Reflectance confocal microscopy terminology glossary for melanocytic skin lesions: A systematic review

Abstract

Background: There is lack of uniformity in the reflectance confocal microscopy (RCM) terminology for melanocytic lesions.

Objective: To review published RCM terms for melanocytic lesions and identify redundant, synonymous terms.

Methods: A systematic review of original research articles adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted until August 15, 2018. Two investigators gathered all published RCM terms used to describe melanoma and melanocytic nevi. Synonymous terms were grouped based on similarity in definition and in histopathologic correlation.

Results: Out of 156 full-text screened articles, 59 studies met the inclusion criteria. We identified 209 terms; 191 (91.4%) corresponding to high-magnification/cellular-level terms and 18 (8.6%) corresponding to low-magnification/architectural patterns terms. The overall average use frequency of RCM terms was 3.1 times (range, 1-31). By grouping of individual RCM terms based on likely synonymous definitions and by eliminating terms lacking clear definition, the total number of RCM terms could be potentially reduced from 209 to 40 terms (80.8% reduction).

Limitations: Non-English and non-peer-reviewed articles were excluded.

Conclusions: This systematic review of published RCM terms identified significant terminology redundancy. It provides the basis for subsequent terminology consensus on melanocytic neoplasms.

Keywords: diagnosis; melanocytic; melanoma; nevus; noninvasive; reflectance confocal microscopy; systematic review.

Figure 1:

PRISMA diagram.

Figure 2:

Examples of reflectance confocal microscopy terms. A-D. ‘High-magnification’/cellular details examples of melanoma features. A. Round (red arrows) and dendritic (yellow arrows) pagetoid cells in the epidermis (2.0 × 2.0 mm). B. Atypical cells at the dermoepidermal junction (DEJ) (yellow arrows) and non-edged papillae (blue asterisks) (2.0 × 2.0 mm). C. Bright, large, dendritic nucleated cells (yellow arrows) with folliculotropism (yellow asterisk shows a hair follicle) in a lentigo maligna melanoma (0.75 × 0.75 mm). D. Dishomogeneous (‘dense and sparse’) nest (yellow arrows) at the dermis level (1.0 × 1.0 mm). E-H. ‘Low-magnification’ / patterns examples used to describe melanocytic lesions. E. Ringed pattern (2.0 × 1.0 mm). F. Meshwork pattern (2.7 × 2.0 mm). G. Clod pattern (2.5 × 3.5 mm). H. Non-specific pattern.