Интеграция конфокальной микроскопии повышает точность диагностики меланомы лица по сравнению с дерматоскопией

The integration of reflectance confocal microscopy (RCM) significantly increases lentigo maligna (LM) and LM melanoma (LMM) sensitivity detection and specificity for benign lesions when compared with dermoscopy alone, according to study findings published in the Journal of the American Academy of Dermatology. A significant proportion of dermatological consultations are for the aesthetic treatment of pigmented or partially-pigmented macules on the face and neck, for which the primary diagnostic challenge is to distinguish between benign lesions and malignant lesions. Therefore, investigators evaluated the effect of RCM integration on dermoscopic triage of equivocal lesions in effort to reduce the need for unnecessary excisions in diagnostically challenging cases. To accomplish this, the investigators conducted a prospective multicenter study (ClinicalTrials.gov Identifier: NCT04789421) in Italy. All consecutive flat facial/neck macules that were assessed between November 2017 and February 2020 were included. Patients with mucosal lesions; lesions that were not accessible (such as located on the eyelid border or inner canthus of the eye); lesions with prevalent erosion, ulceration, and/or hyperkeratosis; lesions modified at follow-up; and recurrent lesions were among those excluded. Overall, 2006 lesions among 801 patients (mean age [range], 66.2 [20-100] years; 60.7% women) were assessed. The mean number of lesions per patient was 2.5. All lesions were located on the head or neck, of which 93% were located on the face, 3% on the neck, 2% on the scalp, and 2% on the ear. Although a small residual risk of missed malignancy persists, the combined approach offers a highly safe, non-invasive pathway for managing equivocal lesions in cosmetically sensitive areas. Dermoscopic evaluation initially classified 91.2% of lesions as probably benign. The remaining 8.8% were considered possibly malignant, of which 38.9% were suspected to be LM/LMM and 61.1% were suspected to be basal cell carcinoma (BCC)/squamous cell carcinoma (SCC). Following dermoscopy/RCM integration, 11.8% of all lesions were considered malignant. This included 226 lesions that were biopsied and excised as well as 10 that were noninvasively treated (including 2 LM and 8 BCC lesions). At follow-up, 26 lesions changed and were removed, including 4 (0.4%) malignancies (including 3 LM and 1 BCC lesion). Histology of 252 excised lesions confirmed 114 malignancies (including 62 LM/LMM and 52 BCC/SCC lesions). While dermoscopy detected 54.8% of LM/LMM and 90.4% of BCC/SCC lesions that were histologically confirmed, RCM diagnosed 91.9% of LM/LMM and 94.2% of BCC/SCC lesions. A minimum of 1-year follow-up was recommended only for the 1690 lesions that were managed conservatively, of which 37% were lost to follow-up. Study limitations include possible selection bias in safety estimates due to missing information and heterogenous follow-up or patients lost to follow-up. Additionally, there is possible verification bias due to histopathology being available only for lesions excised or considered suspicious, with most lesions judged benign managed non-invasively or with follow-up, which possibly inflates sensitivity and specificity estimates. “Integrating RCM significantly improves LM/LMM sensitivity detection and specificity for benign lesions compared to dermoscopy alone, minimizing overtreatment and missed malignancies,” the investigators concluded. They added, “Although a small residual risk of missed malignancy persists, the combined approach offers a highly safe, non-invasive pathway for managing equivocal lesions in cosmetically sensitive areas.” This article originally appeared on Dermatology Advisor