The value of reflectance confocal microscopy in diagnosis of flat pigmented facial lesions: a prospective study

Wurm, E., Pellacani, G., Longo, C., Soyer, H.P., Gonzalez, S., Hofmann-Wellenhof, R., Ahlgrimm-Siess, V., Guitera, P., Sinz, C. and Kittler, H. (2017) The value of reflectance confocal microscopy in diagnosis of flat pigmented facial lesions: a prospective study. Journal of the European Academy of Dermatology and Venereology, 31 8: 1349-1354. doi:10.1111/jdv.14171

Attached Files (Some files may be inaccessible until you login with your UQ eSpace credentials)
Name Description MIMEType Size Downloads
UQ576832_OA.pdf application/pdf 289.55KB 0

Author Wurm, E.
Pellacani, G.
Longo, C.
Soyer, H.P.
Gonzalez, S.
Hofmann-Wellenhof, R.
Ahlgrimm-Siess, V.
Guitera, P.
Sinz, C.
Kittler, H.
Title The value of reflectance confocal microscopy in diagnosis of flat pigmented facial lesions: a prospective study
Journal name Journal of the European Academy of Dermatology and Venereology   Check publisher's open access policy
ISSN 0926-9959
1468-3083
Publication date 2017-05-15
Year available 2017
Sub-type Article (original research)
DOI 10.1111/jdv.14171
Open Access Status File (Author Post-print)
Volume 31
Issue 8
Start page 1349
End page 1354
Total pages 6
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Subject 2708 Dermatology
2725 Infectious Diseases
Abstract Background: Flat pigmented facial lesions are difficult to diagnose even with dermatoscopy. It is controversial how additional information obtained by in vivo reflectance confocal microscopy (RCM) impacts the diagnosis and management. Objective: To examine what in vivo reflectance confocal microscopy of flat pigmented facial lesions adds to clinical examination using dermatoscopy including digital dermatoscopic monitoring. Methods: We prospectively collected 70 cases of flat pigmented facial lesions and recorded diagnoses and management decisions by experts based on direct clinical examination aided by dermatoscopy including digital dermatoscopic monitoring and by remote experts who reviewed the corresponding confocal images. The expert confocal readers were blinded to the clinical and dermatoscopic appearance of the lesion. Results: The sensitivity of dermatoscopy plus digital dermatoscopic monitoring was 95.0% (95% CI 75.13% to 99.87%) and the specificity was 84.0% (95% CI 70.89% to 92.83%). The sensitivity of RCM was 95.0% (95% CI 75.13% to 99.87%) and the specificity was 82.0% (95% CI 68.56% to 91.42%). Conclusion: Although most flat pigmented facial lesions can be managed by clinical examination and dermatoscopy alone, confocal microscopy is a useful adjunct in selected lesions. If RCM is not correlated with clinical and dermatoscopic information, there is risk of overdiagnosis of actinic keratosis, however.
Formatted abstract
Background
Flat pigmented facial lesions are difficult to diagnose even with dermatoscopy. It is controversial how additional information obtained by in vivo reflectance confocal microscopy (RCM) impacts the diagnosis and management.

Objective
To examine what in vivo reflectance confocal microscopy of flat pigmented facial lesions adds to clinical examination using dermatoscopy including digital dermatoscopic monitoring.

Methods
We prospectively collected 70 cases of flat pigmented facial lesions and recorded diagnoses and management decisions by experts based on direct clinical examination aided by dermatoscopy including digital dermatoscopic monitoring and by remote experts who reviewed the corresponding confocal images. The expert confocal readers were blinded to the clinical and dermatoscopic appearance of the lesion.

Results
The sensitivity of dermatoscopy plus digital dermatoscopic monitoring was 95.0% (95% CI 75.13% to 99.87%) and the specificity 84.0% (95% CI 70.89% to 92.83%). The sensitivity of RCM was 95.0% (95% CI 75.13% to 99.87%) and the specificity 82.0% (95% CI 68.56% to 91.42%).

Conclusion
Although most flat pigmented facial lesions can be managed by clinical examination and dermatoscopy alone, confocal microscopy is a useful adjunct in selected lesions. If RCM is not correlated with clinical and dermatoscopic information there is risk of overdiagnosis of actinic keratosis, however.
Keyword Lentigo Maligna Melanoma
Basal-Cell Carcinoma
In-Vivo
Actinic Keratoses
Real-Time
Dermoscopy
Accuracy
Skin
Dermatoscopy
Management
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
UQ Diamantina Institute Publications
Admin Only - UQ Diamantina Institute
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 1 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 2 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 02 May 2017, 12:47:02 EST by Professor Peter Soyer on behalf of UQ Diamantina Institute