Longo C, Oliviero M, Rabinovitz H, Marghoob AA, Halpern AC, Pellacani G, Scope A, Jain M. Reflectance confocal microscopy terminology glossary for melanocytic skin lesions: A systematic review. J Am Acad Dermatol 2020; 84:102-119. [PMID: 32454102 DOI: 10.1016/j.jaad.2020.05.097] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is lack of uniformity in the reflectance confocal microscopy (RCM) terminology for melanocytic lesions. OBJECTIVE To review published RCM terms for melanocytic lesions and identify redundant, synonymous terms. METHODS A systematic review of original research articles adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted until August 15, 2018. Two investigators gathered all published RCM terms used to describe melanoma and melanocytic nevi. Synonymous terms were grouped based on similarity in definition and in histopathologic correlation. RESULTS Out of 156 full-text screened articles, 59 studies met the inclusion criteria. We identified 209 terms; 191 (91.4%) corresponding to high-magnification/cellular-level terms and 18 (8.6%) corresponding to low-magnification/architectural patterns terms. The overall average use frequency of RCM terms was 3.1 times (range, 1-31). By grouping of individual RCM terms based on likely synonymous definitions and by eliminating terms lacking clear definition, the total number of RCM terms could be potentially reduced from 209 to 40 terms (80.8% reduction). LIMITATIONS Non-English and non-peer-reviewed articles were excluded. CONCLUSIONS This systematic review of published RCM terms identified significant terminology redundancy. It provides the basis for subsequent terminology consensus on melanocytic neoplasms.
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Affiliation(s)
- Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Konstantinos Liopyris
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, University of Athens, Andreas Syggros Hospital of Skin and Venereal Diseases, Athens, Greece
| | - Jilliana Monnier
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Saud Aleissa
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lindsay M Boyce
- Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Azienda Unità Sanitaria Locale-Istituo di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | | | | | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alon Scope
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Manu Jain
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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7
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Sahu A, Yélamos O, Iftimia N, Cordova M, Alessi-Fox C, Gill M, Maguluri G, Dusza SW, Navarrete-Dechent C, González S, Rossi AM, Marghoob AA, Rajadhyaksha M, Chen CSJ. Evaluation of a Combined Reflectance Confocal Microscopy-Optical Coherence Tomography Device for Detection and Depth Assessment of Basal Cell Carcinoma. JAMA Dermatol 2019; 154:1175-1183. [PMID: 30140851 DOI: 10.1001/jamadermatol.2018.2446] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
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 Participants This 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 Measures Improvements 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. Results In 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 (R2) 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 Relevance Combined 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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Affiliation(s)
- Aditi Sahu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oriol Yélamos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Nicusor Iftimia
- Biomedical Optics Technologies Group, Physical Sciences Inc, Andover, Massachusetts
| | - Miguel Cordova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christi Alessi-Fox
- Clinical Development, Caliber Imaging and Diagnostics Inc, Rochester, New York
| | - Melissa Gill
- SkinMedical Research and Diagnostics, PLLC, Dobbs Ferry, New York.,Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Gopi Maguluri
- Biomedical Optics Technologies Group, Physical Sciences Inc, Andover, Massachusetts
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cristián Navarrete-Dechent
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Dermatology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Salvador González
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Medicine and Medical Specialties Department, Instituto Ramon y Cajal de Investigacion Sanitaria, Alcalá University, Madrid, Spain.,Department of Dermatology, Alcalá University, Madrid, Spain
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Milind Rajadhyaksha
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chih-Shan J Chen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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8
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A Systematic Review and Meta-Analysis of the Accuracy of in VivoReflectance Confocal Microscopy for the Diagnosis of Primary Basal Cell Carcinoma. J Clin Med 2019; 8:jcm8091462. [PMID: 31540342 PMCID: PMC6780971 DOI: 10.3390/jcm8091462] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 12/18/2022] Open
Abstract
Basal cell carcinoma (BCC) is the most common cancer worldwide and its incidence is constantly rising. Early diagnosis and treatment can significantly reduce patient morbidity and healthcare costs. The value of reflectance confocal microscopy (RCM) in non-melanoma skin cancer diagnosis is still under debate. This systematic review and meta-analysis were conducted to assess the diagnostic accuracy of RCM in primary BCC. PubMed, Google Scholar, Scopus, and Web of Science databases were searched up to July 05, 2019, to collect articles concerning primary BCC diagnosis through RCM. The studies’ methodological quality was assessed by the QUADAS-2 tool. The meta-analysis was conducted using Stata 13.0, RevMan 5.0, and MetaDisc 1.4 software. We included 15 studies totaling a number of 4163 lesions. The pooled sensitivity and specificity were 0.92 (95% CI, 0.87–0.95; I2 = 85.27%) and 0.93 (95% CI, 0.85–0.97; I2 = 94.61%), the pooled positive and negative likelihood ratios were 13.51 (95% CI, 5.8–31.37; I2 = 91.01%) and 0.08 (95% CI, 0.05–0.14; I2 = 84.83%), and the pooled diagnostic odds ratio was 160.31 (95% CI, 64.73–397.02; I2 = 71%). Despite the heterogeneity and risk of bias, this study demonstrates that RCM, through its high sensitivity and specificity, may have a significant clinical impact on the diagnosis of primary BCC.
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9
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Agozzino M, Moscarella E, Babino G, Caccavale S, Piccolo V, Argenziano G. The use of in vivo reflectance confocal microscopy for the diagnosis of melanoma. Expert Rev Anticancer Ther 2019; 19:413-421. [PMID: 30869538 DOI: 10.1080/14737140.2019.1593829] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The use of reflectance confocal microscopy (RCM) for imaging the skin non-invasively raised constantly during the last decade. One of the main field of application is skin cancer diagnosis, and in particular melanoma diagnosis. Several studies have investigated the diagnostic accuracy of RCM as compared to dermoscopic examination, and its value in enhancing early diagnosis of dermoscopic difficult melanomas. Areas covered: The purpose of this paper was to review the principles behind RCM image acquisition as well as to describe and discuss key RCM features of melanoma. Moreover, we conducted a literature search in order to highlight the current available evidence about RCM sensitivity and specificity in the diagnosis of melanoma. Expert commentary: During the last decade, we assisted at the increasing interest in non invasive imaging tools for the diagnosis of skin cancer. RCM is one of the most studied of a series of diagnostic methods that are emerging in the field of melanoma imaging. Most probably in the future, RCM will be more frequently available in tertiary referral centres, thus the knowledge of the pros and contra of the tool and its clinical applicability is of upmost importance in order to allow correct referrals with the final aim of improving diagnostic accuracy.
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Affiliation(s)
- Marina Agozzino
- a Dermatology Unit , University of Campania Luigi Vanvitelli , Naples , Italy
| | - Elvira Moscarella
- a Dermatology Unit , University of Campania Luigi Vanvitelli , Naples , Italy
| | - Graziella Babino
- a Dermatology Unit , University of Campania Luigi Vanvitelli , Naples , Italy
| | - Stefano Caccavale
- a Dermatology Unit , University of Campania Luigi Vanvitelli , Naples , Italy
| | - Vincenzo Piccolo
- a Dermatology Unit , University of Campania Luigi Vanvitelli , Naples , Italy
| | - Giuseppe Argenziano
- a Dermatology Unit , University of Campania Luigi Vanvitelli , Naples , Italy
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10
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Beretti F, Bertoni L, Farnetani F, Pellegrini C, Gorelli G, Cesinaro AM, Reggiani Bonetti L, Di Nardo L, Kaleci S, Chester J, Longo C, Massi D, Fargnoli MC, Pellacani G. Melanoma types by in vivo reflectance confocal microscopy correlated with protein and molecular genetic alterations: A pilot study. Exp Dermatol 2019; 28:254-260. [PMID: 30636079 DOI: 10.1111/exd.13877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 12/21/2022]
Abstract
Cutaneous melanoma (CM) is one of the most prevalent skin cancers, which lacks both a prognostic marker and a specific and lasting treatment, due to the complexity of the disease and heterogeneity of patients. Reflectance confocal microscopy (RCM) in vivo analysis is a versatile approach offering immediate morphological information, enabling the identification of four primary cutaneous RCM CM types. Whether RCM CM types are associated with a specific protein and molecular genetic profiles at the tissue level remains unclear. The current pilot study was designed to identify potential correlations between RCM CM types and specific biological characteristics, combining immunohistochemistry (IHC) and molecular analyses. Eighty primary CMs evaluated at patient bedside with RCM (type 1 [19, 24%], type 2 [12, 15%], type 3 [7, 9%] and type 4 [42, 52%]) were retrospectively evaluated by IHC stains (CD271, CD20, CD31, cyclin D1), fluorescence in situ hybridization FISH for MYC gain and CDKN2A loss and molecular analysis for somatic mutations (BRAF, NRAS and KIT). RCM CM types correlated with markers of stemness property, density of intra-tumoral lymphocytic B infiltrate and cyclin D1 expression, while no significant association was found with blood vessel density nor molecular findings. RCM CM types show a different marker profile expression, suggestive of a progression and an increase in aggressiveness, according to RCM morphologies.
