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Liu H, Jiang H, Shan Q. Reflectance confocal microscopy versus dermoscopy for the diagnosis of cutaneous melanoma: a head-to-head comparative meta-analysis. Melanoma Res 2024; 34:355-365. [PMID: 38847651 DOI: 10.1097/cmr.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
This meta-analysis aimed to evaluate the comparative diagnostic performance of reflectance confocal microscopy (RCM) and dermoscopy in detecting cutaneous melanoma patients. An extensive search was conducted in the PubMed and Embase databases to identify available publications up to December 2023. Studies were included if they evaluated the diagnostic performance of RCM and dermoscopy in patients with cutaneous melanoma. The quality of the included studies was assessed using the Quality Assessment of Diagnostic Performance Studies (QUADAS-2) tool. A total of 14 articles involving 2013 patients were included in the meta-analysis. The overall sensitivity of RCM was 0.94 [95% confidence interval (CI), 0.87-0.98], while the overall sensitivity of dermoscopy was 0.84 (95% CI, 0.71-0.95). These results suggested that RCM has a similar level of sensitivity compared with dermoscopy ( P = 0.15). In contrast, the overall specificity of RCM was 0.76 (95% CI, 0.67-0.85), while the overall specificity of dermoscopy was 0.47 (95% CI, 0.31-0.63). The results indicated that RCM appears to have a higher specificity in comparison to dermoscopy ( P < 0.01). Our meta-analysis indicates that RCM demonstrates superior specificity and similar sensitivity to dermoscopy in detecting cutaneous melanoma patients. The high heterogeneity, however, may impact the evidence of the current study, further larger sample prospective research is required to confirm these findings.
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Affiliation(s)
- Huasheng Liu
- Departments of Burn Plastic and Cosmetic Surgery
| | - Hong Jiang
- Departments of Burn Plastic and Cosmetic Surgery
| | - Qianqian Shan
- Gynecology and Obstetric, Liaocheng People's Hospital, Liaocheng, China
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2
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Dessinioti C, Tsiakou A, Christodoulou A, Stratigos AJ. Clinical and Dermoscopic Findings of Nevi after Photoepilation: A Review. Life (Basel) 2023; 13:1832. [PMID: 37763236 PMCID: PMC10532922 DOI: 10.3390/life13091832] [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: 06/27/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Atypical clinical and dermoscopic findings, or changes in pigmented melanocytic lesions located on body areas treated with lasers or intense pulsed light (IPL) for hair removal (photoepilation), have been described in the literature. There are three prospective studies in a total of 79 individuals with 287 melanocytic nevi and several case reports reporting the dermoscopic findings and changes after photoepilation. Clinical changes have been reported in 20-100% of individuals, while dermoscopic changes have been observed in 48% to 93% of nevi. More frequent dermoscopic changes included bleaching, the development of pigmented globules, and irregular hyperpigmented areas and regression structures, including gray areas, gray dots/globules, and whitish structureless areas. The diagnostic approach for pigmented lesions with atypical dermoscopic findings and changes after photo-epilation included reflectance confocal microscopy, sequential digital dermoscopy follow-up, and/or excision and histopathology. Challenges pertaining to these diagnostic steps in the context of photoepilation include the detection of findings that may warrant a biopsy to exclude melanoma (ugly duckling, irregular hyperpigmented areas, blue-gray or white areas, and loss of pigment network), the potential persistence of changes at follow-up, and that a histopathologic diagnosis may not be possible due to the distortion of melanocytes or complete regression of the lesion. Furthermore, these diagnostic approaches can be time-consuming, require familiarization of the physician with dermoscopic features, may cause anxiety to the individual, and highlight that avoiding passes of the laser or IPL devices over pigmented lesions is key.
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Affiliation(s)
- Clio Dessinioti
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Andriani Tsiakou
- State Department of Dermatology-Venereology, Andreas Sygros Hospital, 16121 Athens, Greece
| | - Athina Christodoulou
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece
| | - Alexander J. Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, 16121 Athens, Greece
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Silver FH, Deshmukh T, Nadiminti H, Tan I. Melanin Stacking Differences in Pigmented and Non-Pigmented Melanomas: Quantitative Differentiation between Pigmented and Non-Pigmented Melanomas Based on Light-Scattering Properties. Life (Basel) 2023; 13:life13041004. [PMID: 37109534 PMCID: PMC10142763 DOI: 10.3390/life13041004] [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: 03/01/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Cutaneous melanoma is a cancer with metastatic potential characterized by varying amounts of pigment-producing melanocytes, and it is one of the most aggressive and fatal forms of skin malignancy, with several hundreds of thousands of cases each year. Early detection and therapy can lead to decreased morbidity and decreased cost of therapy. In the clinic, this often translates to annual skin screenings, especially for high-risk patients, and generous use of the ABCDE (asymmetry, border irregularity, color, diameter, evolving) criteria. We have used a new technique termed vibrational optical coherence tomography (VOCT) to non-invasively differentiate between pigmented and non-pigmented melanomas in a pilot study. The VOCT results reported in this study indicate that both pigmented and non-pigmented melanomas have similar characteristics, including new 80, 130, and 250 Hz peaks. Pigmented melanomas have larger 80 Hz peaks and smaller 250 Hz peaks than non-pigmented cancers. The 80 and 250 Hz peaks can be used to quantitative characterize differences between different melanomas. In addition, infrared light penetration depths indicated that melanin in pigmented melanomas has higher packing densities than in non-pigmented lesions. Using machine learning techniques, the sensitivity and specificity of differentiating skin cancers from normal skin are shown to range from about 78% to over 90% in this pilot study. It is proposed that using AI on both lesion histopathology and mechanovibrational peak heights may provide even higher specificity and sensitivity for differentiating the metastatic potential of different melanocytic lesions.
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Affiliation(s)
- Frederick H Silver
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
- OptoVibronex, LLC, Bethlehem, PA 18015, USA
| | | | - Hari Nadiminti
- Summit Health, Dermatology Department, Berkeley Heights, NJ 07922, USA
| | - Isabella Tan
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
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4
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Dynamic dermoscopic and reflectance confocal microscopic changes of melanocytic lesions excised during follow up. J Am Acad Dermatol 2021; 86:1049-1057. [PMID: 33823198 DOI: 10.1016/j.jaad.2021.03.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Digital dermoscopy follow up (DDF) is useful in improving the recognition of melanoma, catching early changes over time, although benign nevi can also show changes. Reflectance confocal microscopy (RCM) improves accuracy in diagnosing melanoma and decreases the number of unnecessary resections. OBJECTIVE To evaluate dynamic dermoscopic and RCM changes during follow up of equivocal melanocytic lesions and assess the impact of adjunctive RCM to DDF for melanoma diagnosis. METHODS A retrospective, multicenter study of extrafacial atypical melanocytic lesions excised during follow up was performed. Morphologic changes were evaluated, comparing dermoscopy and RCM baseline and follow-up images. RESULTS One hundred thirty-seven atypical melanocytic lesions were studied, including 14 melanomas and 123 benign nevi. Significantly greater changes in DDF of atypical network, regression, atypical streaks, and asymmetrical growth as well as in dynamic RCM of atypical cells and dermal-epidermal junction disarray were noted in melanomas. With adjunctive dynamic RCM and major changes at DDF, sensitivity reached 100%, with 40.6% specificity. LIMITATIONS Selected series of difficult to recognize lesions, with both DDF and dynamic RCM images. CONCLUSION Adjunctive dynamic RCM improves early melanoma recognition sensitivity.
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Defining and Grading Melanocytic Atypia on Reflectance Confocal Microscopy: A Survey of Confocalists in the United States and Abroad. Am J Dermatopathol 2021; 43:601-603. [PMID: 33464745 DOI: 10.1097/dad.0000000000001884] [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]
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6
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Pogorzelska-Antkowiak A, Calik J. Mimics of melanoma in reflectance confocal microscopy. Int J Dermatol 2020; 60:540-546. [PMID: 33166094 DOI: 10.1111/ijd.15306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/06/2020] [Accepted: 10/16/2020] [Indexed: 01/25/2023]
Abstract
The diagnosis of melanoma is challenging for both dermatologists and oncologists. Incidence of melanoma increases at a rate of 3-7% per year. Usage of modern tools such as dermoscopy and in vivo reflectance confocal microscopy improve early diagnosis and can save a life. There are a few melanoma simulators which can cause confusion and mislead in the differential diagnosis. This study aims to present skin lesions which can be similar to melanoma in confocal microscopy and to emphasize the importance of a detailed differential diagnosis. We describe five melanocytic lesions similar to melanoma and misleading confocal features. Although in vivo reflectance confocal microscopy is very useful in differentiating melanocytic lesions, histopathology evaluation in cases of melanoma mimics is definitive.
