Improvement of diagnostic confidence and management of equivocal skin lesions by integration of reflectance confocal microscopy in daily practice: prospective study in two referral skin cancer centers.

Yélamos O, Manubens E, Jain M, Chavez-Bourgeois M, Pulijal SV, Dusza SW, Marchetti MA, Barreiro A, Marino ML, Malvehy J, Cordova MA, Rossi AM, Rajadhyaksha M, Halpern AC, Puig S, Marghoob AA, Carrera C. J Am Acad Dermatol. 2019 Jun 13. pii: S0190-9622(19)30969-7. doi: 10.1016/j.jaad.2019.05.101.


BACKGROUND: Reflectance confocal microscopy (RCM) allows accurate noninvasive in-vivo diagnosis for skin cancer. However, its impact in daily routine on the physician's diagnostic confidence and management is unknown.

OBJECTIVES: We sought to assess the physician´s diagnostic confidence and management before and after RCM of equivocal skin lesions.

METHODS: Prospective, two-center, observational study. During clinical practice, seven dermatologists recorded their diagnostic confidence level, diagnosis and management before and after RCM of clinically/dermoscopically-equivocal lesions concerning for skin cancer. We also evaluated the diagnostic accuracy before and after RCM.

RESULTS: We included 272 consecutive lesions from 226 individuals (mean age 53.5 years). Diagnostic confidence increased from 6.2 to 8.1 after RCM (p<0.001), both when RCM reassured or changed the diagnosis. Lesion management changed in 33.5% cases after RCM, (to observation n=51; to biopsy/excision n=31). After RCM, the number needed to excise was 1.2. Sensitivity for malignancy before and after RCM was 78.2% and 85.1%, respectively. Specificity before and after RCM was 78.8 % and 80%, respectively.

LIMITATIONS: Small sample size, real-life environment, different expertise among RCM users.

CONCLUSION: Physician's diagnostic confidence and accuracy increases after RCM when evaluating equivocal tumors, frequently resulting in management changes, while keeping high diagnostic accuracy.

Copyright © 2019. Published by Elsevier Inc.

KEYWORDS: basal cell carcinoma; diagnostic accuracy; diagnostic confidence level; management; melanoma; reflectance confocal microscopy; skin cancer

PMID:31202873 DOI:10.1016/j.jaad.2019.05.101