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Affiliation(s)
- Francesca Beretti
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Bertoni
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Farnetani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Greta Gorelli
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Anna Maria Cesinaro
- Anatomic Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Luca Reggiani Bonetti
- Department of Medical and Surgical Sciences of Children & Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucia Di Nardo
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - Shaniko Kaleci
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica, Reggio Emilia, Italy
| | - Daniela Massi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Maria C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - Giovanni Pellacani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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11
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Reflectance confocal microscopy terminology glossary for nonmelanocytic skin lesions: A systematic review. J Am Acad Dermatol 2018; 80:1414-1427.e3. [PMID: 30529706 DOI: 10.1016/j.jaad.2018.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is lack of uniformity in reflectance confocal microscopy (RCM) terminology for nonmelanocytic lesions (NMLs). OBJECTIVE To review published RCM terms for NMLs and identify likely synonymous terms. METHODS We conducted a systematic review of original research articles published up to August 19, 2017, adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Two investigators gathered all published RCM terms used to describe basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and seborrheic keratosis/solar lentigo/lichen planus-like keratosis (SK/SL/LPLK). Synonymous terms were grouped on the basis of similarity in definition and histopathologic correlates. RESULTS The inclusion criteria was met by 31 studies. Average frequency of use per term was 1.6 (range 1-8). By grouping synonymous terms, the number of terms could be reduced from 58 to 18 for BCC, 58 to 36 for SCC, 23 to 12 for SK/SL/LPLK, and from 139 to 66 terms (52.5% reduction) in total. The frequency of term usage stratified by anatomic layer (suprabasal epidermis vs epidermal basal layer, dermoepidermal junction, and superficial dermis) was 27 (25.7%) versus 78 (74.2%) for BCC; 60 (64.5%) versus 33 (34.5%) for SCC, and 15 (45.4%) versus 18 (54.5%) for SK/SL/LPLK, respectively. LIMITATIONS Articles that were not peer reviewed were excluded. CONCLUSION Systematic review of published RCM terms provides the basis for future NMLs terminology consensus.
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12
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Dinnes J, Deeks JJ, Saleh D, Chuchu N, Bayliss SE, Patel L, Davenport C, Takwoingi Y, Godfrey K, Matin RN, Patalay R, Williams HC. Reflectance confocal microscopy for diagnosing cutaneous melanoma in adults. Cochrane Database Syst Rev 2018; 12:CD013190. [PMID: 30521681 PMCID: PMC6492459 DOI: 10.1002/14651858.cd013190] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Melanoma has one of the fastest rising incidence rates of any cancer. It accounts for a small percentage of skin cancer cases but is responsible for the majority of skin cancer deaths. Early detection and treatment is key to improving survival; however, anxiety around missing early cases needs to be balanced against appropriate levels of referral and excision of benign lesions. Used in conjunction with clinical or dermoscopic suspicion of malignancy, or both, reflectance confocal microscopy (RCM) may reduce unnecessary excisions without missing melanoma cases. OBJECTIVES To determine the diagnostic accuracy of reflectance confocal microscopy for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults with any lesion suspicious for melanoma and lesions that are difficult to diagnose, and to compare its accuracy with that of dermoscopy. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; and seven other databases. We studied reference lists and published systematic review articles. SELECTION CRITERIA Studies of any design that evaluated RCM alone, or RCM in comparison to dermoscopy, in adults with lesions suspicious for melanoma or atypical intraepidermal melanocytic variants, compared with a reference standard of either histological confirmation or clinical follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic threshold were missing. We estimated summary sensitivities and specificities per algorithm and threshold using the bivariate hierarchical model. To compare RCM with dermoscopy, we grouped studies by population (defined by difficulty of lesion diagnosis) and combined data using hierarchical summary receiver operating characteristic (SROC) methods. Analysis of studies allowing direct comparison between tests was undertaken. To facilitate interpretation of results, we computed values of specificity at the point on the SROC curve with 90% sensitivity as this value lies within the estimates for the majority of analyses. We investigated the impact of using a purposely developed RCM algorithm and in-person test interpretation. MAIN RESULTS The search identified 18 publications reporting on 19 study cohorts with 2838 lesions (including 658 with melanoma), which provided 67 datasets for RCM and seven for dermoscopy. Studies were generally at high or unclear risk of bias across almost all domains and of high or unclear concern regarding applicability of the evidence. Selective participant recruitment, lack of blinding of the reference test to the RCM result, and differential verification were particularly problematic. Studies may not be representative of populations eligible for RCM, and test interpretation was often undertaken remotely from the patient and blinded to clinical information.Meta-analysis found RCM to be more accurate than dermoscopy in studies of participants with any lesion suspicious for melanoma and in participants with lesions that were more difficult to diagnose (equivocal lesion populations). Assuming a fixed sensitivity of 90% for both tests, specificities were 82% for RCM and 42% for dermoscopy for any lesion suspicious for melanoma (9 RCM datasets; 1452 lesions and 370 melanomas). For a hypothetical population of 1000 lesions at the median observed melanoma prevalence of 30%, this equated to a reduction in unnecessary excisions with RCM of 280 compared to dermoscopy, with 30 melanomas missed by both tests. For studies in equivocal lesions, specificities of 86% would be observed for RCM and 49% for dermoscopy (7 RCM datasets; 1177 lesions and 180 melanomas). At the median observed melanoma prevalence of 20%, this reduced unnecessary excisions by 296 with RCM compared with dermoscopy, with 20 melanomas missed by both tests. Across all populations, algorithms and thresholds assessed, the sensitivity and specificity of the Pellacani RCM score at a threshold of three or greater were estimated at 92% (95% confidence interval (CI) 87 to 95) for RCM and 72% (95% CI 62 to 81) for dermoscopy. AUTHORS' CONCLUSIONS RCM may have a potential role in clinical practice, particularly for the assessment of lesions that are difficult to diagnose using visual inspection and dermoscopy alone, where the evidence suggests that RCM may be both more sensitive and specific in comparison to dermoscopy. Given the paucity of data to allow comparison with dermoscopy, the results presented require further confirmation in prospective studies comparing RCM with dermoscopy in a real-world setting in a representative population.
