In vivo confocal microscopy: The role of comparative approach in patients with multiple atypical nevi.
Adult
Area Under Curve
Dermoscopy
Female
Humans
Intravital Microscopy
Male
Melanoma
/ diagnostic imaging
Microscopy, Confocal
Middle Aged
Neoplasms, Multiple Primary
/ diagnostic imaging
Nevus
/ diagnostic imaging
Predictive Value of Tests
ROC Curve
Retrospective Studies
Skin Neoplasms
/ diagnostic imaging
dermoscopy
melanoma
morphologic
reflectance confocal microscopy
Journal
Experimental dermatology
ISSN: 1600-0625
Titre abrégé: Exp Dermatol
Pays: Denmark
ID NLM: 9301549
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
03
06
2020
revised:
23
07
2020
accepted:
28
07
2020
pubmed:
5
8
2020
medline:
26
10
2021
entrez:
5
8
2020
Statut:
ppublish
Résumé
In vivo reflectance confocal microscopy (RCM) increases diagnostic accuracy for melanoma diagnosis when combined with dermoscopy. In patients with multiple atypical nevi, a comparative dermoscopic approach improves melanoma recognition and saves unnecessary excision. The performance of a comparative approach combining dermoscopy and RCM has not been yet investigated. To validate a comparative dermoscopic + RCM approach according to melanoma diagnostic accuracy in patients with multiple atypical nevi. Consecutive patients undergoing RCM examination for ≥3 atypical melanocytic lesions, assessed with a dermoscopic + RCM comparative approach in a real-life setting, from July 2012 to April 2018 at a single centre, were enrolled. Dermoscopic and dermoscopic + RCM morphologic approaches were retrospectively applied by evaluating revisited 7-point checklist, RCM and Delphi scores for each enrolled lesion. Comparative dermoscopic and dermoscopic + RCM approaches were subsequently used. For each approach, lesions were classified as non-suspicious (long-term follow-up) or suspicious (short-term follow-up or excision) and diagnostic accuracy for melanoma diagnosis was assessed. Diagnostic accuracy progressively increased comparing morphologic to comparative approaches, and comparing dermoscopic to dermoscopic + RCM approaches. The retrospective comparative dermoscopic + RCM approach revealed the largest area under the curve (0.84; 95%CI:0.79-0.89; P < .001) and the lowest number needed to excise (5.7). Furthermore, this approach had the highest specificity (67.6%) and sensitivity (100%) levels, which were similar to those verified in the real-life setting. The main study limitations are the retrospective design and high-risk patient inclusion only. Comparative dermoscopic + RCM approach increases melanoma diagnostic accuracy, reducing unnecessary excision without missing melanomas.
Sections du résumé
BACKGROUND
In vivo reflectance confocal microscopy (RCM) increases diagnostic accuracy for melanoma diagnosis when combined with dermoscopy. In patients with multiple atypical nevi, a comparative dermoscopic approach improves melanoma recognition and saves unnecessary excision. The performance of a comparative approach combining dermoscopy and RCM has not been yet investigated.
OBJECTIVE
To validate a comparative dermoscopic + RCM approach according to melanoma diagnostic accuracy in patients with multiple atypical nevi.
METHODS
Consecutive patients undergoing RCM examination for ≥3 atypical melanocytic lesions, assessed with a dermoscopic + RCM comparative approach in a real-life setting, from July 2012 to April 2018 at a single centre, were enrolled. Dermoscopic and dermoscopic + RCM morphologic approaches were retrospectively applied by evaluating revisited 7-point checklist, RCM and Delphi scores for each enrolled lesion. Comparative dermoscopic and dermoscopic + RCM approaches were subsequently used. For each approach, lesions were classified as non-suspicious (long-term follow-up) or suspicious (short-term follow-up or excision) and diagnostic accuracy for melanoma diagnosis was assessed.
RESULTS
Diagnostic accuracy progressively increased comparing morphologic to comparative approaches, and comparing dermoscopic to dermoscopic + RCM approaches. The retrospective comparative dermoscopic + RCM approach revealed the largest area under the curve (0.84; 95%CI:0.79-0.89; P < .001) and the lowest number needed to excise (5.7). Furthermore, this approach had the highest specificity (67.6%) and sensitivity (100%) levels, which were similar to those verified in the real-life setting. The main study limitations are the retrospective design and high-risk patient inclusion only.
CONCLUSIONS
Comparative dermoscopic + RCM approach increases melanoma diagnostic accuracy, reducing unnecessary excision without missing melanomas.
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
945-952Subventions
Organisme : Italian Ministry of Health
ID : NET-2011-02347213
Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
J. Dinnes, J. J. Deeks, D. Saleh, N. Chuchu, S. E. Bayliss, L. Patel, C. Davenport, Y. Takwoingi, K. Godfrey, R. N. Matin, R. Patalay, H. C. Williams, Cochrane Database Syst. Rev. 2018,12(12):CD013190.