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Affiliation(s)
| | - Jacek Calik
- Lower Silesian Oncology Center Wroclaw Department of Chemotherapy, Wroclaw, Poland
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7
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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: 16] [Impact Index Per Article: 4.0] [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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8
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Pezzini C, Kaleci S, Chester J, Farnetani F, Longo C, Pellacani G. Reflectance confocal microscopy diagnostic accuracy for malignant melanoma in different clinical settings: systematic review and meta‐analysis. J Eur Acad Dermatol Venereol 2020; 34:2268-2279. [DOI: 10.1111/jdv.16248] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 01/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- C. Pezzini
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - S. Kaleci
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - J. Chester
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - F. Farnetani
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - C. Longo
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
- Centro Oncologico ad Alta Tecnologia Diagnostica Azienda Unità Sanitaria Locale – IRCCS Reggio Emilia Italy
| | - G. Pellacani
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
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Ahlgrimm‐Siess V, Weitzer F, Arzberger E, Laimer M, Hofmann‐Wellenhof R. Diagnostischer Nutzen der Konfokalmikroskopie als weiterführende Untersuchungsmethode von Gesichtsläsionen. J Dtsch Dermatol Ges 2019; 17:266-274. [DOI: 10.1111/ddg.13748_g] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Verena Ahlgrimm‐Siess
- Abteilung für DermatologieParacelsus Private Medizinische Universität Salzburg Salzburg Österreich
| | - Friedrich Weitzer
- Abteilung für DermatologieMedizinische Universität Graz Graz Österreich
| | - Edith Arzberger
- Abteilung für DermatologieMedizinische Universität Graz Graz Österreich
| | - Martin Laimer
- Abteilung für DermatologieParacelsus Private Medizinische Universität Salzburg Salzburg Österreich
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10
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Dermoscopic features in different dermatopathological stages of cutaneous melanomas. Postepy Dermatol Alergol 2019; 37:677-684. [PMID: 33240005 PMCID: PMC7675076 DOI: 10.5114/ada.2019.83221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/20/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Due to the rising incidence of cutaneous melanoma there is a great need for the development of new diagnostic techniques as well as the improvement of those that are already well known, such as dermoscopy. Since early detection and a proper technique for excising the tumor are crucial for patients' survival, early staging of the tumor is very important. Aim To investigate whether there is a significant difference between the presence of selected dermoscopic features compared to the location on the skin and pathology results: Breslow's depth, mitotic index and ulceration. Material and methods We examined videodermoscopic images of cutaneous melanomas in 81 patients and compared their features with the histological results such as Breslow's depth, mitotic index and ulceration. In the study, we divided and compared the tumors in groups: in situ and invasive, ≤ 1.0 mm and > 1.0 mm thick on the Breslow scale. Results In the study we observed statistically significantly higher prevalence of pseudopods (30.5%) and multicomponent pattern (69.5%) in invasive melanomas in comparison to in situ melanomas (9.1% and 36.4% respectively). White regression structures were more commonly described in invasive melanomas thicker than 1.0 mm on Breslow's scale. Atypical blood vessels and nodules were more specific to invasive melanomas with ulcerations and mitotic index ≥ 1. The atypical pigment network was more specific for thin invasive melanomas. Conclusions Presence of pseudopods, a multicomponent pattern, white regression structures, atypical blood vessels and nodules on dermoscopy suggest invasive (high stage) melanoma.
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11
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Diagnostic accuracy of reflectance confocal microscopy for pigmented skin lesions presenting dermoscopic features of cutaneous melanoma. Postepy Dermatol Alergol 2019; 37:531-534. [PMID: 32994775 PMCID: PMC7507154 DOI: 10.5114/ada.2019.82742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/20/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction The incidence and mortality of melanoma are rising rapidly. Despite ongoing research and the introduction of new therapeutic methods, advanced melanoma is still considered incurable. Early detection and surgical excision of the tumor increases patients’ survival. Since the diagnostic protocol includes surgical excision of all suspicious lesions, it is burdened with a high rate of unnecessary excisions that cause unwanted scarring. This is why the development of accurate diagnostic techniques is crucial. The most common diagnostic tool in early diagnosis of cutaneous melanoma is dermoscopy, though there are emerging new techniques, such as reflectance confocal microscopy and optical coherence tomography. Aim To evaluate diagnostic accuracy of reflectance confocal microscopy as a secondary examination in melanocytic lesions previously diagnosed as melanomas by means of dermoscopy. Material and methods Forty-six melanocytic lesions presenting dermoscopic features of cutaneous malignant melanoma were examined by means of reflectance confocal microscopy. Results The RCM evaluation showed sensitivity at the level of 100% and specificity at 62%. Conclusions It can be estimated that double evaluation of melanocytic lesions by dermoscopy and reflectance confocal microscopy may allow up to 62% of unnecessary excisions to be avoided.
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Ahlgrimm-Siess V, Weitzer F, Arzberger E, Laimer M, Hofmann-Wellenhof R. Diagnostic impact of reflectance confocal microscopy as a second-level examination for facial skin lesions. J Dtsch Dermatol Ges 2019; 17:266-273. [PMID: 30667147 PMCID: PMC6850114 DOI: 10.1111/ddg.13748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/07/2018] [Indexed: 12/02/2022]
Abstract
Background and objective Benign and malignant facial skin lesions may be difficult to differentiate clinically and with dermoscopy. The present study aimed to evaluate the potential utility of in vivo reflectance confocal microscopy (RCM) as a second‐level examination for facial skin neoplasms. Patients and Methods Retrospective and blinded evaluation of 160 consecutive facial lesions was carried out in two separate steps. Clinical and dermoscopic images were assessed first, followed by combined evaluation of clinical/dermoscopic and RCM images. Our study included 60 % malignant lesions, comprising 43 % melanomas, 9 % basal cell carcinomas, 5 % in situ squamous cell carcinomas and 3 % lymphomas. Results Ancillary RCM significantly improved diagnostic specificity for the detection of malignancy compared to clinical/dermoscopic evaluation alone (58 % vs 28 %). However, sensitivity was slightly lower for RCM‐based image evaluation (93 % vs 95 %) due to misclassification of one in situ SCC and one lymphoma. In terms of melanoma diagnosis, RCM‐based image evaluation was generally superior; sensitivity was only slightly increased (88 % vs 87 %), but melanoma specificity was significantly higher (84 % vs 58 %). Conclusion RCM is a valuable diagnostic adjunct for facial skin lesions; unnecessary biopsies in this cosmetically sensitive area could be reduced by one third without missing a melanoma.