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Affiliation(s)
- Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Daniel Saleh
- Newcastle Hospitals NHS Trust, Royal Victoria InfirmaryNewcastle HospitalsNewcastleUK
- The University of Queensland, PA‐Southside Clinical UnitSchool of Clinical MedicineBrisbaneQueenslandAustralia
| | - Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Lopa Patel
- Royal Stoke HospitalPlastic SurgeryStoke‐on‐TrentStaffordshireUKST4 6QG
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Rakesh Patalay
- Guy's and St Thomas' NHS Foundation TrustDepartment of DermatologyDSLU, Cancer CentreGreat Maze PondLondonUKSE1 9RT
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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13
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Dinnes J, Deeks JJ, Chuchu N, Saleh D, Bayliss SE, Takwoingi Y, Davenport C, Patel L, Matin RN, O'Sullivan C, Patalay R, Williams HC. Reflectance confocal microscopy for diagnosing keratinocyte skin cancers in adults. Cochrane Database Syst Rev 2018; 12:CD013191. [PMID: 30521687 PMCID: PMC6516892 DOI: 10.1002/14651858.cd013191] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Early accurate detection of all skin cancer types is important to guide appropriate management and improve morbidity and survival. Basal cell carcinoma (BCC) is usually a localised skin cancer but with potential to infiltrate and damage surrounding tissue, whereas cutaneous squamous cell carcinoma (cSCC) and melanoma are higher risk skin cancers with the potential to metastasise and ultimately lead to death. When used in conjunction with clinical or dermoscopic suspicion of malignancy, or both, reflectance confocal microscopy (RCM) may help to identify cancers eligible for non-surgical treatment without the need for a diagnostic biopsy, particularly in people with suspected BCC. Any potential benefit must be balanced against the risk of any misdiagnoses. OBJECTIVES To determine the diagnostic accuracy of RCM for the detection of BCC, cSCC, or any skin cancer in adults with any suspicious lesion and lesions that are difficult to diagnose (equivocal); and to compare its accuracy with that of usual practice (visual inspection or dermoscopy, or both). SEARCH METHODS We undertook a comprehensive search of the following databases from inception to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA Studies of any design that evaluated the accuracy of RCM alone, or RCM in comparison to visual inspection or dermoscopy, or both, in adults with lesions suspicious for skin cancer compared with a reference standard of either histological confirmation or clinical follow-up, or both. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic threshold were missing. We estimated summary sensitivities and specificities using the bivariate hierarchical model. For computation of likely numbers of true-positive, false-positive, false-negative, and true-negative findings in the 'Summary of findings' tables, we applied summary sensitivity and specificity estimates to lower quartile, median and upper quartiles of the prevalence observed in the study groups. We also investigated the impact of observer experience. MAIN RESULTS The review included 10 studies reporting on 11 study cohorts. All 11 cohorts reported data for the detection of BCC, including 2037 lesions (464 with BCC); and four cohorts reported data for the detection of cSCC, including 834 lesions (71 with cSCC). Only one study also reported data for the detection of BCC or cSCC using dermoscopy, limiting comparisons between RCM and dermoscopy. Studies were at high or unclear risk of bias across almost all methodological quality domains, and were of high or unclear concern regarding applicability of the evidence. Selective participant recruitment, unclear blinding of the reference test, and exclusions due to image quality or technical difficulties were observed. It was unclear whether studies were representative of populations eligible for testing with RCM, and test interpretation was often undertaken using images, remotely from the participant and the interpreter blinded to clinical information that would normally be available in practice.Meta-analysis found RCM to be more sensitive but less specific for the detection of BCC in studies of participants with equivocal lesions (sensitivity 94%, 95% confidence interval (CI) 79% to 98%; specificity 85%, 95% CI 72% to 92%; 3 studies) compared to studies that included any suspicious lesion (sensitivity 76%, 95% CI 45% to 92%; specificity 95%, 95% CI 66% to 99%; 4 studies), although CIs were wide. At the median prevalence of disease of 12.5% observed in studies including any suspicious lesion, applying these results to a hypothetical population of 1000 lesions results in 30 BCCs missed with 44 false-positive results (lesions misdiagnosed as BCCs). At the median prevalence of disease of 15% observed in studies of equivocal lesions, nine BCCs would be missed with 128 false-positive results in a population of 1000 lesions. Across both sets of studies, up to 15% of these false-positive lesions were observed to be melanomas mistaken for BCCs. There was some suggestion of higher sensitivities in studies with more experienced observers. Summary sensitivity and specificity could not be estimated for the detection of cSCC due to paucity of data. AUTHORS' CONCLUSIONS There is insufficient evidence for the use of RCM for the diagnosis of BCC or cSCC in either population group. A possible role for RCM in clinical practice is as a tool to avoid diagnostic biopsies in lesions with a relatively high clinical suspicion of BCC. The potential for, and consequences of, misclassification of other skin cancers such as melanoma as BCCs requires further research. Importantly, data are lacking that compare RCM to standard clinical practice (with or without dermoscopy).
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Affiliation(s)
- Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Daniel Saleh
- Newcastle Hospitals NHS Trust, Royal Victoria InfirmaryNewcastle HospitalsNewcastleUK
- The University of Queensland, PA‐Southside Clinical UnitSchool of Clinical MedicineBrisbaneQueenslandAustralia
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Lopa Patel
- Royal Stoke HospitalPlastic SurgeryStoke‐on‐TrentStaffordshireUKST4 6QG
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | | | - Rakesh Patalay
- Guy's and St Thomas' NHS Foundation TrustDepartment of DermatologyDSLU, Cancer CentreGreat Maze PondLondonUKSE1 9RT
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Elosua-González M, Gamo-Villegas R, Floristán-Muruzábal U, Pinedo-Moraleda F, López-Estebaranz J. Reflectance Confocal Microscopy: A Promising Tool to Identify Malignancy in Melanocytic Lesions Exhibiting a Dermoscopic Island. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Combalia A, Fustà-Novell X, Alejo B, Domínguez M, Barreiro A, Carrera C. Actinic Keratosis—Can Dermoscopy or RCM Differentiate AK (Not Full Thickness Atypia) from Full-Thickness Atypia/Invasive SCC? CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Borsari S, Pampena R, Benati E, Bombonato C, Kyrgidis A, Moscarella E, Lallas A, Argenziano G, Pellacani G, Longo C. In vivo
dermoscopic and confocal microscopy multistep algorithm to detect in situ
melanomas. Br J Dermatol 2018; 179:163-172. [DOI: 10.1111/bjd.16364] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S. Borsari
- Centro Oncologico ad Alta Tecnologia Diagnostica; Azienda Unità Sanitaria Locale - IRCCS; Reggio Emilia Italy
| | - R. Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica; Azienda Unità Sanitaria Locale - IRCCS; Reggio Emilia Italy
| | - E. Benati
- Centro Oncologico ad Alta Tecnologia Diagnostica; Azienda Unità Sanitaria Locale - IRCCS; Reggio Emilia Italy
| | - C. Bombonato
- Centro Oncologico ad Alta Tecnologia Diagnostica; Azienda Unità Sanitaria Locale - IRCCS; Reggio Emilia Italy
| | - A. Kyrgidis
- Centro Oncologico ad Alta Tecnologia Diagnostica; Azienda Unità Sanitaria Locale - IRCCS; Reggio Emilia Italy
| | - E. Moscarella
- Centro Oncologico ad Alta Tecnologia Diagnostica; Azienda Unità Sanitaria Locale - IRCCS; Reggio Emilia Italy
| | - A. Lallas
- First Department of Dermatology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - G. Argenziano
- Dermatology Unit; Second University of Naples; Naples Italy
| | - G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - C. Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica; Azienda Unità Sanitaria Locale - IRCCS; Reggio Emilia Italy
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
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Abstract
Purpose of Review Reflectance confocal microscopy (RCM) enables imaging of skin lesions at cellular level resolution at the bedside (in vivo) or in freshly excised tissue (ex vivo). This article provides an overview of strengths and limitations of non-invasive RCM in skin cancer diagnosis. Recent Findings RCM features of common melanocytic and non-melanocytic skin neoplasms such as melanoma, actinic keratosis/squamous cell carcinoma, basal cell carcinoma, and nevi have been well defined and show good correlation with dermoscopic and histopathologic findings. Due to its technical properties, RCM is especially suitable for the examination of flat skin lesions. Summary In vivo RCM has been shown to increase the accuracy of non-invasive diagnosis of common skin neoplasms and is a valuable adjunct to dermoscopy, particularly in cosmetically and functionally sensitive areas such as the face or the genital area.
