Adjunctive reflectance confocal microscopy improves accuracy of diagnosis of suspect lesions in melanoma: JAMA

Italy: Adjunctive use of reflectance confocal microscopy (RCM) improves diagnostic accuracy for suspect lesions identified with dermoscopy, a recent study has concluded. 

According to the study, published in JAMA Dermatology, RCM for suspect lesions improved in vivo diagnoses in melanoma cases, reducing the number of lesions excised and effectively identifying invasive melanomas at baseline. 

The prevalence of skin cancer is reported as one in every three cancers that are diagnosed. Melanoma is a type of skin cancer that develops from pigment-producing cells. An early and precise diagnosis of melanoma is important for its favorable prognosis and economic solution. In dermatology, reflectance confocal microscopy (RCM) is a non-invasive imaging technique that enables in vivo cutaneous examination, high diagnostic accuracy, and specificity improvements for equivocal lesions. Dermoscopy is accurate it requires numerous unnecessary excisions.

Previous systematic reviews and meta-analyses have concluded that given the data paucity, a comparison of reflectance confocal microscopy (RCM) with dermoscopy is complex. They recommend comparative perspective studies in a real-world setting of suspect lesions.

The author, Giovanni Pellacani, University of Modena and Reggio Emilia, Italy, and colleagues conducted a study to test the hypothesis that RCM reduces unnecessary lesion excision by more than 30% and identifies all melanoma lesions thicker than 0.5 mm at baseline.

The study was a randomized clinical trial including 3165 patients (1608 (50.8%) male, and mean (SD) age 49.3 (14.9) years) were enrolled from 3 dermatology referral centers in Italy (January 2017- December 2019), with a mean follow-up of 9.6 months. The consecutive samples determined through dermoscopy were eligible for inclusion (10 patients refused). The diagnostic analysis included 3078 patients (48 lost, 39 refused excisions). Data were analyzed between April and September 2021

Patients were randomly assigned 1:1 to standard therapeutic care (clinical and dermoscopy evaluation) with or without adjunctive RCM.

Study data showed that,

• Compared to standard therapeutic care only, adjunctive RCM was associated with a higher positive predictive value (18.9 vs 33.3), and a lower benign to a malignant ratio (3.7:1.0 vs 1.8:1.0) and it also reduced the number of unnecessary excisions by 43.4%.

• All lesions (n = 15) with delayed melanoma diagnoses were thinner than 0.5 mm.

From the analysis of the trial data, the author and team conclude that the adjunctive use of RCM for suspect lesions reduces unnecessary excisions and assures the removal of aggressive melanomas at baseline in a real-life, clinical decision-making application for referral centers with RCM.

Reference:

Pellacani G, Farnetani F, Ciardo S, et al. Effect of Reflectance Confocal Microscopy for Suspect Lesions on Diagnostic Accuracy in Melanoma: A Randomized Clinical Trial. JAMA Dermatol. Published online June 01, 2022. doi:10.1001/jamadermatol.2022.1570