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Affiliation(s)
- Verena Ahlgrimm-Siess
- Department of Dermatology, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Friedrich Weitzer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Edith Arzberger
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Martin Laimer
- Department of Dermatology, Paracelsus Private Medical University Salzburg, Salzburg, Austria
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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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14
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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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15
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Dinnes J, Deeks JJ, Chuchu N, Matin RN, Wong KY, Aldridge RB, Durack A, Gulati A, Chan SA, Johnston L, Bayliss SE, Leonardi‐Bee J, Takwoingi Y, Davenport C, O'Sullivan C, Tehrani H, Williams HC. Visual inspection and dermoscopy, alone or in combination, for diagnosing keratinocyte skin cancers in adults. Cochrane Database Syst Rev 2018; 12:CD011901. [PMID: 30521688 PMCID: PMC6516870 DOI: 10.1002/14651858.cd011901.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Early accurate detection of all skin cancer types is important to guide appropriate management, to reduce morbidity and to improve survival. Basal cell carcinoma (BCC) is almost always a localised skin cancer with potential to infiltrate and damage surrounding tissue, whereas a minority of cutaneous squamous cell carcinomas (cSCCs) and invasive melanomas are higher-risk skin cancers with the potential to metastasise and cause death. Dermoscopy has become an important tool to assist specialist clinicians in the diagnosis of melanoma, and is increasingly used in primary-care settings. Dermoscopy is a precision-built handheld illuminated magnifier that allows more detailed examination of the skin down to the level of the superficial dermis. Establishing the value of dermoscopy over and above visual inspection for the diagnosis of BCC or cSCC in primary- and secondary-care settings is critical to understanding its potential contribution to appropriate skin cancer triage, including referral of higher-risk cancers to secondary care, the identification of low-risk skin cancers that might be treated in primary care and to provide reassurance to those with benign skin lesions who can be safely discharged. OBJECTIVES To determine the diagnostic accuracy of visual inspection and dermoscopy, alone or in combination, for the detection of (a) BCC and (b) cSCC, in adults. We separated studies according to whether the diagnosis was recorded face-to-face (in person) or based on remote (image-based) assessment. 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; 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 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. 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 thresholds were missing. We estimated accuracy using hierarchical summary ROC methods. We undertook analysis of studies allowing direct comparison between tests. To facilitate interpretation of results, we computed values of sensitivity at the point on the SROC curve with 80% fixed specificity and values of specificity with 80% fixed sensitivity. We investigated the impact of in-person test interpretation; use of a purposely-developed algorithm to assist diagnosis; and observer expertise. MAIN RESULTS We included 24 publications reporting on 24 study cohorts, providing 27 visual inspection datasets (8805 lesions; 2579 malignancies) and 33 dermoscopy datasets (6855 lesions; 1444 malignancies). The risk of bias was mainly low for the index test (for dermoscopy evaluations) and reference standard domains, particularly for in-person evaluations, and high or unclear for participant selection, application of the index test for visual inspection and for participant flow and timing. We scored concerns about the applicability of study findings as of 'high' or 'unclear' concern for almost all studies across all domains assessed. Selective participant recruitment, lack of reproducibility of diagnostic thresholds and lack of detail on observer expertise were particularly problematic.The detection of BCC was reported in 28 datasets; 15 on an in-person basis and 13 image-based. Analysis of studies by prior testing of participants and according to observer expertise was not possible due to lack of data. Studies were primarily conducted in participants referred for specialist assessment of lesions with available histological classification. We found no clear differences in accuracy between dermoscopy studies undertaken in person and those which evaluated images. The lack of effect observed may be due to other sources of heterogeneity, including variations in the types of skin lesion studied, in dermatoscopes used, or in the use of algorithms and varying thresholds for deciding on a positive test result.Meta-analysis found in-person evaluations of dermoscopy (7 evaluations; 4683 lesions and 363 BCCs) to be more accurate than visual inspection alone for the detection of BCC (8 evaluations; 7017 lesions and 1586 BCCs), with a relative diagnostic odds ratio (RDOR) of 8.2 (95% confidence interval (CI) 3.5 to 19.3; P < 0.001). This corresponds to predicted differences in sensitivity of 14% (93% versus 79%) at a fixed specificity of 80% and predicted differences in specificity of 22% (99% versus 77%) at a fixed sensitivity of 80%. We observed very similar results for the image-based evaluations.When applied to a hypothetical population of 1000 lesions, of which 170 are BCC (based on median BCC prevalence across studies), an increased sensitivity of 14% from dermoscopy would lead to 24 fewer BCCs missed, assuming 166 false positive results from both tests. A 22% increase in specificity from dermoscopy with sensitivity fixed at 80% would result in 183 fewer unnecessary excisions, assuming 34 BCCs missed for both tests. There was not enough evidence to assess the use of algorithms or structured checklists for either visual inspection or dermoscopy.Insufficient data were available to draw conclusions on the accuracy of either test for the detection of cSCCs. AUTHORS' CONCLUSIONS Dermoscopy may be a valuable tool for the diagnosis of BCC as an adjunct to visual inspection of a suspicious skin lesion following a thorough history-taking including assessment of risk factors for keratinocyte cancer. The evidence primarily comes from secondary-care (referred) populations and populations with pigmented lesions or mixed lesion types. There is no clear evidence supporting the use of currently-available formal algorithms to assist dermoscopy diagnosis.
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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
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Kai Yuen Wong
- Oxford University Hospitals NHS Foundation TrustDepartment of Plastic and Reconstructive SurgeryOxfordUK
| | - Roger Benjamin Aldridge
- NHS Lothian/University of EdinburghDepartment of Plastic Surgery25/6 India StreetEdinburghUKEH3 6HE
| | - Alana Durack
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation TrustDermatologyHills RoadCambridgeUKCB2 0QQ
| | - Abha Gulati
- Barts Health NHS TrustDepartment of DermatologyWhitechapelLondonUKE11BB
| | - Sue Ann Chan
- City HospitalBirmingham Skin CentreDudley RdBirminghamUKB18 7QH
| | - Louise Johnston
- NIHR Diagnostic Evidence Co‐operative Newcastle2nd Floor William Leech Building (Rm M2.061) Institute of Cellular Medicine Newcastle UniversityFramlington PlaceNewcastle upon TyneUKNE2 4HH
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Jo Leonardi‐Bee
- The University of NottinghamDivision of Epidemiology and Public HealthClinical Sciences BuildingNottingham City Hospital NHS Trust Campus, Hucknall RoadNottinghamUKNG5 1PB
| | - 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
| | | | - Hamid Tehrani
- Whiston HospitalDepartment of Plastic and Reconstructive SurgeryWarrington RoadLiverpoolUKL35 5DR
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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16
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Dinnes J, Deeks JJ, Chuchu N, Ferrante di Ruffano L, Matin RN, Thomson DR, Wong KY, Aldridge RB, Abbott R, Fawzy M, Bayliss SE, Grainge MJ, Takwoingi Y, Davenport C, Godfrey K, Walter FM, Williams HC. Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults. Cochrane Database Syst Rev 2018; 12:CD011902. [PMID: 30521682 PMCID: PMC6517096 DOI: 10.1002/14651858.cd011902.pub2] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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. Although history-taking and visual inspection of a suspicious lesion by a clinician are usually the first in a series of 'tests' to diagnose skin cancer, dermoscopy has become an important tool to assist diagnosis by specialist clinicians and is increasingly used in primary care settings. Dermoscopy is a magnification technique using visible light that allows more detailed examination of the skin compared to examination by the naked eye alone. Establishing the additive value of dermoscopy over and above visual inspection alone across a range of observers and settings is critical to understanding its contribution for the diagnosis of melanoma and to future understanding of the potential role of the growing number of other high-resolution image analysis techniques. OBJECTIVES To determine the diagnostic accuracy of dermoscopy alone, or when added to visual inspection of a skin lesion, for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults. We separated studies according to whether the diagnosis was recorded face-to-face (in-person), or based on remote (image-based), assessment. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: CENTRAL; 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 dermoscopy in adults with lesions suspicious for melanoma, compared with a reference standard of either histological confirmation or clinical follow-up. Data on the accuracy of visual inspection, to allow comparisons of tests, was included only if reported in the included studies of dermoscopy. 