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18
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Pathan S, Prabhu KG, Siddalingaswamy P. Techniques and algorithms for computer aided diagnosis of pigmented skin lesions—A review. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.07.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Elosua-González M, Gamo-Villegas R, Floristán-Muruzábal U, Pinedo-Moraleda F, López-Estebaranz JL. Reflectance Confocal Microscopy: A Promising Tool to Identify Malignancy in Melanocytic Lesions Exhibiting a Dermoscopic Island. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:e37-e41. [PMID: 29173995 DOI: 10.1016/j.ad.2017.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/16/2017] [Accepted: 06/25/2017] [Indexed: 10/18/2022] Open
Abstract
The dermoscopic island is described as a well-defined area in a melanocytic lesion, with a different dermoscopic pattern from the rest of the lesion. It is predictive of melanoma, particularly when the pattern of the island is atypical. We present the reflectance confocal microscopy (RCM) findings in 3 lesions with dermoscopic islands: nevus-associated melanoma, melanocytic nevus, and in situ melanoma. The nevus-associated melanoma and in situ melanoma presented cellular atypia (atypical cells in isolation or forming nests) and architectural distortion on RCM. The nevus presented a dermoscopic island with a typical globular pattern with dense nests and no atypia on RCM. Dermoscopic island is mainly associated with in situ and nevus-associated melanomas. RCM offers good cellular resolution to the depth of the reticular dermis and is useful for diagnosing of melanomas presenting a dermoscopic island.
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Affiliation(s)
- M Elosua-González
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - R Gamo-Villegas
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - U Floristán-Muruzábal
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - F Pinedo-Moraleda
- Servicio de Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J L López-Estebaranz
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Cüre K, Kocatürk E, Koku Aksu AE, Yüksel T, Leblebici C, Özekinci S, Özkaya Ö, Değirmentepe E. Brooke-Spiegler syndrome: focus on reflectance confocal microscopy findings of trichoepithelioma and flat cylindroma. Clin Exp Dermatol 2017; 42:906-909. [PMID: 28976013 DOI: 10.1111/ced.13223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2016] [Indexed: 11/28/2022]
Abstract
Brooke-Spiegler syndrome (BSS) is a rare, autosomal dominant disorder characterized by multiple adnexal tumours, especially trichoepitheliomas, cylindromas and occasionally spiradenomas. These lesions usually begin to appear in the second or third decade of life. Malignant transformation of pre-existing tumours may occur. In vivo reflectance-mode confocal microscopy (RCM) is a noninvasive method that can be used to visualize the epidermis and the upper dermis at almost histological resolution. It has been used to evaluate several skin conditions, especially malignant lesions, and has been reported to be useful for differentiating between malignant and benign skin tumours. Only a few studies have reported on the use of confocal microscopy to characterize the features of benign adnexal neoplasms. We present a patient with BSS who presented to our clinic with multiple skin tumours. The possible utility of RCM for identifying adnexal neoplasms is emphasized in this report, which also describes the observed microscopic features.
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Affiliation(s)
- K Cüre
- Department of Dermatology, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - E Kocatürk
- Department of Dermatology, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - A E Koku Aksu
- Department of Dermatology, Istanbul Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - T Yüksel
- Department of Dermatology, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - C Leblebici
- Department of Pathology, Istanbul Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - S Özekinci
- Department of Pathology, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Ö Özkaya
- Department of Plastic and Reconstructive Surgery, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - E Değirmentepe
- Department of Dermatology, Turkiye Cumhuriyeti Saglik Bakanligi Okmeydani Egitim ve Arastirma Hastanesi, Istanbul, Turkey
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Gómez-Martín I, Moreno S, Andrades-López E, Hernández-Muñoz I, Gallardo F, Barranco C, Pujol RM, Segura S. Histopathologic and Immunohistochemical Correlates of Confocal Descriptors in Pigmented Facial Macules on Photodamaged Skin. JAMA Dermatol 2017; 153:771-780. [PMID: 28564685 DOI: 10.1001/jamadermatol.2017.1323] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pigmented facial macules on photodamaged skin are a clinical, dermoscopic, and histopathologic challenge. Objectives To clinically and dermoscopically characterize, by means of reflectance confocal microscopy (RCM), ambiguous pigmented facial macules and establish a correlation between RCM, histopathologic, and immunohistochemical findings. Design, Setting, and Participants A prospective study of ambiguous pigmented facial macules on photodamaged skin was conducted in a tertiary referral center for dermatology between January 1, 2009, and December 31, 2015. Sixty-one patients with 63 ambiguous pigmented facial macules and 12 control photodamaged facial areas were included in the study. Melanocyte density in 1-mm basal layers was determined in skin biopsy specimens from all lesions stained with hematoxylin-eosin and immunohistochemical markers (melan-A, microphthalmia-associated transcription factor, and SRY-related HMG-box gene 10). Dermoscopic, RCM images, and histopathologic preparations were systematically evaluated for the presence of lentigo maligna (LM) criteria. Confocal evaluation was blinded to clinical and dermoscopic diagnosis. Sensitivity and specificity of RCM for LM diagnosis and κ value to establish correlations between dermoscopy, RCM, and histopathology were performed. Main Outcomes and Measures Sensitivity and specificity of RCM for LM diagnosis. Results Of the 61 patients included in the study, 31 (51%) were women; mean (SD) age was 71.8 (13.1) years. Twenty-four of the 63 (38%) lesions were diagnosed as LM or LM melanoma (LMM) and 39 (62%) as benign pigmented lesions. Reflectance confocal microscopy enhanced the diagnosis of pigmented facial macules with 91.7% sensitivity and 86.8% specificity. Multivariate analysis showed 2 dermoscopic and 2 confocal features associated with LM or LMM: (1) asymmetric follicular pigmentation and targetlike structures, and (2) round, large pagetoid cells and follicular localization of atypical cells, respectively. Continuous proliferation of atypical melanocytes was found in 21 (88%) LM or LMM and in 3 (77%) benign lesions. Asymmetric pigmented follicular openings by dermoscopy correlated with follicular localization of pagetoid cells by RCM (κ = 0.499, P < .001). The presence of 3 or more atypical cells at the dermal-epidermal junction (DEJ) by RCM correlated with hyperplasia of melanocytes in hematoxylin-eosin sections (κ = 0.422, P < .001). Conclusions and Relevance Reflectance confocal microscopy improves LM diagnosis in photodamaged skin with good histopathologic correlation although false-positive and false-negative cases exist. False-positives obtained with RCM in photodamaged skin are due to the presence of basal melanocyte hyperplasia and intraepidermal Langerhans cells. Histopathologic features of these lesions sometimes are not enough for a definite diagnosis and immunohistochemical studies may be required.
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Affiliation(s)
- Ignacio Gómez-Martín
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Univesitat Autònoma de Barcelona, Barcelona, Spain
| | - Sara Moreno
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Univesitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Fernando Gallardo
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Univesitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Barranco
- Department of Pathology Hospital del Mar-Parc de Salut Mar, Univesitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Univesitat Autònoma de Barcelona, Barcelona, Spain.,Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Sonia Segura
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Univesitat Autònoma de Barcelona, Barcelona, Spain.,Institut Mar d'Investigacions Mèdiques, Barcelona, Spain
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Witkowski A, Łudzik J, Soyer HP. Telediagnosis with Confocal Microscopy: A Reality or a Dream? Dermatol Clin 2017; 34:505-512. [PMID: 27692456 DOI: 10.1016/j.det.2016.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Reflectance confocal microscopy (RCM) is becoming more popular among dermatologists aiming to improve their bedside diagnostic accuracy and reduce unnecessary removal of benign cutaneous lesions. With increased interest in the field, limitation of experts, and dedicated training programs, telemedicine application to RCM (teleconfocal) helps to connect patients with experts at a distance. Diagnostic accuracy of store-and-forward telemedicine review of RCM images, patient safety, and cost-effectiveness are important considerations for proper acceptance and usage of the technology in the medical community.
