In vivo confocal microscopy: The role of comparative approach in patients with multiple atypical nevi.
Exp Dermatol
; 29(10): 945-952, 2020 10.
Article
em En
| MEDLINE
| ID: mdl-32748489
ABSTRACT
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%CI0.79-0.89; 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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias Cutâneas
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Melanoma
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Neoplasias Primárias Múltiplas
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Nevo
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article