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 accuracy 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 sensitivity at the point on the SROC curve with 80% fixed specificity and values of specificity with 80% fixed sensitivity. We investigated the impact of in-person test interpretation; use of a purposely developed algorithm to assist diagnosis; observer expertise; and dermoscopy training. MAIN RESULTS We included a total of 104 study publications reporting on 103 study cohorts with 42,788 lesions (including 5700 cases), providing 354 datasets for dermoscopy. The risk of bias was mainly low for the index test and reference standard domains and mainly high or unclear for participant selection and participant flow. Concerns regarding the applicability of study findings were largely scored as 'high' concern in three of four domains assessed. Selective participant recruitment, lack of reproducibility of diagnostic thresholds and lack of detail on observer expertise were particularly problematic.The accuracy of dermoscopy for the detection of invasive melanoma or atypical intraepidermal melanocytic variants was reported in 86 datasets; 26 for evaluations conducted in person (dermoscopy added to visual inspection), and 60 for image-based evaluations (diagnosis based on interpretation of dermoscopic images). Analyses of studies by prior testing revealed no obvious effect on accuracy; analyses were hampered by the lack of studies in primary care, lack of relevant information and the restricted inclusion of lesions selected for biopsy or excision. Accuracy was higher for in-person diagnosis compared to image-based evaluations (relative diagnostic odds ratio (RDOR) 4.6, 95% confidence interval (CI) 2.4 to 9.0; P < 0.001).We compared accuracy for (a), in-person evaluations of dermoscopy (26 evaluations; 23,169 lesions and 1664 melanomas),versus visual inspection alone (13 evaluations; 6740 lesions and 459 melanomas), and for (b), image-based evaluations of dermoscopy (60 evaluations; 13,475 lesions and 2851 melanomas),versus image-based visual inspection (11 evaluations; 1740 lesions and 305 melanomas). For both comparisons, meta-analysis found dermoscopy to be more accurate than visual inspection alone, with RDORs of (a), 4.7 (95% CI 3.0 to 7.5; P < 0.001), and (b), 5.6 (95% CI 3.7 to 8.5; P < 0.001). For a), the predicted difference in sensitivity at a fixed specificity of 80% was 16% (95% CI 8% to 23%; 92% for dermoscopy + visual inspection versus 76% for visual inspection), and predicted difference in specificity at a fixed sensitivity of 80% was 20% (95% CI 7% to 33%; 95% for dermoscopy + visual inspection versus 75% for visual inspection). For b) the predicted differences in sensitivity was 34% (95% CI 24% to 46%; 81% for dermoscopy versus 47% for visual inspection), at a fixed specificity of 80%, and predicted difference in specificity was 40% (95% CI 27% to 57%; 82% for dermoscopy versus 42% for visual inspection), at a fixed sensitivity of 80%.Using the median prevalence of disease in each set of studies ((a), 12% for in-person and (b), 24% for image-based), for a hypothetical population of 1000 lesions, an increase in sensitivity of (a), 16% (in-person), and (b), 34% (image-based), from using dermoscopy at a fixed specificity of 80% equates to a reduction in the number of melanomas missed of (a), 19 and (b), 81 with (a), 176 and (b), 152 false positive results. An increase in specificity of (a), 20% (in-person), and (b), 40% (image-based), at a fixed sensitivity of 80% equates to a reduction in the number of unnecessary excisions from using dermoscopy of (a), 176 and (b), 304 with (a), 24 and (b), 48 melanomas missed.The use of a named or published algorithm to assist dermoscopy interpretation (as opposed to no reported algorithm or reported use of pattern analysis), had no significant impact on accuracy either for in-person (RDOR 1.4, 95% CI 0.34 to 5.6; P = 0.17), or image-based (RDOR 1.4, 95% CI 0.60 to 3.3; P = 0.22), evaluations. This result was supported by subgroup analysis according to algorithm used. We observed higher accuracy for observers reported as having high experience and for those classed as 'expert consultants' in comparison to those considered to have less experience in dermoscopy, particularly for image-based evaluations. Evidence for the effect of dermoscopy training on test accuracy was very limited but suggested associated improvements in sensitivity. AUTHORS' CONCLUSIONS Despite the observed limitations in the evidence base, dermoscopy is a valuable tool to support the visual inspection of a suspicious skin lesion for the detection of melanoma and atypical intraepidermal melanocytic variants, particularly in referred populations and in the hands of experienced users. Data to support its use in primary care are limited, however, it may assist in triaging suspicious lesions for urgent referral when employed by suitably trained clinicians. Formal algorithms may be of most use for dermoscopy training purposes and for less expert observers, however reliable data comparing approaches using dermoscopy in person are lacking.
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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
| | | | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | | | - Kai Yuen Wong
- Oxford University Hospitals NHS Foundation TrustDepartment of Plastic and Reconstructive SurgeryOxfordUK
| | - Roger Benjamin Aldridge
- NHS Lothian/University of EdinburghDepartment of Plastic Surgery25/6 India StreetEdinburghUKEH3 6HE
| | - Rachel Abbott
- University Hospital of WalesWelsh Institute of DermatologyHeath ParkCardiffUKCF14 4XW
| | - Monica Fawzy
- Norfolk and Norwich University Hospital NHS TrustDepartment of Plastic and Reconstructive SurgeryColney LaneNorwichUKNR4 7UY
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Matthew J Grainge
- School of MedicineDivision of Epidemiology and Public HealthUniversity of NottinghamNottinghamUKNG7 2UH
| | - 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
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | - Fiona M Walter
- University of CambridgePublic Health & Primary CareStrangeways Research Laboratory, Worts CausewayCambridgeUKCB1 8RN
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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17
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Adler NR, Kelly JW, Guitera P, Menzies SW, Chamberlain AJ, Fishburn P, Button-Sloan AE, Heal C, Soyer HP, Thompson JF. Methods of melanoma detection and of skin monitoring for individuals at high risk of melanoma: new Australian clinical practice. Med J Aust 2018; 210:41-47. [PMID: 30636296 DOI: 10.5694/mja2.12033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The evidence-based national clinical practice guidelines for the management of cutaneous melanoma published in 2008 are currently being updated. This article summarises the findings from multiple chapters of the guidelines on different methods of melanoma detection and of monitoring the skin for patients at high risk of melanoma. Early detection of melanoma is critical, as thinner tumours are associated with enhanced survival; therefore, strategies to improve early detection are important to reduce melanoma-related mortality. MAIN RECOMMENDATIONS Clinicians who perform skin examinations for the purpose of detecting skin cancer should be trained in and use dermoscopy. The use of short term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual melanocytic lesions of concern. The use of long term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual or multiple melanocytic lesions for routine surveillance of high risk patients. The use of total body photography should be considered in managing patients at increased risk for melanoma, particularly those with high naevus counts and dysplastic naevi. There is insufficient evidence to recommend the routine use of automated instruments for the clinical diagnosis of primary melanoma. MANAGEMENT OVERVIEW Determining the relative indications for each diagnostic method and how each method should be introduced into the surveillance of a patient requires careful consideration and an individualised approach.
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Affiliation(s)
- Nikki R Adler
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC
| | - John W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC.,Armadale Dermatology, Melbourne, VIC
| | - Pascale Guitera
- Melanoma Institute Australia, Sydney, NSW.,University of Sydney, Sydney, NSW.,Royal Prince Alfred Hospital, Sydney, NSW
| | - Scott W Menzies
- Sydney Melanoma Diagnostic Centre, University of Sydney, Sydney, NSW
| | - Alex J Chamberlain
- Victorian Melanoma Service, Alfred Health, Melbourne, VIC.,Glenferrie Dermatology, Melbourne, VIC
| | | | | | | | - H Peter Soyer
- Dermatology Research Centre, Diamantina Institute, University of Queensland, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
| | - John F Thompson
- Melanoma Institute Australia, Sydney, NSW.,University of Sydney, Sydney, NSW
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18
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Peccerillo F, Mandel V, Di Tullio F, Ciardo S, Chester J, Kaleci S, de Carvalho N, Del Duca E, Giannetti L, Mazzoni L, Nisticò S, Stanganelli I, Pellacani G, Farnetani F. Lesions Mimicking Melanoma at Dermoscopy Confirmed Basal Cell Carcinoma: Evaluation with Reflectance Confocal Microscopy. Dermatology 2018; 235:35-44. [DOI: 10.1159/000493727] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/10/2018] [Indexed: 11/19/2022] Open
Abstract
Background: Atypical basal cell carcinoma (BCC), characterized by equivocal dermoscopic features typical of malignant melanoma (MM), can be difficult to diagnose. Reflectance confocal microscopy (RCM) enables in vivo imaging at nearly histological resolution. Objectives: To evaluate with RCM atypical melanocytic lesions identified in dermoscopy, according to common RCM criteria for the differential diagnosis of BCC, and to identify representative RCM parameters for superficial (sBCCs) and nonsuperficial (nsBCCs) basal cell carcinomas (BCCs). Methods: A retrospective analysis of consecutive patients evaluated with RCM, selecting excised lesions classified at dermoscopy with ≥1 score from the re visited 7-point checklist, mimicking melanoma, registered between 2010 and 2016. Cluster analysis identified BCC subclassifications. Results: Of 178 atypical lesions, 34 lesions were diagnosed as BCCs with RCM. Lesions were confirmed BCCs with histopathology. Dermoscopic features included atypical network (55.9%) and regression structures (35.5%) associated with sBCCs, and an atypical vascular pattern (58.8%) and irregular blotches (58.8%) with nsBCCs. Hierarchical cluster analysis identified 2 clusters: cluster 1 (100% sBCCs) was characterized by the presence of cords connected to the epidermis (90%, p < 0.001), tumor islands located in the epidermis (100%, p < 0.001), smaller vascular diameter (100%, p < 0.001) and solar elastosis (90%, p = 0.017), and cluster 2 (nsBCCs 85%) was defined by the dermic location of tumor islands (87.5%, p < 0.001) with branch-like structures (70.8%, p = 0.007) and surrounding collagen (83.3%, p = 0.012), peripheral palisading (83.3%, p = 0.012) and coiled vascular morphology (79.2%, p < 0.001) with a larger vascular diameter (50%, p < 0.001). Conclusions: RCM is able to diagnose BCCs mimicking melanoma at dermoscopy and seems able to identify sBCCs and nsBCCs.
