Document Detail

Reflectance confocal microscopy as a second-level examination in skin oncology improves diagnostic accuracy and saves unnecessary excisions: a longitudinal prospective study.
MedLine Citation:
PMID:  24891083     Owner:  NLM     Status:  Publisher    
BACKGROUND: Dermatoscopy increases both sensitivity and specificity for melanoma diagnosis. Reflectance confocal microscopy (RCM) is a non invasive technique which complements dermatoscopy, in the evaluation of equivocal lesions at cellular resolution.
OBJECTIVES: The purpose of the study was to prospectively determine the potential impact of confocal microscopy when implemented in a routine melanoma diagnosis workflow.
PATIENTS AND METHODS: Patients referred to a single Melanoma Clinic were consecutively enrolled. At dermatoscopy, patients were referred to one of the following pathways: 1- No further examination; 2- RCM examination: atypical lesion/s were referred for either: i) RCM Documentation (lesions with consistent suspicious clinical/dermatoscopic criteria, already qualified and scheduled for surgical excision) or ii) RCM Consultation for equivocal lesions, where RCM diagnosis would determine lesion definite outcome (excision or digital follow-up).
RESULTS: RCM examination was performed for 41% of 1005 patients enrolled. In 2/3 of these cases RCM influenced the lesion outcome. The systematic application of RCM for equivocal lesions saved over 50% benign lesions from unnecessary excision. The number needed to excise (NNE) a melanoma was 6.8 with RCM examination, compared to a hypothetical 14.6 without RCM evaluation.
CONCLUSION: RCM as a second level -level examination to dermatoscopy proved to be highly accurate in diagnosis and reduced the number of unnecessary excisions. Improved accuracy, considering that RCM enabled the detection of the 6 melanomas (2%) in the group of 308 lesions eligible for follow-up, also minimizes the risk of referring a melanoma to digital dermatoscopy monitoring, and potentially losing the patient to follow-up. This article is protected by copyright. All rights reserved.
G Pellacani; P Pepe; A Casari; C Longo
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-5-29
Journal Detail:
Title:  The British journal of dermatology     Volume:  -     ISSN:  1365-2133     ISO Abbreviation:  Br. J. Dermatol.     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-6-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0004041     Medline TA:  Br J Dermatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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