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Reflectance Confocal Microscopy Reduces Unnecessary Excision and Assures Removal of Aggressive Melanomas
Randomized trial results show adjunctive use of reflectance confocal microscopy for suspect lesions in real-world clinical application reduces unnecessary excisions and assures the removal of aggressive melanomas.
“The systematic application of [reflectance confocal microscopy] in the triage of high-risk patients should improve diagnostic accuracy and reduce unnecessary excisions for histopathological diagnostic confirmation, thereby reducing costs, surgical waiting lists, and delayed diagnoses,” wrote Giovanni Pellacani, MD, Chairman of the Department of Dermatology at the University of Modena and Reggio Emilia, and colleagues.
The randomized clinical trial assigned 3165 patients (50.8% male) with a mean age of 49.3 years from 3 dermatology referral centers in Italy in a 1:1 ratio to receive standard therapeutic care (clinical and dermoscopy evaluation) with or without adjunctive reflectance confocal microscopy.
Among participants, adjunctive reflectance confocal microscopy was associated with a higher positive predictive value (18.9 vs 33.3), lower benign to malignant ratio (3.7:1 vs 1.8:1), and a number needed to excise reduction of 43.4% (5.3 vs 3) compared to standard therapeutic care only. Dr Pellacani and colleagues reported that all lesions (n = 15) with delayed melanoma diagnoses were thinner than 0.5 mm.
“This randomized clinical trial shows that adjunctive use of [reflectance confocal microscopy] for suspect lesions reduces unnecessary excisions and assures the removal of aggressive melanomas at baseline in a real-life, clinical decision-making application for referral centers with [reflectance confocal microscopy],” concluded Dr Pellacani and colleagues.
Source:
Pellacani G, Farnetani F, Ciardo S, et al. Effect of Reflectance Confocal Microscopy for Suspect Lesions on Diagnostic Accuracy in Melanoma: A Randomized Clinical Trial. JAMA Dermatol. Published online June 01, 2022. doi:10.1001/jamadermatol.2022.1570.