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Waddell A, Star P, Guitera P. Advances in the use of reflectance confocal microscopy in melanoma. Melanoma Manag 2018; 5:MMT04. [PMID: 30190930 PMCID: PMC6122529 DOI: 10.2217/mmt-2018-0001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/12/2018] [Indexed: 12/15/2022] Open
Abstract
In vivo reflectance confocal microscopy (RCM) is a noninvasive high-resolution skin imaging tool that has become an important adjunct to clinical exam, dermoscopy and histopathology assessment, in the diagnosis and management of melanoma. RCM generates a horizontal view of the skin, whereby cellular and subcellular (e.g., nuclei, melanophages, collagen) structures, to the level of the upper dermis, are projected onto a screen at near-histological resolution. Morphologic descriptors, standardized terminology, and diagnostic algorithms are well established for the RCM assessment of melanoma, melanocytic, and nonmelanocytic lesions. Clinical applications of RCM in melanoma are broad and include diagnosis, assessment of large lesions on cosmetically sensitive areas, directing areas to biopsy, delineating margins prior to surgery, detecting response to treatment and assessing recurrence. This review will provide an overview of RCM technology, findings by melanoma subtype, clinical applications, as well as explore the accuracy of RCM for melanoma diagnosis, pitfalls and emerging uses of this technology ex vivo.
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Affiliation(s)
- Andréanne Waddell
- Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Department of Medicine/Division of Dermatology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Department of Medicine/Division of Dermatology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Phoebe Star
- Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia.,Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Melanoma Institute Australia, The Poche Centre, North Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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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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Hartmann D, Krammer S, Bachmann MR, Mathemeier L, Ruzicka T, Bagci IS, von Braunmühl T. Ex vivo confocal microscopy features of cutaneous squamous cell carcinoma. JOURNAL OF BIOPHOTONICS 2018; 11:e201700318. [PMID: 29227042 DOI: 10.1002/jbio.201700318] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/07/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Rapid microscopic evaluation of cutaneous squamous cell carcinoma (SCC), its grade of differentiation and level of invasiveness would enable better management of patients' therapy. OBJECTIVES Analyzing specific ex vivo confocal microscopy criteria whether they can predict diagnosis of invasive SCC vs carcinoma in situ and poorly differentiated or undifferentiated vs well and moderately differentiated SCC. METHODS Ex vivo confocal images of 102 SCCs in 57 patients were evaluated immediately after excision for the presence of predefined criteria based on confocal and histological knowledge. RESULTS In histopathological examination, 30 SCCs were in situ and 72 invasive. Of these, 29 invasive SCC tumors were well, 19 moderately, 15 poorly differentiated and 9 undifferentiated. χ2 analysis demonstrated that presence of erosion/ulceration, plump bright or speckled cells in dermis, keratin pearls and peritumoral inflammatory infiltrate correlated with diagnosis of invasive SCC. Erosion/ulceration and peritumoral inflammatory infiltrate were observed more frequently in poorly differentiated or undifferentiated tumors. Plump bright or speckled cells in the dermis were observed less often in well-differentiated tumors. The presence of keratin pearls was associated with well or moderately differentiated tumors. CONCLUSION Ex vivo CLSM allowed rapid examination of SCC and provided useful information on invasiveness and grading of the tumor.
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Affiliation(s)
- Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Sebastian Krammer
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Mario R Bachmann
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Leonie Mathemeier
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Isin S Bagci
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergy, University Hospital LMU, Munich, Germany
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22
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Hartmann D, Krammer S, Vural S, Bachmann MR, Ruini C, Sárdy M, Ruzicka T, Berking C, von Braunmühl T. Immunofluorescence and confocal microscopy for ex-vivo diagnosis of melanocytic and non-melanocytic skin tumors: A pilot study. JOURNAL OF BIOPHOTONICS 2018; 11:e201700211. [PMID: 28949458 DOI: 10.1002/jbio.201700211] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/16/2017] [Accepted: 09/22/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Ex-vivo confocal laser scanning microscopy (ex-vivo CLSM) offers rapid examination of freshly excised tissue. During the conventional examination immunohistochemistry enables to distinguish various cell types. The possibility of immunofluorescent techniques could enhance the accuracy of the diagnosis performed by ex-vivo CLSM. METHODS The tissue probes from various skin tumors were stained with FITC-labeled S-100A10, Melan-A and anti-Ber-EP4 antibodies before examination with ex-vivo CLSM in the fluorescence and reflectance modes. Results were compared to negative controls and conventional histopathology. The staining protocols were evaluated by establishing a scoring system according to the signal intensity found in ex-vivo CLSM. RESULTS S100 immunostaining was successful in 55.6%. Dilution of 1:200 resulted in the best possible evaluation of the tumor. The best suitable protocol was protocol B (phosphate buffered saline [PBS], without blocking agent). Melan A immunostaining was positive in 66.7%, the best dilution was 1:500 and protocol B (PBS, without blocking agent) was the most suitable. Ber-EP4 immunostaining presented a signal in 85.7%, the best dilutions were 1:200 and 1:500 and protocol A (PBS, with blocking agent) showed most optimal results. CONCLUSION The use of fluorescent-labeled antibodies in ex-vivo CLSM is possible and could improve intraoperative diagnostics of skin tumors.
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Affiliation(s)
- Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Sebastian Krammer
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Secil Vural
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | | | - Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Miklós Sárdy
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Thomas Ruzicka
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Carola Berking
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
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23
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Edwards SJ, Mavranezouli I, Osei-Assibey G, Marceniuk G, Wakefield V, Karner C. VivaScope® 1500 and 3000 systems for detecting and monitoring skin lesions: a systematic review and economic evaluation. Health Technol Assess 2018; 20:1-260. [PMID: 27483991 DOI: 10.3310/hta20580] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Skin cancer is one of the most common cancers in the UK. The main risk factor is exposure to ultraviolet radiation from sunlight or the use of sunbeds. Patients with suspicious skin lesions are first examined with a dermoscope. After examination, those with non-cancerous lesions are discharged, but lesions that are still considered clinically suspicious are surgically removed. VivaScope(®) is a non-invasive technology designed to be used in conjunction with dermoscopy to provide a more accurate diagnosis, leading to fewer biopsies of benign lesions or to provide more accurate presurgical margins reducing the risk of cancer recurrence. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of VivaScope(®) 1500 (Caliber Imaging and Diagnostics, Rochester, NY, USA; Lucid Inc., Rochester, NY, USA; or Lucid Inc., MAVIG GmbH, Munich, Germany) and VivaScope(®) 3000 (Caliber Imaging and Diagnostics, Rochester, NY, USA) in the diagnosis of equivocal skin lesions, and VivaScope 3000 in lesion margin delineation prior to surgical excision of lesions. DATA SOURCES Databases (MEDLINE, EMBASE and The Cochrane Library) were searched on 14 October 2014, reference lists of included papers were assessed and clinical experts were contacted for additional information on published and unpublished studies. METHODS A systematic review was carried out to identify randomised controlled trials (RCTs) or observational studies evaluating dermoscopy plus VivaScope, or VivaScope alone, with histopathology as the reference test. A probabilistic de novo economic model was developed to synthesise the available data on costs and clinical outcomes from the UK NHS perspective. All costs were expressed as 2014 prices. RESULTS Sixteen studies were included in the review, but they were too heterogeneous to be combined in a meta-analysis. One of two diagnostic studies that were deemed most representative of UK clinical practice reported that dermoscopy plus VivaScope 1500 was significantly more sensitive than dermoscopy alone in the diagnosis of melanoma (97.8% vs. 94.6%; p = 0.043) and significantly more specific than dermoscopy alone in the diagnosis of non-melanoma (92.4% vs. 26.74%; p < 0.000001). The results of another study suggest 100% [95% confidence interval (CI) 86.16% to 100%] sensitivity for dermoscopy plus VivaScope 1500 versus 100% (95% CI 91.51% to 100%) for dermoscopy alone. Specificity varied from 51.77% to 80.2% depending on the analysis set used. In terms of margin delineation with VivaScope, one study found that 17 out of 29 patients with visible lentigo maligna (LM) had subclinical disease of > 5 mm beyond the dermoscopically identified margin. Using 'optimistic' diagnostic data, the economic model resulted in an incremental cost-effectiveness ratio (ICER) of £8877 per quality-adjusted life-year (QALY) (£9362 per QALY), while the 'less favourable' diagnostic data resulted in an ICER of £19,095 per QALY (£25,453 per QALY) in the diagnosis of suspected melanomas. VivaScope was also shown to be a dominant strategy when used for the diagnostic assessment of suspected basal cell carcinoma (BCC). Regarding margin delineation of LM, mapping with VivaScope was cost-effective, with an ICER of £10,241 per QALY (£11,651 per QALY). However, when VivaScope was used for diagnosis as well as mapping of LM, then the intervention cost was reduced and VivaScope became a dominant strategy. LIMITATIONS There is an absence of UK data in the included studies and, therefore, generalisability of the results to the UK population is unclear. CONCLUSIONS The use of VivaScope appears to be a cost-effective strategy in the diagnostic assessment of equivocal melanomas and BCCs, and in margin delineation of LM prior to surgical treatment. FUTURE WORK High-quality RCTs are required in a UK population to assess the diagnostic accuracy of VivaScope in people with equivocal lesions. STUDY REGISTRATION This study is registered as PROSPERO CRD42014014433. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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24