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Affiliation(s)
- Alexander Witkowski
- Department of Dermatology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy.
| | - Joanna Łudzik
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, ul. Sw. Łazarza 16, 31-530 Krakow, Poland
| | - H Peter Soyer
- Dermatology Research Centre, Translational Research Institute, School of Medicine, The University of Queensland, 37 Kent Street Woolloongabba QLD 4102, Australia
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23
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24
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25
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Xiong YD, Ma S, Li X, Zhong X, Duan C, Chen Q. A meta-analysis of reflectance confocal microscopy for the diagnosis of malignant skin tumours. J Eur Acad Dermatol Venereol 2016; 30:1295-302. [PMID: 27230832 DOI: 10.1111/jdv.13712] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/31/2016] [Indexed: 12/20/2022]
Abstract
Early diagnosis is extremely important for treatment and prognosis of skin cancer. Reflectance confocal microscopy (RCM) is a recently developed technique used to diagnose skin cancer. This meta-analysis was carried out to assess the accuracy of RCM for the diagnosis of malignant skin tumours. We conducted a systematic literature search of EMBASE, PubMed, the Cochrane Library and Web of Science database for relevant articles in English published up to 24 December 2015. The quality of the included studies was assessed using the QUADAS-2 tool. Statistical analyses were conducted using the software Meta-Disc version 1.4 and STATA version 12.0. A total of 21 studies involving 3108 patients with a total of 3602 lesions were included in the per-lesion analysis. The corresponding pooled results for sensitivity and specificity were 93.6% (95% CI: 0.92-0.95) and 82.7% (95% CI: 0.81-0.84) respectively. Positive likelihood ratio and negative likelihood ratio were 5.84 (95% CI: 4.27-7.98) and 0.08 (95% CI: 0.07-0.10) respectively. Subgroup analysis showed that RCM had a sensitivity of 92.7% (95% CI: 0.90-0.95) and a specificity of 78.3% (95% CI: 0.76-0.81) for detecting melanoma. The pooled sensitivity and specificity of RCM for detecting basal cell carcinoma were 91.7% (95% CI: 0.87-0.95) and 91.3% (95% CI: 0.94-0.96) respectively. RCM is a valid method of identifying malignant skin tumours accurately.
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Affiliation(s)
- Y D Xiong
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - S Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - X Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - X Zhong
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - C Duan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Q Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
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Persechino F, Longo C, Cesinaro AM, Cinotti E, Ciardo S, Pellacani G, Bassoli S. [Dermoscopic and reflectance confocal microscopic features of clonal seborrhoeic keratosis]. Ann Dermatol Venereol 2015; 143:164-6. [PMID: 26708205 DOI: 10.1016/j.annder.2015.10.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/10/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- F Persechino
- Service de dermatologie, université de Modène-et-Reggio-Emilia, via università, 4, 41121 Modena MO, Italie
| | - C Longo
- Unité de cancérologie cutanée, Arcispedale Santa-Maria Nuova - IRCCS, Reggio-Emilia, Viale Risorgimento, 80, Reggio-Emilia RE, Italie
| | - A M Cesinaro
- Service d'anatomopathologie, université de Modène-et-Reggio-Emilia, via Università, 4, 41121 Modena MO, Italie
| | - E Cinotti
- Service de dermatologie, hôpital Nord Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
| | - S Ciardo
- Service de dermatologie, université de Modène-et-Reggio-Emilia, via università, 4, 41121 Modena MO, Italie
| | - G Pellacani
- Service de dermatologie, université de Modène-et-Reggio-Emilia, via università, 4, 41121 Modena MO, Italie
| | - S Bassoli
- Service de dermatologie, université de Modène-et-Reggio-Emilia, via università, 4, 41121 Modena MO, Italie
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Longo C, Moscarella E, Argenziano G, Lallas A, Raucci M, Pellacani G, Scope A. Reflectance confocal microscopy in the diagnosis of solitary pink skin tumours: review of diagnostic clues. Br J Dermatol 2015; 173:31-41. [DOI: 10.1111/bjd.13689] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 01/17/2023]
Affiliation(s)
- C. Longo
- Dermatology and Skin Cancer Unit; Arcispedale S. Maria Nuova; IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
| | - E. Moscarella
- Dermatology and Skin Cancer Unit; Arcispedale S. Maria Nuova; IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
| | - G. Argenziano
- Dermatology and Skin Cancer Unit; Arcispedale S. Maria Nuova; IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
| | - A. Lallas
- Dermatology and Skin Cancer Unit; Arcispedale S. Maria Nuova; IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
| | - M. Raucci
- Dermatology and Skin Cancer Unit; Arcispedale S. Maria Nuova; IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
| | - G. Pellacani
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
| | - A. Scope
- Department of Dermatology; Sheba Medical Center and Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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28
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Pellacani G, Pepe P, Casari A, Longo C. Reflectance confocal microscopy as a second-level examination in skin oncology improves diagnostic accuracy and saves unnecessary excisions: a longitudinal prospective study. Br J Dermatol 2014; 171:1044-51. [PMID: 24891083 DOI: 10.1111/bjd.13148] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dermatoscopy increases both the sensitivity and specificity of melanoma diagnosis. Reflectance confocal microscopy (RCM) is a noninvasive technique that complements dermatoscopy in the evaluation of equivocal lesions at cellular resolution. OBJECTIVES To determine prospectively the potential impact of confocal microscopy when implemented in a routine melanoma diagnosis workflow. METHODS Patients referred to a single melanoma clinic were consecutively enrolled. At dermatoscopy, patients were referred to one of the following pathways: (i) no further examination or (ii) RCM examination. On examination atypical lesion(s) were referred for either (a) RCM documentation (lesions with consistent suspicious clinical/dermatoscopic criteria, already qualified and scheduled for surgical excision) or (b) RCM consultation for equivocal lesions, where RCM diagnosis would determine lesion definite outcome (excision or digital follow-up). RESULTS Reflectance confocal microscopy examination was performed for 41% of 1005 patients enrolled. In two-thirds of these cases RCM influenced the lesion outcome. The systematic application of RCM for equivocal lesions saved over 50% of benign lesions from unnecessary excision. The number needed to excise a melanoma was 6·8 with RCM examination, compared with a hypothetical 14·6 without RCM evaluation. CONCLUSIONS Reflectance confocal microscopy as a second-level examination to dermatoscopy proved to be highly accurate in diagnosis and reduced the number of unnecessary excisions. Improved accuracy, considering that RCM enabled the detection of the six melanomas (2%) in the group of 308 lesions eligible for follow-up, also minimizes the risk of referring a melanoma to digital dermatoscopy monitoring, and potentially losing the patient to follow-up.
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Affiliation(s)
- G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41124, Italy
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29
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Guitera P, Haydu LE, Menzies SW, Scolyer RA, Hong A, Fogarty GB, Gallardo F, Segura S. Surveillance for treatment failure of lentigo maligna with dermoscopy and in vivo confocal microscopy: new descriptors. Br J Dermatol 2014; 170:1305-12. [PMID: 24641247 DOI: 10.1111/bjd.12839] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nonsurgical treatment (radiotherapy, imiquimod) is increasingly employed for the management of lentigo maligna (LM). While the diagnosis of LM remains difficult, the detection of treatment failure is even more challenging. OBJECTIVES To describe the sensitivity and specificity for the diagnosis of LM of individual features and methods using dermoscopy and in vivo reflectance confocal microscopy (RCM) to aid in the detection of treatment failure of LM following nonsurgical treatment. METHODS A retrospective study of dermoscopy and RCM images (blinded to the correlation with pathology) in patients with biopsy-confirmed LM who were undergoing nonsurgical treatment in two referral institutions - one in Sydney, Australia, and the other in Barcelona, Spain. Ninety-eight patients were treated nonsurgically for LM during the period 2006-2012. Thirty-one patients had abnormal dermoscopy or RCM evaluation, and had a biopsy that identified LM recurrence in 15 patients and nonmelanoma diagnoses in 16 patients (one Bowen disease, 15 solar changes). RESULTS The diagnosis of treatment failure was difficult with dermoscopy, with a sensitivity of 80% and specificity of 56%, even with the interpretation of an expert. The best criterion was asymmetric hyperpigmented follicular openings, but this was present in only 47% of treatment failure LM. Isolated, very fine brown dots ('dust' appearance) correlated highly with the diagnosis of treatment failure LM (73% sensitivity and 88% specificity) and with pagetoid cells seen with RCM. The LM score, comprising six criteria, had a specificity of 94% and sensitivity of 100%. CONCLUSIONS These methods and descriptors should help to manage the diagnosis of treatment failure.
