Melanocytic or Not? Dermoscopy and Reflectance Confocal Microscopy for Lesions Difficult to Diagnose: A Cross-Sectional Diagnostic Accuracy Study

Background: Different techniques for non-invasive skin examination and early diagnosis of skin lesions are available nowadays, being dermoscopy and reflectance confocal microscopy (RCM) the most diffused ones. Several studies supported the complementary use of dermoscopy and RCM that improves diagnostic accuracy when dealing with melanocytic lesions. Objectives: To analyze RCM diagnostic accuracy in the differential diagnosis between melanocytic and non-melanocytic lesions. Methods: This is a cohort selected cross-sectional study conducted at the Dermatology Unit of the University of Campania L. Vanvitelli, Naples, Italy, from 2012 to 2020. We searched the image database for all excised lesions for which the clinical and dermatoscopic differential diagnosis was between melanocytic and non-melanocytic and for which an RCM examination was performed. Sensitivity, specificity, and diagnostic accuracy values were estimated. Results: The study included 53 cases that were found to have disagreement between clinical, histological and RCM diagnosis, of which, in 31 cases the differential diagnosis was melanocytic vs non-melanocytic lesion. The RCM reached a specificity of 87% (95% CI: 0.73-1) and a sensitivity of 62.5% (95% CI: 0.29-0.96) in the present sample. Diagnostic accuracy was 80.6% (95% CI: 0.67-0.94). Conclusion: RCM has a high specificity in differentiating between difficult-to-diagnose melanocytic and non-melanocytic lesions.

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Diagnostic accuracy of reflectance confocal microscopy using VivaScope for detecting and monitoring skin lesions: a systematic review

Clinical and Experimental Dermatology ◽

10.1111/ced.13055 ◽

2017 ◽

Vol 42 (3) ◽

pp. 266-275 ◽

Cited By ~ 16

Author(s):

S. J. Edwards ◽

G. Osei-Assibey ◽

R. Patalay ◽

V. Wakefield ◽

C. Karner

Keyword(s):

Systematic Review ◽

Confocal Microscopy ◽

Diagnostic Accuracy ◽

Skin Lesions ◽

Reflectance Confocal Microscopy

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Case Report: melanoma and melanocytic nevus differentiation with reflectance confocal microscopy.

F1000Research ◽

10.12688/f1000research.6793.1 ◽

2015 ◽

Vol 4 ◽

pp. 257

Author(s):

Joanna Łudzik ◽

Alexander M Witkowski ◽

Giovanni Pellacani

Keyword(s):

Confocal Microscopy ◽

Benign Lesion ◽

Skin Lesions ◽

Melanocytic Nevus ◽

Reflectance Confocal Microscopy ◽

Melanocytic Lesion ◽

Non Invasive ◽

Malignant Skin Tumors ◽

Malignant Skin ◽

Bedside Diagnosis

Historically, melanoma has been typically diagnosed by naked-eye examination and confirmed with invasive biopsy. However, recently the use of reflectance confocal microscopy enables non-invasive bedside diagnosis of clinically equivocal lesions. We present a case in which reflectance confocal microscopy was used to evaluate two skin lesions in the same patient confirming the diagnosis of a melanoma and potentially avoiding invasive biopsy in the second benign melanocytic lesion. Clinicians should be aware of the availability of new non-invasive technologies that can aid in early diagnosis of malignant skin tumors and potentially reduce the number of benign lesion excisions.