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Kardynal A, Olszewska M, de Carvalho N, Walecka I, Pellacani G, Rudnicka L. Reflectance confocal microscopy features of thin versus thick melanomas. GIORN ITAL DERMAT V 2018; 154:379-385. [PMID: 29368860 DOI: 10.23736/s0392-0488.18.05863-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In-vivo reflectance confocal microscopy (RCM) plays an increasingly important role in differential diagnosis of melanoma. The aim of the study was to assess typical confocal features of thin (≤1 mm according to Breslow index) versus thick (>1mm) melanomas. METHODS Thirty patients with histopathologically confirmed cutaneous melanoma were included in the study. RCM was performed with Vivascope equipment prior to excision. Fifteen melanomas were thin (Breslow thickness ≤1 mm) and 15 were thick (Breslow thickness >1 mm). RESULTS In the RCM examination, the following features were more frequently observed in thin compared to thick melanomas: edged papillae (26.7% vs. 0%, P=0.032) and areas with honeycomb or cobblestone pattern (33.3% vs. 6.7%, P=0.068). Both features are present in benign melanocytic lesions, so in melanoma are good prognostic factors. The group of thick melanomas compared to the group of thin melanomas in the RCM images presented with greater frequency of roundish cells (100% vs. 40%, P=0.001), non-edged papillae (100% vs. 60%, P=0.006), numerous pagetoid cells (73.3% vs. 33.3%, P=0.028), numerous atypical cells at dermal-epidermal junction (53.3% vs. 20%, P=0.058) and epidermal disarray (93.3% vs. 66.7%, P=0.068). CONCLUSIONS Non-invasive imaging methods helps in deepening of knowledge about the evolution and biology of melanoma. The most characteristic features for thin melanomas in confocal examination are: fragments of cobblestone or honeycomb pattern and edged papillae (as good prognostic factors). The features of thick melanomas in RCM examination are: roundish cells, non-edged papillae, numerous pagetoid cells at dermal-epidermal junction and epidermal disarray.
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Affiliation(s)
| | | | - Nathalie de Carvalho
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Irena Walecka
- Department of Dermatology, CSK MSWiA, Warsaw, Poland
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Poland -
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25
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De Pace B, Farnetani F, Losi A, Ciardo S, De Carvalho N, Cesinaro A, Reggiani Bonetti L, Chester J, Kaleci S, Del Duca E, Nisticò S, Longo C, Pellacani G. Reinterpreting dermoscopic pigment network with reflectance confocal microscopy for identification of melanoma-specific features. J Eur Acad Dermatol Venereol 2017; 32:947-955. [DOI: 10.1111/jdv.14675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
- B. De Pace
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
| | - F. Farnetani
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
| | - A. Losi
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
| | - S. Ciardo
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
| | - N. De Carvalho
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
| | - A.M. Cesinaro
- Department of Pathology; University of Modena and Reggio Emilia; Modena Italy
| | - L. Reggiani Bonetti
- Department of Pathology; University of Modena and Reggio Emilia; Modena Italy
| | - J. Chester
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
| | - S. Kaleci
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
| | - E. Del Duca
- Division of Dermatology; Department of Systems medicine; University of Rome Tor Vergata; Rome Italy
| | - S.P. Nisticò
- Dermatology Department of Health Sciences; ‘Magna Graecia’ University of Catanzaro; Catanzaro Italy
| | - C. Longo
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
- Skin Cancer Unit; Arcispedale Santa Maria Nuova - IRCCS; Reggio Emilia Italy
| | - G. Pellacani
- Dermatology Unit; University of Modena and Reggio Emilia; Modena Italy
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26
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Witkowski AM, Łudzik J, Arginelli F, Bassoli S, Benati E, Casari A, De Carvalho N, De Pace B, Farnetani F, Losi A, Manfredini M, Reggiani C, Malvehy J, Pellacani G. Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases. PLoS One 2017; 12:e0187748. [PMID: 29121636 PMCID: PMC5679638 DOI: 10.1371/journal.pone.0187748] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 10/25/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is an imaging device that permits non-invasive visualization of cellular morphology and has been shown to improve diagnostic accuracy of dermoscopically equivocal cutaneous lesions. The application of double reader concordance evaluation of dermoscopy-RCM image sets in retrospective settings and its potential application to telemedicine evaluation has not been tested in a large study population. OBJECTIVE To improve diagnostic sensitivity of RCM image diagnosis using a double reader concordance evaluation approach; to reduce mismanagement of equivocal cutaneous lesions in retrospective consultation and telemedicine settings. METHODS 1000 combined dermoscopy-RCM image sets were evaluated in blind by 10 readers with advanced training and internship in dermoscopy and RCM evaluation. We compared sensitivity and specificity of single reader evaluation versus double reader concordance evaluation as well as the effect of diagnostic confidence on lesion management in a retrospective setting. RESULTS Single reader evaluation resulted in an overall sensitivity of 95.2% and specificity of 76.3%, with misdiagnosis of 8 melanomas, 4 basal cell carcinomas and 2 squamous cell carcinomas. Combined double reader evaluation resulted in an overall sensitivity of 98.3% and specificity of 65.5%, with misdiagnosis of 1 in-situ melanoma and 2 basal cell carcinomas. CONCLUSION Evaluation of dermoscopy-RCM image sets of cutaneous lesions by single reader evaluation in retrospective settings is limited by sensitivity levels that may result in potential mismanagement of malignant lesions. Double reader blind concordance evaluation may improve the sensitivity of diagnosis and management safety. The use of a second check can be implemented in telemedicine settings where expert consultation and second opinions may be required.
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Affiliation(s)
- A. M. Witkowski
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- * E-mail:
| | - J. Łudzik
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Biostatistics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - F. Arginelli
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - S. Bassoli
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - E. Benati
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - A. Casari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - N. De Carvalho
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - B. De Pace
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - F. Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - A. Losi
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M. Manfredini
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C. Reggiani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - J. Malvehy
- Dermatology Department, Melanoma Unit, Barcelona, Spain
| | - G. Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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27
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Automated video-mosaicking approach for confocal microscopic imaging in vivo: an approach to address challenges in imaging living tissue and extend field of view. Sci Rep 2017; 7:10759. [PMID: 28883434 PMCID: PMC5589933 DOI: 10.1038/s41598-017-11072-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/11/2017] [Indexed: 12/12/2022] Open
Abstract
We describe a computer vision-based mosaicking method for in vivo videos of reflectance confocal microscopy (RCM). RCM is a microscopic imaging technique, which enables the users to rapidly examine tissue in vivo. Providing resolution at cellular-level morphology, RCM imaging combined with mosaicking has shown to be highly sensitive and specific for non-invasively guiding skin cancer diagnosis. However, current RCM mosaicking techniques with existing microscopes have been limited to two-dimensional sequences of individual still images, acquired in a highly controlled manner, and along a specific predefined raster path, covering a limited area. The recent advent of smaller handheld microscopes is enabling acquisition of videos, acquired in a relatively uncontrolled manner and along an ad-hoc arbitrarily free-form, non-rastered path. Mosaicking of video-images (video-mosaicking) is necessary to display large areas of tissue. Our video-mosaicking methods addresses this need. The method can handle unique challenges encountered during video capture such as motion blur artifacts due to rapid motion of the microscope over the imaged area, warping in frames due to changes in contact angle and varying resolution with depth. We present test examples of video-mosaics of melanoma and non-melanoma skin cancers, to demonstrate potential clinical utility.
