Reflectance confocal microscopy made easy

The 4 must-know key features for the diagnosis of melanoma and nonmelanoma skin cancers

Giovanni Pellacani, Alon Scope, Salvador Gonzalez, Pascale Guitera, Francesca Farnetani, Josep Malvehy, Alexander Witkowski, Nathalie De Carvalho, Omar Lupi, Caterina Longo

Research output: Contribution to journalArticle

Abstract

Background: Reflectance confocal microscopy (RCM)-based skin cancer diagnosis requires proficiency. Objective: To identify a short list of key RCM features of skin cancers and test their diagnostic utility. Methods: We identified key RCM features through consensus among 6 experts using a modified Delphi method. To test the diagnostic utility of these RCM key features, 10 novice RCM readers evaluated a subset of 100 RCM cases from a retrospective data set of benign and malignant skin neoplasms. Results: From 56 features reported in the literature, the experts identified 18 RCM features as highly valuable for skin cancer diagnosis. On the basis of consensus definitions, these RCM features were further clustered into 2 melanoma-specific key features (atypical cells and dermoepidermal junction disarray), 1 basal cell carcinoma–specific key feature (basaloid cords/islands), and 1 squamous cell carcinoma–specific key feature (keratinocyte disarray). The novice reading study showed that the presence of at least 1 of the 4 key features was associated with an overall sensitivity for skin cancer diagnosis of 91%, with a sensitivity for melanoma of 93%, a sensitivity for basal cell carcinoma of 92%, and a sensitivity for squamous cell carcinoma of 67%, and an overall specificity of 57%. Limitations: The consensus was based on only six RCM experts and the validation study was retrospective. Conclusions: A consensus terminology short list identifying the 4 RCM key features for skin cancer diagnosis may facilitate dissemination of RCM to novice users.

Original languageEnglish
JournalJournal of the American Academy of Dermatology
DOIs
Publication statusPublished - Jan 1 2019

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Skin Neoplasms
Confocal Microscopy
Melanoma
Intercellular Junctions
Validation Studies
Basal Cell Carcinoma
Skin Tests
Keratinocytes
Routine Diagnostic Tests
Islands
Terminology
Reading
Squamous Cell Carcinoma
Epithelial Cells

Keywords

  • basal cell carcinoma
  • Delphi consensus method
  • diagnostic criteria
  • melanoma
  • nevi
  • reflectance confocal microscopy
  • squamous cell carcinoma

ASJC Scopus subject areas

  • Dermatology

Cite this

Reflectance confocal microscopy made easy : The 4 must-know key features for the diagnosis of melanoma and nonmelanoma skin cancers. / Pellacani, Giovanni; Scope, Alon; Gonzalez, Salvador; Guitera, Pascale; Farnetani, Francesca; Malvehy, Josep; Witkowski, Alexander; De Carvalho, Nathalie; Lupi, Omar; Longo, Caterina.

In: Journal of the American Academy of Dermatology, 01.01.2019.

Research output: Contribution to journalArticle

Pellacani, Giovanni ; Scope, Alon ; Gonzalez, Salvador ; Guitera, Pascale ; Farnetani, Francesca ; Malvehy, Josep ; Witkowski, Alexander ; De Carvalho, Nathalie ; Lupi, Omar ; Longo, Caterina. / Reflectance confocal microscopy made easy : The 4 must-know key features for the diagnosis of melanoma and nonmelanoma skin cancers. In: Journal of the American Academy of Dermatology. 2019.
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