Clinical indications for use of reflectance confocal microscopy for skin cancer diagnosis

Stefania Borsari, Riccardo Pampena, Aimilios Lallas, Athanassios Kyrgidis, Elvira Moscarella, Elisa Benati, Margherita Raucci, Giovanni Pellacani, Iris Zalaudek, Giuseppe Argenziano, Caterina Longo

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Importance Reflectance confocal microscopy (RCM) improves diagnostic accuracy in skin cancer detection when combined with dermoscopy; however, little evidence has been gathered regarding its real impact on routine clinical workflow, and, to our knowledge, no studies have defined the terms for its optimal application. Objective To identify lesions on which RCM performs better in terms of diagnostic accuracy and consequently to outline the best indications for use of RCM. Design, Setting, and Participants Prospectively acquired and evaluated RCM images from consecutive patients with at least 1 clinically and/or dermoscopically equivocal skin lesion referred to RCM imaging, from January 2012 to October 2014, carried out in a tertiary referral academic center. Main Outcomes and Measures A total of 1279 equivocal skin lesions were sent for RCM imaging. Spearman correlation, univariate, and multivariate regression models were performed to find features significantly correlated with RCM outcome. Results In a total of 1279 lesions in 1147 patients, RCM sensitivity and specificity were 95.3% and 83.9%, respectively. The number of lesions needed to excise to rule out a melanoma was 2.4. After univariate and multivariate regression analysis, head and neck resulted as the most appropriate body location for confocal examination; RCM showed a high diagnostic accuracy for lesions located on sun-damaged skin (adjusted odds ratio [aOR], 2.13; 95% CI, 1.37-3.30; P=.001) and typified by dermoscopic regression (aOR, 2.13; 95% CI, 1.31-3.47; P=.002) or basal-cell carcinoma specific criteria (aOR, 9.35; 95% CI, 1.28-68.58; P=.03). Conclusions and Relevance Lesions located on the head and neck, damaged by chronic sun-exposure, and dermoscopically typified by regression represent best indications for the use of RCM.

Original languageEnglish
Pages (from-to)1093-1098
Number of pages6
JournalJAMA Dermatology
Volume152
Issue number10
DOIs
Publication statusPublished - Oct 1 2016

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Skin Neoplasms
Confocal Microscopy
Odds Ratio
Solar System
Skin
Neck
Head
Dermoscopy
Workflow
Basal Cell Carcinoma
Tertiary Care Centers
Melanoma
Multivariate Analysis
Regression Analysis
Outcome Assessment (Health Care)
Sensitivity and Specificity

ASJC Scopus subject areas

  • Dermatology

Cite this

Borsari, S., Pampena, R., Lallas, A., Kyrgidis, A., Moscarella, E., Benati, E., ... Longo, C. (2016). Clinical indications for use of reflectance confocal microscopy for skin cancer diagnosis. JAMA Dermatology, 152(10), 1093-1098. https://doi.org/10.1001/jamadermatol.2016.1188

Clinical indications for use of reflectance confocal microscopy for skin cancer diagnosis. / Borsari, Stefania; Pampena, Riccardo; Lallas, Aimilios; Kyrgidis, Athanassios; Moscarella, Elvira; Benati, Elisa; Raucci, Margherita; Pellacani, Giovanni; Zalaudek, Iris; Argenziano, Giuseppe; Longo, Caterina.

In: JAMA Dermatology, Vol. 152, No. 10, 01.10.2016, p. 1093-1098.

Research output: Contribution to journalArticle

Borsari, S, Pampena, R, Lallas, A, Kyrgidis, A, Moscarella, E, Benati, E, Raucci, M, Pellacani, G, Zalaudek, I, Argenziano, G & Longo, C 2016, 'Clinical indications for use of reflectance confocal microscopy for skin cancer diagnosis', JAMA Dermatology, vol. 152, no. 10, pp. 1093-1098. https://doi.org/10.1001/jamadermatol.2016.1188
Borsari S, Pampena R, Lallas A, Kyrgidis A, Moscarella E, Benati E et al. Clinical indications for use of reflectance confocal microscopy for skin cancer diagnosis. JAMA Dermatology. 2016 Oct 1;152(10):1093-1098. https://doi.org/10.1001/jamadermatol.2016.1188
Borsari, Stefania ; Pampena, Riccardo ; Lallas, Aimilios ; Kyrgidis, Athanassios ; Moscarella, Elvira ; Benati, Elisa ; Raucci, Margherita ; Pellacani, Giovanni ; Zalaudek, Iris ; Argenziano, Giuseppe ; Longo, Caterina. / Clinical indications for use of reflectance confocal microscopy for skin cancer diagnosis. In: JAMA Dermatology. 2016 ; Vol. 152, No. 10. pp. 1093-1098.
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