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Diagnostic accuracy of reflectance confocal microscopy for pigmented skin lesions presenting dermoscopic features of cutaneous melanoma

Advances in Dermatology and Allergology ◽

10.5114/ada.2019.82742 ◽

2020 ◽

Vol 37 (4) ◽

pp. 531-534

Author(s):

Katarzyna Podolec ◽

Magdalena Pirowska ◽

Grzegorz Dyduch ◽

Anna Wojas-Pelc

Keyword(s):

Confocal Microscopy ◽

Diagnostic Accuracy ◽

Cutaneous Melanoma ◽

Skin Lesions ◽

Reflectance Confocal Microscopy ◽

Pigmented Skin Lesions

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Systematic review of diagnostic accuracy of reflectance confocal microscopy for melanoma diagnosis in patients with clinically equivocal skin lesions

Dermatology Practical & Conceptual ◽

10.5826/dpc.0304a05 ◽

2013 ◽

Vol 3 (4) ◽

Cited By ~ 60

Author(s):

Alexander Stevenson ◽

Sharon Mickan ◽

Susan Mallett ◽

Mekhala Ayya

Keyword(s):

Systematic Review ◽

Confocal Microscopy ◽

Diagnostic Accuracy ◽

Skin Lesions ◽

Reflectance Confocal Microscopy ◽

Melanoma Diagnosis

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Diagnostic Accuracy of Reflectance Confocal Microscopy for Diagnosis of Skin Lesions: An Update

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0124-oa ◽

2018 ◽

Vol 143 (3) ◽

pp. 326-329 ◽

Cited By ~ 5

Author(s):

Babar K. Rao ◽

Ann M John ◽

Gina Francisco ◽

Attiya Haroon

Keyword(s):

Raman Spectroscopy ◽

Optical Coherence Tomography ◽

Confocal Microscopy ◽

Diagnostic Accuracy ◽

Real Time ◽

Skin Lesions ◽

High Accuracy ◽

Reflectance Confocal Microscopy ◽

Current Standard ◽

Suspicious Lesions

Context.— Histopathology is the current standard to diagnose skin disease. However, biopsy may not always be feasible, such as in patients with multiple nevi, a patient with a lesion on an aesthetically significant site, or in children. Recently, noninvasive techniques, including reflectance confocal microscopy (RCM), optical coherence tomography, and Raman spectroscopy, have enabled dermatologists to manage skin lesions in real time without the need for biopsy. Objective.— To report the updated diagnostic accuracy of RCM for equivocal skin lesions. Design.— In this study, we retrospectively reviewed our data of clinically suspicious lesions from 2010 to 2017 that were evaluated by RCM. Results.— Our results showed an overall sensitivity of 98.2% and specificity of 99.8%. Conclusions.— In conclusion, RCM is a noninvasive real-time tool with the potential to diagnose skin lesions with high accuracy and without biopsy.

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Dermoscopy in Pigmented Squamous Cell Carcinoma

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2009.08069 ◽

2009 ◽

Vol 13 (6) ◽

pp. 326-329 ◽

Cited By ~ 2

Author(s):

Vincenzo de Giorgi ◽

Barbara Alfaioli ◽

Federica Papi ◽

Agata Janowska ◽

Marta Grazzini ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Differential Diagnosis ◽

Cell Carcinoma ◽

Squamous Cell ◽

Potential Role ◽

Diagnostic Errors ◽

Skin Lesions ◽

Melanocytic Lesion ◽

Melanocytic Lesions ◽

Pigmented Skin Lesions

Background: The diagnosis of squamous cell carcinoma (SCC) is, generally, a clinical diagnosis, but in some cases, when the lesion is pigmented, as in our case, the differential diagnosis between pigmented SCC and other pigmented skin lesions, in particular melanocytic lesions, is difficult. Dermoscopy may improve the early diagnosis of SCC and thus play a role in its preoperative classification. However, its potential role has been hampered so far by the fact that little is known about the dermoscopic features of pigmented SCC. Objective: We report the case of a rare pigmented SCC dermoscopically mimicking a melanocytic lesion whose dermoscopic features have been investigated. Conclusion: On the basis of the literature and our experience, pigmented SCC can present dermoscopic features typical of melanocytic lesions, such as radial streaks, globules, and homogeneous blue pigmentation, and can lead dermatologists to diagnostic errors.

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