The impact of in vivo reflectance confocal microscopy on the diagnostic accuracy of lentigo maligna and equivocal pigmented and nonpigmented macules of the face

Pascale Guitera, Giovanni Pellacani, Kerry A. Crotty, Richard A. Scolyer, Ling Xi L Li, Sara Bassoli, Marco Vinceti, Harold Rabinovitz, Caterina Longo, Scott W. Menzies

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Abstract

Limited studies have reported the in vivo reflectance confocal microscopy (RCM) features of lentigo maligna (LM). A total of 64 RCM features were scored retrospectively and blinded to diagnosis in a consecutive series of RCM sampled, clinically equivocal, macules of the face (n81 LM, n203 benign macules (BMs)). In addition to describing RCM diagnostic features for LM (univariate), an algorithm was developed (LM score) to distinguish LM from BM. This comprised two major features each scoring 2 points (nonedged papillae and round large pagetoid cells 20 m), and four minor features; three scored 1 point each (three or more atypical cells at the dermoepidermal junction in five 0.5 × 0.5 mm 2 fields, follicular localization of atypical cells, and nucleated cells within the dermal papillae), and one (negative) feature scored 1 point (a broadened honeycomb pattern). A LM score of 2 resulted in a sensitivity of 85% and specificity of 76% for the diagnosis of LM (odds ratio (OR) for LM 18.6; 95% confidence interval: 9.3-37.1). The algorithm was equally effective in the diagnosis of amelanotic lesions and showed good interobserver reproducibility (87%). In a test set of 29 LMs and 44 BMs, the OR for LM was 60.7 (confidence interval: 11.9-309) (93% sensitivity, 82% specificity).

Original languageEnglish
Pages (from-to)2080-2091
Number of pages12
JournalJournal of Investigative Dermatology
Volume130
Issue number8
DOIs
Publication statusPublished - Aug 2010

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Hutchinson's Melanotic Freckle
Confocal microscopy
Confocal Microscopy
Odds Ratio
Confidence Intervals
Sensitivity and Specificity

ASJC Scopus subject areas

  • Dermatology
  • Biochemistry
  • Cell Biology
  • Molecular Biology

Cite this

The impact of in vivo reflectance confocal microscopy on the diagnostic accuracy of lentigo maligna and equivocal pigmented and nonpigmented macules of the face. / Guitera, Pascale; Pellacani, Giovanni; Crotty, Kerry A.; Scolyer, Richard A.; Li, Ling Xi L; Bassoli, Sara; Vinceti, Marco; Rabinovitz, Harold; Longo, Caterina; Menzies, Scott W.

In: Journal of Investigative Dermatology, Vol. 130, No. 8, 08.2010, p. 2080-2091.

Research output: Contribution to journalArticle

Guitera, Pascale ; Pellacani, Giovanni ; Crotty, Kerry A. ; Scolyer, Richard A. ; Li, Ling Xi L ; Bassoli, Sara ; Vinceti, Marco ; Rabinovitz, Harold ; Longo, Caterina ; Menzies, Scott W. / The impact of in vivo reflectance confocal microscopy on the diagnostic accuracy of lentigo maligna and equivocal pigmented and nonpigmented macules of the face. In: Journal of Investigative Dermatology. 2010 ; Vol. 130, No. 8. pp. 2080-2091.
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abstract = "Limited studies have reported the in vivo reflectance confocal microscopy (RCM) features of lentigo maligna (LM). A total of 64 RCM features were scored retrospectively and blinded to diagnosis in a consecutive series of RCM sampled, clinically equivocal, macules of the face (n81 LM, n203 benign macules (BMs)). In addition to describing RCM diagnostic features for LM (univariate), an algorithm was developed (LM score) to distinguish LM from BM. This comprised two major features each scoring 2 points (nonedged papillae and round large pagetoid cells 20 m), and four minor features; three scored 1 point each (three or more atypical cells at the dermoepidermal junction in five 0.5 × 0.5 mm 2 fields, follicular localization of atypical cells, and nucleated cells within the dermal papillae), and one (negative) feature scored 1 point (a broadened honeycomb pattern). A LM score of 2 resulted in a sensitivity of 85{\%} and specificity of 76{\%} for the diagnosis of LM (odds ratio (OR) for LM 18.6; 95{\%} confidence interval: 9.3-37.1). The algorithm was equally effective in the diagnosis of amelanotic lesions and showed good interobserver reproducibility (87{\%}). In a test set of 29 LMs and 44 BMs, the OR for LM was 60.7 (confidence interval: 11.9-309) (93{\%} sensitivity, 82{\%} specificity).",
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