Diagnostic accuracy of pigmented labial macules by in vivo reflectance confocal microscopy and correlation among techniques - 15/04/20

Doi : 10.1016/j.jaad.2020.02.067

Ignacio Gómez-Martín, MD ^a,^⁎ , Helena Collgros, MD ^b, Peter M. Ferguson, MD, PhD ^c, Alicia Barreiro, MD ^d, Pascale Guitera, MD, PhD ^b,^e, Evelyn Andrades-López, BS ^f, Susana Puig, MD, PhD ^d,^g, Ramon M. Pujol, MD, PhD ^a,^f, Carlos Barranco, MD ^h, Llúcia Alòs, MD, PhD ⁱ, Sonia Segura, MD, PhD ^a,^f
^a Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Departament de Medicina de la UAB, Universitat Autònoma de Barcelona, Barcelona, Spain
^b Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
^c Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
^d Department of Dermatology, Hospital Clínic-Instituto de Investigaciones Biomédicas August Pi i Sunyer, University of Barcelona, Barcelona, Spain
^e Melanoma Institute Australia and Central Clinical School, Sydney University, New South Wales, Australia
^f Institut Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
^g Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
^h Department of Pathology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
ⁱ Department of Pathology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain

^∗Correspondence to: Ignacio Gómez-Martín, MD, Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Departament de Medicina de la UAB, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain.Department of DermatologyHospital del Mar-Parc de Salut MarDepartament de Medicina de la UABUniversitat Autònoma de BarcelonaPasseig Marítim 25-29Barcelona08003Spain

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Abstract

Background

Pigmented labial macules (PLMs) are clinical, dermoscopic, and histopathologic challenges.

Objective

To describe and evaluate the utility of reflectance confocal microscopy (RCM) in PLMs and to establish a correlation between dermoscopy, RCM, histopathology, and immunohistochemistry.

Methods

Prospective study of PLMs from 4 tertiary referral dermatology centers. The study included 51 biopsy specimen-proven PLMs. Dermoscopic, RCM images, and histopathologic preparations were evaluated for malignant criteria. Diagnostic accuracy of RCM for melanoma diagnosis, RCM Lip Score previously reported, and κ values between techniques were calculated.

Results

Included were 5 melanomas and 46 benign PLMs. Dermoscopically, melanomas exhibited more frequently ≥3 colors and ≥3 structures. With RCM, pagetoid spreading, epithelial disarray, continuous proliferation of atypical cells around papillae, nonhomogeneously distributed papillae, marked cellular atypia, and a higher number of dendritic cells per papillae were more frequent in melanomas. The RCM Lip Score was significantly higher in malignant lesions. Good κ values were observed in most of the evaluated features. A perfect sensitivity and specificity was obtained combining dermoscopy and RCM.

Limitations

A low number of melanomas were obtained.

Conclusions

RCM improves lip melanoma diagnosis, and the RCM Lip Score represents a useful tool for the evaluation of a PLM.

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Key words : dermoscopy, labial macule, melanoma, melanotic macule, reflectance confocal microscopy

Abbreviations used : ECJ, MM, PLM, RCM

Plan

Materials and methods

Clinical, dermoscopic, and RCM data

Histopathologic and immunohistochemical findings

Correlation between techniques

Specific diagnosis, sensitivity, and specificity

Discussion

Conclusions

	Funding sources: None.
	Conflicts of interest: None disclosed.
	IRB approval status: Reviewed and approved (Hospital del Mar, Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia; approval 2014/6000/I and X11-0090 and HREC/11/RPAH/123).