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. 2021 Mar;43(3):895-902.
doi: 10.1002/hed.26545. Epub 2020 Nov 24.

Handheld reflectance confocal microscopy: Personalized and accurate presurgical delineation of lentigo maligna (melanoma)

Yannick S Elshot  1   2 , Biljana Zupan-Kajcovski  1 , William M C Klop  3 , Marcel W Bekkenk  2 , Marianne B Crijns  1 , Menno A de Rie  2 , Alfons J M Balm  3   4
Affiliations

Handheld reflectance confocal microscopy: Personalized and accurate presurgical delineation of lentigo maligna (melanoma)

Yannick S Elshot et al. Head Neck. 2021 Mar.

Abstract

Background: The surgical treatment of lentigo maligna melanoma is associated with high rates of local recurrence. Handheld reflectance confocal microscopy (HH-RCM) allows for in vivo presurgical detection of subclinical lentigo maligna (melanoma) (LM/LMM).

Methods: A single-center retrospective study from December 2015 to July 2017. Frequency and extent of negative surgical margins, and the diagnostic accuracy of presurgical mapping by HH-RCM was determined.

Results: Twenty-six consecutive patients with LM/LMM were included. In 45.8%, HH-RCM detected subclinical LM with a sensitivity of 0.90 and specificity of 0.86. The management was changed in two (7.7%) patients. Of the 24 remaining lesions, 95.8% were excised with negative margins with a mean histological margin of 3.1 and 5.3 mm for LM and LMM, respectively. At a mean follow-up of 36.7 months, there was one (4.8%) confirmed recurrence.

Conclusions: Our method of presurgical delineation by HH-RCM appears to provide a reliable method for the surgical treatment of LM/LMM with a limited rate of overtreatment.

Keywords: diagnostic accuracy; lentigo maligna; presurgical mapping; reflectance confocal microscopy.

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Figures

FIGURE 1
FIGURE 1
A, Step 1: Lentigo maligna located on the left zygoma delineated by a surgical marker including the 5 mm surgical margins. B, Step 2: Circumferential placement of adhesive rings (5.5 mm diameter and 4 mm inner area) bordering the surgical margin. C, Step 3: Evaluation of the inner areas of the adhesive rings. In the presence of lentigo maligna criteria a new margin was drawn, and the margin persevered in the absence of subclinical lentigo maligna. D, Step 4: New adhesive rings were placed at the new margins and steps 1 to 3 repeated until the entire circumference was negative for lentigo maligna criteria on HH‐RCM examination [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Handheld reflectance confocal microscopy of the inner area of an adhesive ring showing atypical dendritic cells at the level of the dermo‐epidermal junction
FIGURE 3
FIGURE 3
Patient flowchart
FIGURE 4
FIGURE 4
A case of a lentigo maligna on the right cheek with subclinical spread (solid line) [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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