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28
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Chen LL, Scope A, De Carvalho N, Rabinovitz HS, Pellacani G. Difficult-to-diagnose facial melanomas: Utility of reflectance confocal microscopy in uncovering the diagnosis. JAAD Case Rep 2017; 3:379-383. [PMID: 28831415 PMCID: PMC5555088 DOI: 10.1016/j.jdcr.2017.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Lucy L. Chen
- Department of Dermatology, University of Miami School of Medicine, Miami, Florida
- Correspondence to: Lucy L. Chen, MD, University of Miami Miller School of Medicine, Department of Dermatology and Cutaneous Surgery, 1600 NW 10 Avenue, Room 2023, Miami, FL 33136.University of Miami Miller School of MedicineDepartment of Dermatology and Cutaneous Surgery1600 NW 10 Avenue, Room 2023MiamiFL33136
| | - Alon Scope
- Department of Dermatology, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Nathalie De Carvalho
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Harold S. Rabinovitz
- Department of Dermatology, University of Miami School of Medicine, Miami, Florida
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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29
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Abstract
Reflectance confocal microscopy (RCM) together with dermoscopy enables improved differentiation of melanomas from most nevi. The resulting high sensitivity for detecting melanoma with RCM is complemented by a concomitant increased specificity, which results in the reduction of unnecessary biopsies of nevi. Although RCM can achieve high diagnostic accuracy for early melanoma detection, false-negative and false-positive cases of melanoma are occasionally encountered. This article reviews the essential clues and pitfalls for the diagnosis of melanoma via RCM and highlights the importance of evaluating RCM findings in light of the clinical scenario and dermoscopic features.
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Affiliation(s)
- Cristina Carrera
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBER de Enfermedades Raras, Instituto de Salud Carlos III, University of Barcelona, Villarroel 170, Escala 1-4, Barcelona 08036, Spain
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 800 Veterans Memorial Highway, 2nd Floor, Hauppauge, NY 11788, USA.
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30
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Saral S, Hartmann D, Letulè V, Ruzicka T, Ruini C, von Braunmühl T. "Twin lesions": Which one is the bad one? Improvement of clinical diagnosis with reflectance confocal microscopy. Dermatol Pract Concept 2017; 7:11-17. [PMID: 28243488 PMCID: PMC5315034 DOI: 10.5826/dpc.0701a02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/22/2016] [Indexed: 12/02/2022] Open
Abstract
Background In vivo reflectance confocal microscopy (RCM) is a novel non-invasive diagnostic tool, which is used to differentiate skin lesions. Even in lesions with similar dermatoscopic images, RCM may improve diagnostic accuracy. Methods Three sets of false “twin lesions” with similar macroscopic and dermatoscopic images are matched. All lesions are evaluated with RCM and lesions are excised for further evaluation. Corresponding features in confocal images, dermatoscopy and histopathology are discussed. Results In all matched pairs, one of the lesions was diagnosed as melanoma with the observation of melanoma findings such as: epidermal disarray, pagetoid cells in epidermis and cellular atypia at the junction. Benign lesions were differentiated easily with RCM imaging. Conclusion Examining dermatoscopically difficult and/or similar lesions with RCM facilitates diagnostic and therapeutic decision making. Using RCM in daily practice may contribute to a decrease in unnecessary excisions.
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Affiliation(s)
- Secil Saral
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Department of Dermatology and Venereology, Ankara University, Ankara, Turkey
| | - Daniela Hartmann
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany
| | - Valerie Letulè
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany
| | - Thomas Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Cristel Ruini
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany
| | - Tanja von Braunmühl
- Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany; Städtisches Klinikum München, Fachklinik für Dermatologie und Allergologie, Munich, Germany
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Edwards SJ, Osei-Assibey G, Patalay R, Wakefield V, Karner C. Diagnostic accuracy of reflectance confocal microscopy using VivaScope for detecting and monitoring skin lesions: a systematic review. Clin Exp Dermatol 2017; 42:266-275. [PMID: 28218469 DOI: 10.1111/ced.13055] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Skin cancer is one of the most common cancers in the UK. Patients with suspicious skin lesions are assessed clinically with/without dermoscopy, and lesions still considered suspicious are then surgically removed or have the diagnosis confirmed by a punch biopsy. AIM To evaluate the diagnostic accuracy of the in vivo VivaScope© reflective confocal microscopy (RCM) system, a noninvasive technology designed to provide a more accurate presurgical diagnosis, leading to fewer biopsies of benign lesions, or to provide greater accuracy for lesion margins. METHODS MEDLINE, EMBASE and the Cochrane Library were searched to identify studies evaluating dermoscopy plus RCM, or RCM alone, with histopathology as the reference test. Clinical experts were also contacted for information on unpublished studies. RESULTS Eleven studies met the inclusion criteria but were too heterogeneous to be combined by meta-analysis. Results indicated that VivaScope subsequent to dermoscopy may improve diagnostic accuracy of malignant melanomas compared with dermoscopy. For margin delineation, the data suggest that mapping using VivaScope 1500 for lentigo maligna (LM) and LM melanoma may improve accuracy in terms of complete excision of lesions compared with dermoscopically determined margins. For basal cell carcinoma, the limited data show high diagnostic accuracy with both VivaScope 1500 and VivaScope 3000. Evidence on the effectiveness of VivaScope in diagnosing cutaneous squamous cell carcinomas was very limited. CONCLUSION The use of VivaScope 1500 following dermoscopy may improve patient care and management of suspicious skin lesions, although the generalizability of these results to the UK population remains unclear.
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Affiliation(s)
- S J Edwards
- BMJ Technology Assessment Group, BMJ, London, UK
| | | | - R Patalay
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - V Wakefield
- BMJ Technology Assessment Group, BMJ, London, UK
| | - C Karner
- BMJ Technology Assessment Group, BMJ, London, UK
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Floristán Muruzábal U, Gamo Villegas R, Pampín Franco A, Pinedo Moraleda F, Pérez Fernández E, López-Estebaranz JL. Combined in vivo reflectance confocal microscopy and digital dermoscopy for follow up of patients at high risk of malignant melanoma: A prospective case series study. J Dermatol 2017; 44:681-689. [PMID: 28191661 DOI: 10.1111/1346-8138.13743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/21/2016] [Indexed: 01/27/2023]
Abstract
Digital dermoscopy (DD) follow up is a useful strategy for monitoring patients at high risk of melanoma. Reflectance confocal microscopy (RCM) is a valuable second-level examination after dermoscopy for the evaluation of difficult to diagnose lesions. The aim of this study was to assess the value of RCM in routine DD monitoring of patients at high risk of melanoma. In this prospective study, performed over 22 months, changing melanocytic lesions were detected by DD and excised. RCM imaging was performed before surgical excision of all the lesions, and histopathology used as the gold standard diagnostic test. Eighty-seven lesions, including 11 thin melanomas, were studied. Dermoscopic evaluation at follow up revealed a significant association between melanoma and asymmetry in two axes (P = 0.035). Enlargement and other changes in structure or color did not significantly differ between nevi and melanomas. Widespread pagetoid cells, non-edged papillae, irregular and dishomogeneous junctional clusters, and sheet-like structures were significantly associated with malignancy (P < 0.001). RCM allowed accurate diagnosis of melanoma in 10 of 11 cases (90.9%). The remaining case was classified as a dysplastic nevus. Forty-six lesions (52.8%) in which RCM revealed no atypia were deemed unnecessarily removed. This study was limited by sample size. In conclusion, combined DD and RCM facilitates the recognition of thin malignant melanomas and reduces unnecessary excisions.
