Dynamic dermoscopic and reflectance confocal microscopic changes of melanocytic lesions excised during follow up - 04/05/21

Doi : 10.1016/j.jaad.2021.03.081

Alessandra Grazia Condorelli, MD ^a,^⁎ , Francesca Farnetani, MD ^a, Silvana Ciardo, BSc ^a, Johanna Chester, BA ^a, Shaniko Kaleci, PhD ^a, Ignazio Stanganelli, MD ^b,^c, Laura Mazzoni, BSc ^b, Serena Magi, BSc ^b, Victor Desmond Mandel, MD ^a,^b, Marica Mirra, BSc ^d, Riccardo Pampena, MD ^d, Margherita Raucci, RN ^d, Caterina Longo, MD, PhD ^a,^d, Giovanni Pellacani, MD ^a,^e
^a Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
^b Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”—IRST S.r.l. Istituto di Ricovero e Cura a Carattere Scientifico, Meldola (FC), Italy
^c Dermatology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
^d Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale–IRCCS, Reggio Emilia, Italy
^e Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, Rome, Italy

^∗Correspondence and reprint requests to: Alessandra Grazia Condorelli, MD, Via del Pozzo 71, 41125, Modena, Italy.Via del Pozzo 71Modena41125Italy

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Abstract

Background

Digital dermoscopy follow up (DDF) is useful in improving the recognition of melanoma, catching early changes over time, although benign nevi can also show changes. Reflectance confocal microscopy (RCM) improves accuracy in diagnosing melanoma and decreases the number of unnecessary resections.

Objective

To evaluate dynamic dermoscopic and RCM changes during follow up of equivocal melanocytic lesions and assess the impact of adjunctive RCM to DDF for melanoma diagnosis.

Methods

A retrospective, multicenter study of extrafacial atypical melanocytic lesions excised during follow up was performed. Morphologic changes were evaluated, comparing dermoscopy and RCM baseline and follow-up images.

Results

One hundred thirty-seven atypical melanocytic lesions were studied, including 14 melanomas and 123 benign nevi. Significantly greater changes in DDF of atypical network, regression, atypical streaks, and asymmetrical growth as well as in dynamic RCM of atypical cells and dermal-epidermal junction disarray were noted in melanomas. With adjunctive dynamic RCM and major changes at DDF, sensitivity reached 100%, with 40.6% specificity.

Limitations

Selected series of difficult to recognize lesions, with both DDF and dynamic RCM images.

Conclusion

Adjunctive dynamic RCM improves early melanoma recognition sensitivity.

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Key words : dermoscopy, dynamic, follow up, melanocytic lesions, melanoma, reflectence confocal microscopy

Abbreviations used : DDF, DEJ, RCM

Plan

Dermoscopic evaluation

	Funding sources: Supported by the Italian Ministry of Health (Project code: NET-2011-02347213).
	IRB approval status: Approved by the Institutional Review Board (Comitato Etico Provinciale, Azienda Ospedaliero-Universitaria di Modena), project number 2191/C.E.