Melanoma Coverage from Every Angle

WCD 2019: Can Reflectance Confocal Microscopy Prevent Unnecessary Skin Lesion Excision?

By: Joseph Fanelli
Posted: Tuesday, July 9, 2019

According to findings presented at the 24th World Congress of Dermatology (WCD) in Milan, reflectance confocal microscopy can “significantly reduce” unnecessary lesion excisions when diagnosing skin tumors while still remaining effective in diagnosing melanoma. The procedure reportedly works as a second noninvasive imaging technique after dermoscopy, concluded Riccardo Pampena, MD, of the Centro Oncologico Ad Alta Tecnologica Diagnostica, Reggio Emilia, Italy, and colleagues.

“Our preliminary results support the indication for widespread use of confocal microscopy in melanoma diagnosis, combined with clinical and dermoscopic examination,” Dr. Pampena and coauthor Giovanni Pellacani, MD, of the University of Modena and Reggio Emilia, Italy, said in a joint statement to PracticeUpdate. “New devices allowing a faster image acquisition are further supporting this process.”

In this prospective, multicenter, randomized trial, investigators enrolled patents from three Italian health centers with at least one skin lesion suspicious of melanoma. Ultimately, 1,435 lesions were examined, with 746 inspected by dermoscopy plus reflectance confocal microscopy and 689 examined with dermoscopy alone. In the former cohort, 296 lesions (39.7%) were excised, and 450 lesions (31.4%) were scheduled for follow-up procedures. In the dermoscopy-alone cohort, lesions were always excised.

In total, 717 lesions provided histopathologic reports, with 327 lesions from the dermoscopy-alone cohort diagnosed as benign and 119 lesions identified with dermoscopy plus reflectance confocal microscopy reported as benign. Conversely, lesions from the dermoscopy-alone group were discovered to be malignant in 169 cases (141 melanomas), compared with 102 cases (97 melanomas) for lesions in the dual-method group.

The authors found that the use of reflectance confocal microscopy prevented unnecessary excisions in 449 of 568 benign lesions (79%), with only 1 false-negative case of melanoma excised at follow-up. Additionally, the investigators observed that the combination of clinical, dermoscopic, and confocal examinations resulted in a sensitivity of 99% and a specificity of 79%, respectively.

Disclosure: The study authors’ disclosure information may be found at

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