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Affiliation(s)
- P Guitera
- Melanoma Institute Australia, Poche Centre, 40 Rocklands Road, North Sydney, NSW, 2060, Australia; Department of Sydney Melanoma Diagnostic Centre, Missenden Road Camperdown, NSW, 2050, Australia; Discipline of Dermatology, The University of Sydney, Sydney, NSW, Australia
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30
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Moscarella E, Rabinovitz H, Zalaudek I, Piana S, Stanganelli I, Oliviero MC, Lallas A, Ardigo M, Cota C, Catricalà C, Mazzoni L, Pellacani G, Argenziano G, Longo C. Dermoscopy and reflectance confocal microscopy of pigmented actinic keratoses: a morphological study. J Eur Acad Dermatol Venereol 2014; 29:307-314. [DOI: 10.1111/jdv.12532] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- E. Moscarella
- Dermatology and Skin Cancer Unit Arcispedale s.maria Nuova IRCCS Reggio Emilia Italy
| | | | - I. Zalaudek
- Department of Dermatology Medical University of Graz Graz Austria
| | - S. Piana
- Pathology Unit Arcispedale S.Maria Nuova IRCCS Reggio Emilia Italy
| | - I. Stanganelli
- Skin Cancer Unit IRCCS IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori Meldola (FC) Italy
| | | | - A. Lallas
- Dermatology and Skin Cancer Unit Arcispedale s.maria Nuova IRCCS Reggio Emilia Italy
| | - M. Ardigo
- Department of Dermatology San Gallicano Dermatologic Institute IRCCS Rome Italy
| | - C. Cota
- Oncologic Dermatology San Gallicano Dermatologic Institute IRCCS Rome Italy
| | - C. Catricalà
- Oncologic Dermatology San Gallicano Dermatologic Institute IRCCS Rome Italy
| | - L. Mazzoni
- Skin Cancer Unit IRCCS IRST Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori Meldola (FC) Italy
| | - G. Pellacani
- Department of Dermatology University of Modena and Reggio Emilia Modena Italy
| | - G. Argenziano
- Dermatology and Skin Cancer Unit Arcispedale s.maria Nuova IRCCS Reggio Emilia Italy
| | - C. Longo
- Dermatology and Skin Cancer Unit Arcispedale s.maria Nuova IRCCS Reggio Emilia Italy
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Li W, Wang S, Xu AE. Role of in vivo reflectance confocal microscopy in determining stability in vitiligo: a preliminary study. Indian J Dermatol 2013; 58:429-32. [PMID: 24249892 PMCID: PMC3827512 DOI: 10.4103/0019-5154.119948] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Vitiligo is an acquired pigmentary disorder. In vivo reflectance confocal microscopy (RCM) reproducible imaging technique has already been reported to be useful in the diagnosis of other skin diseases. OBJECTIVE To define RCM features of vitiligo on different clinical stages. MATERIALS AND METHODS A total of 125 patients with a clinical diagnosis of vitiligo were included in this study. After informed consent, lesional skins of those vitiligo patients were characterized by using RCM. Five patients with inflammatory cell infiltration observed at the edge of skin lesions and another 5 patients without inflammatory cell infiltration were selected. Biopsies were performed at same sites of the RCM examination areas for histological and immune-histological analysis. RESULTS In the active stage of vitiligo, the RCM examination revealed that the bright dermal papillary rings presented at the dermoepidermal junction level in normal skin lost their integrity or totally disappeared, border between vitiligo lesion and normal skin became unclear, and highly refractile cells that referred to infiltrated inflammatory cells could be seen within the papillary dermis at the edge of the lesions. In the stable stage of vitiligo, the RCM showed a complete loss of melanin in lesional skin and a clear border between lesional and normal skin. CONCLUSION A simple clinical examination with RCM may reliably and efficiently allow evaluation of the stability status of vitiligo lesions.
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Affiliation(s)
- Wei Li
- Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
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Stevenson AD, Mickan S, Mallett S, Ayya M. Systematic review of diagnostic accuracy of reflectance confocal microscopy for melanoma diagnosis in patients with clinically equivocal skin lesions. Dermatol Pract Concept 2013; 3:19-27. [PMID: 24282659 PMCID: PMC3839827 DOI: 10.5826/dpc.0304a05] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/25/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Melanoma is a cancer of the skin and is increasing in incidence in the UK and Europe. Melanoma is a condition that is often curable if detected at an early stage, which makes accurate diagnosis vital. Reflectance confocal microscopy (RCM) is a tool used to image the skin. It gives high magnification images of the skin, which may provide more accurate diagnosis of lesions that are equivocal on clinical examination and dermoscopy. OBJECTIVE To determine the diagnostic accuracy of reflectance confocal microscopy (RCM), for melanoma diagnosis, as an add-on test to clinical examination and dermoscopy in the diagnosis of equivocal pigmented skin lesions using histopathology as the reference standard. METHODS A search was conducted of MEDLINE, EMBASE and six other electronic databases from inception to present. Forward citation searching and hand searching of reference lists were also conducted. Diagnostic accuracy studies that assess RCM in the diagnosis of melanoma were included in the review. Two contributors conducted the search, data extraction and assessment of methodological quality using QUADAS-2. Statistical analysis was performed using hierarchical bivariate random effects meta-analysis. RESULTS 951 titles and abstracts were screened. Five studies comprising 909 lesions were eligible for meta-analysis. Meta-analysis returned a per lesion sensitivity of 93% [95% CI 89-96] and a specificity of 76% [95% CI 68-83]. CONCLUSIONS The utility of reflectance confocal microscopy (RCM) as an add-on test for the diagnosis of melanoma depends on the trade off between over-excising benign lesions and misdiagnosing melanoma as benign. This becomes important when considering lesions on surgically difficult or cosmetically important areas of the body.
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Gill M, Longo C, Farnetani F, Cesinaro AM, González S, Pellacani G. Non-invasive in vivo dermatopathology: identification of reflectance confocal microscopic correlates to specific histological features seen in melanocytic neoplasms. J Eur Acad Dermatol Venereol 2013; 28:1069-78. [PMID: 24147614 DOI: 10.1111/jdv.12285] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 09/16/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) allows for non-invasive, in vivo evaluation of skin lesions and it has been extensively applied in skin oncology although systematic studies on nevi characterization are still lacking. OBJECTIVE The aim of this study was to determine whether reliable RCM correlates to histological features used to diagnose melanocytic neoplasms exist. METHODS We blindly evaluated the RCM and histological features of 64 melanocytic neoplasms (19 non-dysplastic nevi, 27 dysplastic nevi, 14 melanomas) and analysed the data using Spearman's rho calculation. RESULTS Many histological features can be identified using RCM. Elongated rete ridges corresponded on RCM to edge papillae, whereas flattened rete ridges to several features which involve dermal-epidermal junction disruption. Bridging of junctional nesting (JN) corresponded on RCM to both JN with irregular size/shape and JN with short interconnections. While we could reliably identify dermal melanocytes, the RCM features did not reliably distinguish between benign and concerning dermal melanocytic arrangements, suggesting further refinement of dermal melanocytic RCM features is needed. CONCLUSION Reliable correlates for epidermal and junctional histological features used to diagnose melanocytic neoplasms are identifiable on RCM, suggesting harnessing histological criteria may be a reasonable method to move beyond the algorithmic approach.