R. Pampena, S. Borsari, M. Lai, E. Benati, S. Longhitano, M. Mirra, A. Kyrgidis, G. Pellacani, C. Longo, J. Eur. Acad. Dermatol. Venereol. 2019, 33, 1541.
A. Lallas, C. Longo, M. Manfredini, E. Benati, G. Babino, C. Chinazzo, Z. Apalla, C. Papageorgiou, E. Moscarella, A. Kyrgidis, G. Argenziano, JAMA Dermat. 2018, 154, 414.
S. Borsari, R. Pampena, E. Benati, C. Bombonato, A. Kyrgidis, E. Moscarella, A. Lallas, G. Argenziano, G. Pellacani, C. Longo, Br. J. Dermatol. 2018, 179, 163.
G. Argenziano, J. Giacomel, I. Zalaudek, A. Blum, R. P. Braun, H. Cabo, A. Halpern, R. Hofmann-Wellenhof, J. Malvehy, A. A. Marghoob, S. Menzies, E. Moscarella, G. Pellacani, S. Puig, H. Rabinovitz, T. Saida, S. Seidenari, H. P. Soyer, W. Stolz, L. Thomas, H. Kittler, Dermatol. Clin. 2013, 31, 525.
G. Argenziano, C. Catricalà, M. Ardigo, P. Buccini, P. De Simone, L. Eibenschutz, A. Ferrari, G. Mariani, V. Silipo, I. Zalaudek, Arch. Dermatol. 2011, 147, 46.
E. Moscarella, I. Tion, I. Zalaudek, A. Lallas, A. Kyrgidis, C. Longo, M. Lombardi, M. Raucci, R. Satta, R. Alfano, G. Argenziano, J. Eur. Acad. Dermatol. Venereol. 2017, 31, 247.
E. Moscarella, R. Pampena, A. Kyrgidis, I. Tion, C. Longo, A. Lallas, G. Argenziano, J. Am. Acad. Dermatol. 2015, 73, 168.
G. Salerni, T. Teràn, S. Puig, J. Malvehy, I. Zalaudek, G. Argenziano, H. Kittler, J. Eur. Acad. Dermatol. Venereol. 2013, 27, 805.
G. Argenziano, I. Mordente, G. Ferrara, A. Sgambato, P. Annese, I. Zalaudek, Br. J. Dermatol. 2008, 159, 331.
S. Segura, G. Pellacani, S. Puig, C. Longo, S. Bassoli, P. Guitera, J. Palou, S. Menzies, S. Seidenari, J. Malvehy, Arch. Dermatol. 2008, 144, 1311.
I. Stanganelli, C. Longo, L. Mazzoni, S. Magi, M. Medri, G. Lanzanova, F. Farnetani, G. Pellacani, Br. J. Dermatol. 2015, 172, 365.
L. Lovatto, C. Carrera, G. Salerni, L. Alòs, J. Malvehy, S. Puig, J. Eur. Acad Dermatol. Venereol. 1918, 2015, 29.
O. Yélamos, E. Manubens, M. Jain, M. Chavez-Bourgeois, S. V. Pulijal, S. W. Dusza, M. A. Marchetti, A. Barreiro, M. L. Marino, J. Malvehy, M. A. Cordova, A. M. Rossi, M. Rajadhyaksha, A. C. Halpern, S. Puig, A. A. Marghoob, C. Carrera, J. Am. Acad. Dermatol. 2019, S0190-9622, 30969.
M. Rajadhyaksha, M. Grossman, D. Esterowitz, R. H. Webb, R. R. Anderson, J. Invest. Dermatol. 1995, 104, 946.
M. Rajadhyaksha, S. González, J. M. Zavislan, R. R. Anderson, R. H. Webb, J. Invest. Dermatol. 1999, 113, 293.
G. Argenziano, C. Catricalà, M. Ardigo, P. Buccini, P. De Simone, L. Eibenschutz, A. Ferrari, G. Mariani, V. Silipo, I. Sperduti, I. Zalaudek, Br. J. Dermatol. 2011, 164, 785.
G. Pellacani, A. M. Cesinaro, S. Seidenari, J. Am. Acad. Dermatol. 2005, 53, 979.
G. Pellacani, A. Scope, S. Gonzalez, P. Guitera, F. Farnetani, J. Malvehy, A. Witkowski, N. De Carvalho, O. Lupi, C. Longo, J. Am. Acad. Dermatol. 2019, 81, 520.
R. Pampena, S. Piana, E. Moscarella, C. Longo, A. Lallas, R. Alfano, G. Argenziano, J. Eur. Acad. Dermatol. Venereol. 2016, 30, e70.
E. Moscarella, C. Bombonato, R. Pampena, A. Kyrgidis, E. Benati, S. Piana, S. Borsari, A. Lallas, G. Pellacani, G. Argenziano, C. Longo, Exp. Dermatol. 2019, 28, 129.