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Affiliation(s)
- Uxúa Floristán Muruzábal
- Department of Dermatology, University Hospital Fundación Alcorcón, Rey Juan Carlos University, Madrid, Spain
| | - Reyes Gamo Villegas
- Department of Dermatology, University Hospital Fundación Alcorcón, Rey Juan Carlos University, Madrid, Spain
| | - Ana Pampín Franco
- Department of Dermatology, University Hospital Fundación Alcorcón, Rey Juan Carlos University, Madrid, Spain
| | - Fernando Pinedo Moraleda
- Department of Pathology, University Hospital Fundación Alcorcón, Rey Juan Carlos University, Madrid, Spain
| | - Elia Pérez Fernández
- Research Institute, University Hospital Fundación Alcorcón, Rey Juan Carlos University, Madrid, Spain
| | - José Luis López-Estebaranz
- Department of Dermatology, University Hospital Fundación Alcorcón, Rey Juan Carlos University, Madrid, Spain
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Rajadhyaksha M, Marghoob A, Rossi A, Halpern AC, Nehal KS. Reflectance confocal microscopy of skin in vivo: From bench to bedside. Lasers Surg Med 2016; 49:7-19. [PMID: 27785781 DOI: 10.1002/lsm.22600] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 12/24/2022]
Abstract
Following more than two decades of effort, reflectance confocal microscopy (RCM) imaging of skin was granted codes for reimbursement by the US Centers for Medicare and Medicaid Services. Dermatologists in the USA have started billing and receiving reimbursement for the imaging procedure and for the reading and interpretation of images. RCM imaging combined with dermoscopic examination is guiding the triage of lesions into those that appear benign, which are being spared from biopsy, against those that appear suspicious, which are then biopsied. Thus far, a few thousand patients have been spared from biopsy of benign lesions. The journey of RCM imaging from bench to bedside is certainly a success story, but still much more work lies ahead toward wider dissemination, acceptance, and adoption. We present a brief review of RCM imaging and highlight key challenges and opportunities. The success of RCM imaging paves the way for other emerging optical technologies, as well-and our bet for the future is on multimodal approaches. Lasers Surg. Med. 49:7-19, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Milind Rajadhyaksha
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allan C Halpern
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kishwer S Nehal
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Dickensheets DL, Kreitinger S, Peterson G, Heger M, Rajadhyaksha M. Dermoscopy-guided reflectance confocal microscopy of skin using high-NA objective lens with integrated wide-field color camera. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016; 9689. [PMID: 28919662 DOI: 10.1117/12.2213332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Reflectance Confocal Microscopy, or RCM, is being increasingly used to guide diagnosis of skin lesions. The combination of widefield dermoscopy (WFD) with RCM is highly sensitive (~90%) and specific (~ 90%) for noninvasively detecting melanocytic and non-melanocytic skin lesions. The combined WFD and RCM approach is being implemented on patients to triage lesions into benign (with no biopsy) versus suspicious (followed by biopsy and pathology). Currently, however, WFD and RCM imaging are performed with separate instruments, while using an adhesive ring attached to the skin to sequentially image the same region and co-register the images. The latest small handheld RCM instruments offer no provision yet for a co-registered wide-field image. This paper describes an innovative solution that integrates an ultra-miniature dermoscopy camera into the RCM objective lens, providing simultaneous wide-field color images of the skin surface and RCM images of the subsurface cellular structure. The objective lens (0.9 NA) includes a hyperhemisphere lens and an ultra-miniature CMOS color camera, commanding a 4 mm wide dermoscopy view of the skin surface. The camera obscures the central portion of the aperture of the objective lens, but the resulting annular aperture provides excellent RCM optical sectioning and resolution. Preliminary testing on healthy volunteers showed the feasibility of combined WFD and RCM imaging to concurrently show the skin surface in wide-field and the underlying microscopic cellular-level detail. The paper describes this unique integrated dermoscopic WFD/RCM lens, and shows representative images. The potential for dermoscopy-guided RCM for skin cancer diagnosis is discussed.
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Affiliation(s)
- David L Dickensheets
- Electrical and Computer Engineering Dept., Montana State University, Bozeman, MT 59717
| | - Seth Kreitinger
- Electrical and Computer Engineering Dept., Montana State University, Bozeman, MT 59717
| | - Gary Peterson
- Dermatology Department, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Heger
- Electrical and Computer Engineering Dept., Montana State University, Bozeman, MT 59717
| | - Milind Rajadhyaksha
- Dermatology Department, Memorial Sloan Kettering Cancer Center, New York, NY
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Kubanova AA, Kubanov AA, Smolyannikova VA, Gribanov NV, Makhakova YUB. Diagnostic value of the confocal laser scanning microscopy in vivo. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-3-67-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The confocal laser scanning microscopy in vivo is a promising study method to visualize cell structures of epidermis and papillary dermis without affecting the skin integrity, which provides for a resolution and contrast similar to those characteristic of the classical histology examination. Goal. To assess the confocal laser scanning microscopy in vivo (CLSM) technique for diagnosing actinic keratosis, psoriasis vulgaris and rosacea vs. the classical histology examination. Study materials. The article describes the results obtained by using the confocal laser scanning microscopy in vivo technique vs. the histology examination in 10 patients with erythematous actinic keratosis, 10 patients with extensive psoriasis and 10 patients with erythematous and papulous rosacea. Results. The article describes diagnostically significant signs of the diseases detected by using the confocal laser scanning microscopy in vivo as well as the potential of this method in terms of diagnosing inflammatory skin diseases.
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Kasprzak JM, Xu YG. Diagnosis and management of lentigo maligna: a review. Drugs Context 2015; 4:212281. [PMID: 26082796 PMCID: PMC4453766 DOI: 10.7573/dic.212281] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/12/2015] [Indexed: 01/14/2023] Open
Abstract
Lentigo maligna is a melanocytic neoplasm occurring on sun-exposed skin, usually on the head and neck, of middle-aged and elderly patients. It is thought to represent the in situ phase of lentigo maligna melanoma. The ill-defined nature and potentially large size of lesions can pose significant diagnostic and treatment challenges. The goal of therapy is to cure the lesions in order to prevent development of invasive disease, and surgical excision is the treatment of choice to achieve clear histological margins. Nonsurgical treatment modalities have been reported; however, evidence is lacking to support their use. Age, general health, and comorbidities need to be taken into account when deciding the right treatment modality for each individual patient.
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Affiliation(s)
- Julia M Kasprzak
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yaohui G Xu
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Lovatto L, Carrera C, Salerni G, Alós L, Malvehy J, Puig S. In vivo reflectance confocal microscopy of equivocal melanocytic lesions detected by digital dermoscopy follow-up. J Eur Acad Dermatol Venereol 2015; 29:1918-25. [PMID: 25752663 DOI: 10.1111/jdv.13067] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Digital follow-up is a useful method for the detection of melanoma in atypical mole syndrome patients. The combination of digital follow-up (DFU) and reflectance confocal microscopy (RCM) could be useful to increase the accuracy in the classification of equivocal lesions in atypical mole syndrome patients. OBJECTIVES To assess the impact of RCM analysis on sensitivity and specificity of digital follow-up in a high-risk melanoma setting. METHODS Retrospective study with dermoscopy and RCM of consecutive equivocal atypical melanocytic lesions exhibiting changes in digital dermoscopy in a referral centre. RESULTS Sixty-four lesions from 51 patients were included. Thirteen changing lesions (20.3%) corresponded to eight melanomas in situ and five invasive melanomas with Breslow less than 1 mm. Fifty-one lesions corresponded to melanocytic naevus with variable atypia. Total dermoscopy scores were not different between naevus and melanoma neither in the baseline (mean 5.06 and 5.24; P = 0.37) nor in the follow-up dermoscopic control (mean 5.44 and 5.55; P = 0.37). The only significant dermoscopic feature associated with melanoma in multivariate analysis was the presence of streaks after follow-up (P = 0.027; OR = 3.6; CI 1.50-8.70). The confocal microscopy evaluation (by means both the Modena and Barcelona methods) showed a sensitivity and specificity for the diagnosis of melanoma of 100% and 69% respectively. Based on our experience, the combination of RCM and DFU could have avoided 35 of 51 nevi excised. CONCLUSIONS Reflectance confocal microscopy evaluation of equivocal lesions detected by DFU improved the accuracy in the detection of melanoma. The combination of dermoscopy, DFU and confocal microscopy in equivocal lesions can be useful to dramatically reduce the number of excisions of benign lesions in atypical mole syndrome patients.
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Affiliation(s)
- L Lovatto
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain
| | - C Carrera
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain.,Centro Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain.,University of Barcelona, Spain
| | - G Salerni
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain
| | - L Alós
- University of Barcelona, Spain.,Pathology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - J Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain.,Centro Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain.,University of Barcelona, Spain
| | - S Puig
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Barcelona, Spain.,Centro Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain.,University of Barcelona, Spain
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