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. 2021 Sep 1;11(4):e2021127.
doi: 10.5826/dpc.1104a127. eCollection 2021 Sep.

Melanocytic or Not? Dermoscopy and Reflectance Confocal Microscopy for Lesions Difficult to Diagnose: A Cross-Sectional Diagnostic Accuracy Study

Camila Scharf  1 , Giuseppe Argenziano  1 , Gabriella Brancaccio  1 , Gaetano Licata  1 , Andrea Ronchi  2 , Elvira Moscarella  1
Affiliations

Melanocytic or Not? Dermoscopy and Reflectance Confocal Microscopy for Lesions Difficult to Diagnose: A Cross-Sectional Diagnostic Accuracy Study

Camila Scharf et al. Dermatol Pract Concept. .

Abstract

Background: Different techniques for non-invasive skin examination and early diagnosis of skin lesions are available nowadays, being dermoscopy and reflectance confocal microscopy (RCM) the most diffused ones. Several studies supported the complementary use of dermoscopy and RCM that improves diagnostic accuracy when dealing with melanocytic lesions.

Objectives: To analyze RCM diagnostic accuracy in the differential diagnosis between melanocytic and non-melanocytic lesions.

Methods: This is a cohort selected cross-sectional study conducted at the Dermatology Unit of the University of Campania L. Vanvitelli, Naples, Italy, from 2012 to 2020. We searched the image database for all excised lesions for which the clinical and dermatoscopic differential diagnosis was between melanocytic and non-melanocytic and for which an RCM examination was performed. Sensitivity, specificity, and diagnostic accuracy values were estimated.

Results: The study included 53 cases that were found to have disagreement between clinical, histological and RCM diagnosis, of which, in 31 cases the differential diagnosis was melanocytic vs non-melanocytic lesion. The RCM reached a specificity of 87% (95% CI: 0.73-1) and a sensitivity of 62.5% (95% CI: 0.29-0.96) in the present sample. Diagnostic accuracy was 80.6% (95% CI: 0.67-0.94).

Conclusion: RCM has a high specificity in differentiating between difficult-to-diagnose melanocytic and non-melanocytic lesions.

Keywords: dermoscopy; diagnosis; melanocytic; reflectance confocal microscopy; skin cancer.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Melanoma in situ on the back of a 75-year old woman. (A) A pigmented macule on a background of intense solar damage. (B) Dermoscopy showing atypical network and regression.
Figure 2
Figure 2
RCM imaging of case 1. Mosaic at the level of the dermal epidermal junction (1.5x2.5 mm), showing meshwork pattern (square). Roundish and dendritic pagetoid cells (arrows).
Figure 3
Figure 3
Case 2: Basal cell carcinoma on the tip of the nose in a 60 year-old man. (A) Clinical image: a pigmented macule of 1 cm diameter. (B) In dermoscopy multiple brown concentric structures and peripheral leaf like areas. (C) RCM image showing bright tumor islands.
Figure 4
Figure 4
Case 3: Basal cell carcinoma in differential diagnosis with solar lentigo and melanoma. (A) Flat facial lesion on the face of a 40 year-old woman with undefined borders (B) Dermoscopic analysis revealing brown pseudonetwork and grey globules.
Figure 5
Figure 5
RCM of case 3. RCM Mosaic (2.5 x 1.5 mm) at the level of the upper dermis featuring tumoral islands, typical of BCC.
See this image and copyright information in PMC

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