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Affiliation(s)
- M Gill
- Dobbs Ferry, Skin Medical Research and Diagnostics, New York, NY, USA
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Rao BK, Mateus R, Wassef C, Pellacani G. In vivo confocal microscopy in clinical practice: comparison of bedside diagnostic accuracy of a trained physician and distant diagnosis of an expert reader. J Am Acad Dermatol 2013; 69:e295-300. [PMID: 24035553 DOI: 10.1016/j.jaad.2013.07.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is an imaging tool that allows the visualization of cellular details without biopsy. To our knowledge, RCM sensitivity and specificity has not been studied in a telemedicine setting. OBJECTIVE We sought to assess RCM diagnostic accuracy in a support teleconsultation setting. METHODS Between June 2010 and September 2011, 340 lesions were imaged using a confocal scanning microscope. The images were evaluated by 2 readers, one on site, and the other at a distance. RESULTS A total of 334 cases were included. For each reader the sensitivity was greater than 90% and specificity for each reader was greater than 60%. Both readers had a combined sensitivity of 98.6% and 44% specificity. LIMITATIONS RCM may be limited in the correct classification of epithelial tumors. CONCLUSIONS RCM is a tool in the clinical diagnosis of skin lesions, providing a high diagnostic accuracy in teleconsultation use.
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Affiliation(s)
- Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
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Longo C, Zalaudek I, Moscarella E, Lallas A, Piana S, Pellacani G, Argenziano G. Clonal seborrheic keratosis: dermoscopic and confocal microscopy characterization. J Eur Acad Dermatol Venereol 2013; 28:1397-400. [PMID: 24033484 DOI: 10.1111/jdv.12261] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/06/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The diagnosis of clonal seborrheic keratosis may be challenging clinically and histologically. OBJECTIVE In our study, we describe the common aspects of this benign entity that show peculiar dermoscopic and confocal findings. METHODS A total of nine clonal seborrheic keratosis were analyzed. RESULTS Upon dermoscopy, it reveals the presence of globular-like structures and sharply demarcated borders whereas confocal microscopy displays the typical intraepidermal nesting of pigmented keratinocytes that permits to have a reliable in vivo diagnosis. CONCLUSIONS Dermoscopy and confocal microscopy permit to in vivo diagnose this variant of seborrheic keratosis.
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Affiliation(s)
- C Longo
- Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
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Longo C, Farnetani F, Ciardo S, Cesinaro A, Moscarella E, Ponti G, Zalaudek I, Argenziano G, Pellacani G. Is confocal microscopy a valuable tool in diagnosing nodular lesions? A study of 140 cases. Br J Dermatol 2013; 169:58-67. [PMID: 23374159 DOI: 10.1111/bjd.12259] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 12/01/2022]
Affiliation(s)
- C. Longo
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS); Reggio Emilia Italy
| | - F. Farnetani
- Departments of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Ciardo
- Departments of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - A.M. Cesinaro
- Pathology; University of Modena and Reggio Emilia; Modena Italy
| | - E. Moscarella
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS); Reggio Emilia Italy
- Departments of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - G. Ponti
- Clinical and Diagnostic Medicine and Public Health; University of Modena and Reggio Emilia; Modena Italy
| | - I. Zalaudek
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS); Reggio Emilia Italy
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - G. Argenziano
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova (Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS); Reggio Emilia Italy
| | - G. Pellacani
- Departments of Dermatology; University of Modena and Reggio Emilia; Modena Italy
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Sattler EC, Maier T, Hoffmann VS, Hegyi J, Ruzicka T, Berking C. Noninvasive in vivo detection and quantification of Demodex mites by confocal laser scanning microscopy. Br J Dermatol 2013; 167:1042-7. [PMID: 22716072 DOI: 10.1111/j.1365-2133.2012.11096.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In many Demodex-associated skin diseases Demodex mites are present in abundance and seem to be at least partially pathogenic. So far all diagnostic approaches such as scraping or standardized superficial skin biopsy are (semi-)invasive and may cause discomfort to the patient. OBJECTIVES To see whether confocal laser scanning microscopy (CLSM) - a noninvasive method for the visualization of superficial skin layers - is able to detect and quantify D. folliculorum in facial skin of patients with rosacea. METHODS Twenty-five patients (34-72 years of age) with facial rosacea and 25 age- and sex-matched normal controls were examined by CLSM. Mosaics of 8 × 8 mm and 5 × 5 mm were created by scanning horizontal layers of lesional skin and quantification of mites per follicle and per area as well as follicles per area was performed. RESULTS In all patients D. folliculorum could be detected by CLSM and presented as roundish or lengthy cone-shaped structures. CLSM allowed the quantification of Demodex mites and revealed significant differences (P < 0·0001): the mean number of mites was 165·4 per 8 × 8 mm area and 94·2 per 5 × 5 mm area in the patients compared with 34·7 and 22·4, respectively, in the controls. The corresponding mean number of mites per follicle was 0·7 and 0·8, respectively, in the patients and 0·1 and 0·2, respectively, in the controls. CONCLUSIONS With the help of CLSM it is possible to detect, image and quantify Demodex mites noninvasively in facial skin of patients with rosacea.
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Affiliation(s)
- E C Sattler
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstr. 9-11, 80337 Munich, Germany.
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Contaldo M, Agozzino M, Moscarella E, Esposito S, Serpico R, Ardigò M. In VivoCharacterization of Healthy Oral Mucosa by Reflectance Confocal Microscopy: A Translational Research for Optical Biopsy. Ultrastruct Pathol 2013; 37:151-8. [DOI: 10.3109/01913123.2013.776656] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Debarbieux S, Dalle S, Depaepe L, Poulalhon N, Balme B, Thomas L. Second primary melanomas treated with BRAF blockers: study by reflectance confocal microscopy. Br J Dermatol 2013; 168:1230-5. [DOI: 10.1111/bjd.12210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Can noninvasive imaging tools potentially predict the risk of ulceration in invasive melanomas showing blue and black colors? Melanoma Res 2013; 23:125-31. [DOI: 10.1097/cmr.0b013e32835d90b8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Reflectance confocal microscopy (RCM) enables the noninvasive in vivo imaging of the skin with a horizontal axis and a cellular-level resolution allowing the study of the skin from superficial layers to papillary dermis. It has arisen an important tool in the study of tumors and specially an important role in the characterization of melanoma. Melanocytic lesions present a large number of characteristic findings visible in upper parts of the tumors, such as in the case of melanoma: pagetoid roundish or dendritic cells in superficial epidermis, atypical nests at the dermoepidermal junction, nonedged papillae and atypical nucleated cells in papillary dermis. Several studies have demonstrated that RCM may improve the accuracy in the differentiation of benign and malignant melanocytic lesions as an adjuvant technique to dermoscopy, and three main algorithms have been developed to apply in equivocal lesions. The advantage of in vivo observation in real time of the tumor at the bedside is opening the clinical applications of RCM in the evaluation of melanocytic lesions, and in particular in the study of facial maculae and lentigo maligna melanoma, amelanotic melanoma, and management of subclinical margins, recurrences, or monitoring noninvasive treatment of tumors.
