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. 2025 Sep;93(3):663-670.
doi: 10.1016/j.jaad.2025.05.1362. Epub 2025 May 12.

Reflectance confocal microscopy terminology for nonmelanocytic skin lesions: A Delphi consensus of experts

Cristian Navarrete-Dechent  1 , Caterina Longo  2 , Konstantinos Liopyris  3 , Marco Ardigo  4 , Verena Ahlgrimm-Siess  5 , Phillipe Bahadoran  6 , Cristina Carrera  7 , Juliana Casagrande Tavoloni Braga  8 , Chih-Shan J Chen  9 , Lilia Correa  10 , Nathalie de Carvahlo  11 , John Durkin  12 , Francesca Farnetani  13 , Jane M Grant-Kels  14 , Melissa Gill  15 , Salvador Gonzalez  16 , Daniela Hartmann  17 , Rainer Hoffman-Wellenhof  18 , Albert Huho  19 , Joanna Ludzik  20 , Josep Malvehy  7 , Ashfaq A Marghoob  9 , Elvira Moscarella  21 , Margaret Oliviero  22 , Susana Puig  7 , Harold Rabinovitz  22 , Babar Rao  23 , Gisele G Rezze  24 , Anthony M Rossi  9 , Gene Rubinstein  25 , Cristel Ruini  26 , Elke Sattler  27 , H Peter Soyer  28 , Rodrigo Schwartz  29 , Steven Thng  30 , Martina Ulrich  31 , Alexander Witkowski  20 , Stephen W Dusza  9 , Pascale Guitera  32 , Giovanni Pellacani  33 , Alon Scope  34 , Manu Jain  35
Affiliations

Reflectance confocal microscopy terminology for nonmelanocytic skin lesions: A Delphi consensus of experts

Cristian Navarrete-Dechent et al. J Am Acad Dermatol. 2025 Sep.

Abstract

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

Objective: To establish expert consensus on a standardized set of RCM terms that describe non-melanocytic lesions (NMLs).

Methods: We invited RCM experts to participate in a Delphi-consensus study. Fifty-nine RCM descriptors were extracted from a previous systematic review on RCM terminology for describing NML. Of these, 35 items were presented as 4 groups of synonymous terms and 24 items as single, nonsynonymous terms. For the first round, an agreement threshold was set at >70%. Participants could also propose new terms. Terms with ≤70% agreement and newly proposed terms were carried over to the next round. For subsequent rounds, agreement threshold was set at >50%.

Results: The study was conducted between June 2021 and May 2023. Forty-two of 44 (95%) invited experts participated. Three iterative Delphi rounds were completed, resulting in a consensus list of 36 terms, including 32 synonymous and 4 nonsynonymous terms for describing NML.

Limitations: Only experts were included. We did not evaluate definitions of terms in the study.

Conclusions: We propose a simplified list of RCM terms, vetted by RCM experts, for describing and diagnosing NML. Uniform terminology could benefit clinical practice, research, and education.

Keywords: Bowen's disease; Delphi; actinic keratosis; basal cell carcinoma; noninvasive; reflectance confocal microscopy; seborrheic keratosis; solar lentigo; squamous cell carcinoma.

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Conflict of interest statement

Conflicts of interest Dr Jain is a consultant for Enspectra Inc. Dr Soyer is a shareholder of MoleMap NZ Limited and an e-dermatologist consultant at GmbH and undertakes regular teledermatological reporting for both companies. Dr Soyer is also a medical consultant for Canfield Scientific Inc and a medical advisor for First Derm. Dr Correa is a consultant for Accutec blades and Enspectra Health and a consultant and researcher for Novartis Pharmaceutical and a researcher for Pfizer and Sanofi. She is also a speaker for La Roche-Possay. Drs Navarrete-Dechent, Longo, Liopyris, Ardigo, Ahlgrimm-Siess, Bahadoran, Carrera, Tavoloni Braga, Chen, Carvahlo, Durkin, Farnetani, Grant-Kels, Gill, Gonzalez, Hartmann, Hoffman-Wellenhof, Huho, Ludzik, Malvehy, Marghoob, Moscarella, Puig, Rabinovitz, Rao, Rezze, Rossi, Rubinstein, Ruini, Sattler, Schwartz, Thng, Ulrich, Witkowski, Dusza, Guitera, Pellacani, Scope, and Author Oliviero have no conflicts of interest to declare.

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