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Affiliation(s)
- Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
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Moscarella E, Rabinovitz H, Oliviero MC, Brown L, Longo C, Zalaudek I, Piana S, Farnetani F, Lallas A, Argenziano G, Pellacani G. The Role of Reflectance Confocal Microscopy as an Aid in the Diagnosis of Collision Tumors. Dermatology 2013; 227:109-17. [PMID: 24080548 DOI: 10.1159/000351771] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/06/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Elvira Moscarella
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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Debarbieux S, Depaepe L, Poulalhon N, Dalle S, Balme B, Thomas L. Reflectance confocal microscopy characteristics of eight cases of pustular eruptions and histopathological correlations. Skin Res Technol 2012; 19:e444-52. [PMID: 22934633 DOI: 10.1111/j.1600-0846.2012.00662.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM)'s interest has been well established for the non-invasive diagnosis of skin cancers, especially melanocytic, and in the differential diagnosis between benign and malignant cutaneous lesions. However, its diagnostic interest in inflammatory skin diseases still needs to be demonstrated. Our purpose was to evaluate the correlation between RCM and conventional histopathology in a series of pustular eruptions of different pathogeny. METHODS Reflectance confocal microscopy analysis was performed in eight consecutive unselected patients in whom the diagnoses of pustular psoriasis, bacterial sur-infection, herpes-type virus skin sur-infection, Sneddon-Wilkinson subcorneal putulosis and Hailey-Hailey disease have been made and images were compared to conventional histopathology. RESULTS Neutrophils within the epidermis exhibited never reported earlier specific features, with either a shiny granular sludge or polylobated particules with a bright granular content. Moreover, some specific etiologies could be identified, such as acantholysis and herpes-type virus-infected keratinocytes. CONCLUSION Our studies show a good correlation between RCM and conventional histopathology in pustular eruptions. Reflectance confocal microscopy may play an important role in the differential diagnosis of pustular eruptions; as most of the pathologic clues are epidermal, narrow thickness of the field of imaging, its main technical limitation, is indeed of lesser importance.
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Debarbieux S, Hospod V, Depaepe L, Balme B, Poulalhon N, Thomas L. Perioperative confocal microscopy of the nail matrix in the management ofin situor minimally invasive subungual melanomas. Br J Dermatol 2012; 167:828-36. [DOI: 10.1111/j.1365-2133.2012.11013.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rothmund G, Sattler EC, Kaestle R, Fischer C, Haas CJ, Starz H, Welzel J. Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis - comparison of six diagnostic methods. Mycoses 2012; 56:47-55. [PMID: 22524550 DOI: 10.1111/j.1439-0507.2012.02198.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Onychomycosis is common and can mimic several different nail disorders. Accurate diagnosis is essential to choose the optimum antifungal therapy. The aim of this study was to evaluate the use of confocal laser scanning microscopy (CLSM) and optical coherence tomography (OCT) as new non-invasive diagnostic tools in onychomycosis and to compare them with the established techniques. In a prospective trial, 50 patients with suspected onychomycosis and 10 controls were examined by CLSM and OCT. Parallel KOH preparation, culture, PAS-staining and PCR were performed. PCR showed the highest sensitivity, followed by CLSM, PAS and KOH preparation. OCT offered the second best sensitivity but displayed the lowest specificity. CLSM and KOH preparation showed a high specificity and CLSM offered the best positive predictive value, similar to KOH preparation and OCT. Fungal culture showed the lowest sensitivity and the worst negative predictive value, yet culture and PCR are the only techniques able to identify genus and species. In summary, CLSM was comparable to PAS staining and superior to KOH preparation. Due to the low specificity we assess OCT not as appropriate. In the differentiation of species PCR outplays the fungal culture in terms of time and sensitivity.
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Affiliation(s)
- G Rothmund
- Department of Dermatology and Allergology, General Hospital Augsburg, Augsburg, Germany
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Debarbieux S, Depaepe L, Poulalhon N, Balme B, Dalle S, Thomas L. Reflectance confocal microscopy accurately discriminates between benign and malignant melanocytic lesions exhibiting a 'dermoscopic island'. J Eur Acad Dermatol Venereol 2012; 27:e159-65. [PMID: 22486883 DOI: 10.1111/j.1468-3083.2012.04533.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The 'dermoscopic island' is a term that was recently proposed to design an area of a pigmented lesion with a uniform dermoscopic pattern different from the remainder of the lesion. The positive predictive value of this sign for the diagnosis of melanoma is about 50%. OBJECTIVE The purpose of our study was to see if reflectance confocal microscopy (RCM) permitted to accurately distinguish between nevi and melanoma in such lesions. METHODS Five lesions of five consecutive unselected patients, with a dermoscopic island but no feasible clear cut diagnosis on the basis of dermoscopy alone were examined by RCM before excision for histopathological evaluation. RESULTS Two lesions corresponded to nevi, and three lesions were early melanomas arising on a benign naevus in one case, and on a dysplastic naevus in two cases. In all five cases, RCM permitted to make the correct diagnosis, with a very good correlation with conventional histopathology. CONCLUSION Reflectance confocal microscopy appears as a promising tool not only to enhance the early diagnosis of melanoma but also to avoid unnecessary excisions of lesions with a dermoscopic island.
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Affiliation(s)
- S Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud, Lyon 1 University, France.
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Pistone G, Doukaki S, Rizzo D, Aricò M, Bongiorno MR. Reflectance mode confocal microscopy and digital image analysis in naevus of Hori and pathogenetic evaluation. Br J Dermatol 2012; 167:692-4. [PMID: 22413966 DOI: 10.1111/j.1365-2133.2012.10942.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sattler E, Kaestle R, Rothmund G, Welzel J. Confocal laser scanning microscopy, optical coherence tomography and transonychial water loss for in vivo investigation of nails. Br J Dermatol 2012; 166:740-6. [DOI: 10.1111/j.1365-2133.2011.10730.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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In vivo confocal microscopy for detection and grading of dysplastic nevi: A pilot study. J Am Acad Dermatol 2012; 66:e109-21. [DOI: 10.1016/j.jaad.2011.05.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 05/02/2011] [Accepted: 05/09/2011] [Indexed: 11/19/2022]
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Lange-Asschenfeldt S, Babilli J, Beyer M, Ríus-Diaz F, González S, Stockfleth E, Ulrich M. Consistency and distribution of reflectance confocal microscopy features for diagnosis of cutaneous T cell lymphoma. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:016001. [PMID: 22352651 PMCID: PMC3602809 DOI: 10.1117/1.jbo.17.1.016001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 10/28/2011] [Accepted: 11/02/2011] [Indexed: 05/31/2023]
Abstract
Reflectance confocal microscopy (RCM) represents a noninvasive imaging technique that has previously been used for characterization of mycosis fungoides (MF) in a pilot study. We aimed to test the applicability of RCM for diagnosis and differential diagnosis of MF in a clinical study. A total of 39 test sites of 15 patients with a biopsy-proven diagnosis of either MF, parapsoriasis, Sézary syndrome, or lymphomatoid papulosis were analyzed for presence and absence of RCM features of MF. Cochran and Chi(2) analysis were applied to test the concordance between investigators and the distribution of RCM features, respectively. For selected parameters, the Cochran analysis showed good concordance between investigators. Inter-observer reproducibility was highest for junctional atypical lymphocytes, architectural disarray, and spongiosis. Similarly, Chi(2) analysis demonstrated that selected features were present at particularly high frequency in individual skin diseases, with values ranging from 73% to 100% of all examined cases.
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MESH Headings
- Chi-Square Distribution
- Diagnosis, Differential
- Humans
- Lymphoma, T-Cell, Cutaneous/chemistry
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/pathology
- Microscopy, Confocal/methods
- Parapsoriasis
- Reproducibility of Results
- Sensitivity and Specificity
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Affiliation(s)
| | - Jasmin Babilli
- Universitätsmedizin Charité, Department of Dermatology, Berlin, Germany
| | - Marc Beyer
- Universitätsmedizin Charité, Department of Dermatology, Berlin, Germany
| | | | - Salvador González
- Memorial Sloan Kettering Cancer Center, Division of Dermatology, New York, New York
| | - Eggert Stockfleth
- Universitätsmedizin Charité, Department of Dermatology, Berlin, Germany
| | - Martina Ulrich
- Universitätsmedizin Charité, Department of Dermatology, Berlin, Germany
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