Reflectance confocal microscopy terminology for nonmelanocytic skin lesions: A Delphi consensus of experts - 01/06/25

Doi : 10.1016/j.jaad.2025.05.1362

Cristian Navarrete-Dechent, MD ^a,^b,^⁎ , Caterina Longo, MD, PhD ^c,^d, Konstantinos Liopyris, MD ^e, Marco Ardigo, MD, PhD ^f,^g, Verena Ahlgrimm-Siess, MD ^h, Phillipe Bahadoran, MD, PhD ⁱ, Cristina Carrera, MD, PhD ^j,^k, Juliana Casagrande Tavoloni Braga, MD, PhD ^l, Chih-Shan J. Chen, MD, PhD ^b, Lilia Correa, MD ^m,ⁿ, Nathalie de Carvahlo, MD, PhD ^o, John Durkin, MD ^p,^q, Francesca Farnetani, MD ^c, Jane M. Grant-Kels, MD ^r,^s, Melissa Gill, MD ^t,^u,^v, Salvador Gonzalez, MD, PhD ^w, Daniela Hartmann, MD ^x,^y, Rainer Hoffman-Wellenhof, MD ^z, Albert Huho, MD ^aa, Joanna Ludzik, MD, PhD ^ab, Josep Malvehy, MD, PhD ^j,^k, Ashfaq A. Marghoob, MD ^b, Elvira Moscarella, MD, PhD ^ac, Margaret Oliviero, ARNP ^ad, Susana Puig, MD, PhD ^j,^k, Harold Rabinovitz, MD ^ad, Babar Rao, MD ^ae,^af,^ag, Gisele G. Rezze, MD, PhD ^ah, Anthony M. Rossi, MD ^b, Gene Rubinstein, MD ^ai, Cristel Ruini, MD, PhD ^x,^aj, Elke Sattler, MD ^x, H. Peter Soyer, MD ^ak,^al, Rodrigo Schwartz, MD ^am, Steven Thng, MD ^an, Martina Ulrich, MD ^ao, Alexander Witkowski, MD, PhD ^ab, Stephen W. Dusza, DrPH ^b, Pascale Guitera, MD, PhD ^ap,^aq,^ar, Giovanni Pellacani, MD ^aj, Alon Scope, MD ^ar, Manu Jain, MD ^b,^⁎
^a Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
^b Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
^c Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
^d Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
^e Department of Dermatology, University of Athens, Andreas Syggros Hospital of Skin and Venereal Diseases, Athens, Greece
^f Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
^g Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
^h Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
ⁱ Department of Dermatology, Nice University Hospital, Nice, France
^j Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
^k Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
^l Department of Cutaneous Oncology, Hospital A.C. Camargo Cancer Center, São Paulo, SP, Brazil
^m Department of Dermatology, University of South Florida, Tampa, Florida
ⁿ Cutaneous Oncology Department, Moffitt Cancer Center, Tampa, Florida
^o Clinica de Dermatologia Dra Nathalie de Carvalho, Rio de Janeiro, Brazil
^p University of New Mexico School of Medicine, Albuquerque, New Mexico
^q Department of Dermatology, University of New Mexico School of Medicine, Albuquerque, New Mexico
^r Dermatology Department, University of Connecticut School of Medicine, Farmington, Connecticut
^s Dermatology Department, University of Florida College of Medicine, Gainesville, Florida
^t Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, New York
^u Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Solna, Stockholm, Sweden
^v Faculty of Medicine and Health Sciences, University of Alcalá de Henares, Madrid, Spain
^w Department of Medicine and Medical Specialties, Alcala University, Madrid, Spain
^x Department of Dermatology and Allergy, LMU University Hospital, LMU Munich, Munich, Germany
^y Department of Dermatology and Allergy, Munich Municipal Hospital, Munich, Germany
^z Medical University of Graz Department of Dermatology and Venereology, Graz, Austria
^aa Upstate Dermatology, Castleton-on-Hudson, New York
^ab Department of Dermatology, Oregon Health & Science University, Portland, Oregon
^ac Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania, Naples, Italy
^ad Dermatology Associates, Plantation, Florida
^ae Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
^af Department of Dermatology, Rao Dermatology, Atlantic Highlands, New Jersey
^ag Department of Dermatology, Weill Cornell Medicine, New York, New York
^ah Dermatology Department and Medical Science Department, University of Trieste, Trieste, Italy
^ai Dermatology and Laser Centre, Studio City, California
^aj Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza” University of Rome, Rome, Italy
^ak Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
^al Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
^am Department of Dermatology, Escuela de Medicina, Universidad de Chile, Santiago, Chile
^an National Skin Centre, Singapore
^ao CMB Collegium Medicum Berlin GmbH, Berlin, Germany
^ap Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
^aq Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia
^ar The Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel

^∗Correspondence to: Manu Jain, MD, Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 E 74th St, New York, NY 10021.Dermatology ServiceDepartment of MedicineMemorial Sloan Kettering Cancer Center530 E 74th StNew YorkNY10021^∗∗Cristian Navarrete-Dechent, MD, Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 6th Floor, Santiago, Chile 8330077.Department of DermatologyEscuela de MedicinaPontificia Universidad Católica de ChileDiagonal Paraguay 3626th FloorSantiago8330077Chile

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Abstract

Background

There is lack of uniformity in reflectance confocal microscopy (RCM) terminology.

Objective

To establish expert consensus on a standardized set of RCM terms that describe non-melanocytic lesions (NMLs).

Methods

We invited RCM experts to participate in a Delphi-consensus study. Fifty-nine RCM descriptors were extracted from a previous systematic review on RCM terminology for describing NML. Of these, 35 items were presented as 4 groups of synonymous terms and 24 items as single, nonsynonymous terms. For the first round, an agreement threshold was set at >70%. Participants could also propose new terms. Terms with ≤70% agreement and newly proposed terms were carried over to the next round. For subsequent rounds, agreement threshold was set at >50%.

Results

The study was conducted between June 2021 and May 2023. Forty-two of 44 (95%) invited experts participated. Three iterative Delphi rounds were completed, resulting in a consensus list of 36 terms, including 32 synonymous and 4 nonsynonymous terms for describing NML.

Limitations

Only experts were included. We did not evaluate definitions of terms in the study.

Conclusions

We propose a simplified list of RCM terms, vetted by RCM experts, for describing and diagnosing NML. Uniform terminology could benefit clinical practice, research, and education.

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Key words : actinic keratosis, basal cell carcinoma, Bowen's disease, Delphi, noninvasive, reflectance confocal microscopy, seborrheic keratosis, solar lentigo, squamous cell carcinoma

Abbreviations used : BCC, NML, RCM, SCC, SL/SK/LPLK

Plan

Third round and final round

Discussion

	Drs Pellacani and Scope shared senior authorship.
	Funding sources: This research is funded in part by a grant from the National Cancer Institute/National Institutes of Health (P30-CA008748) made to the Memorial Sloan Kettering Cancer Center. Dr Scope's RCM research is funded by the Israel Science Foundation (ISF-1546-16). Dr Navarrete-Dechent research was also funded by ANID - Millennium Science Initiative Program (ICN2021_004).
	Patient consent: Not applicable.
	IRB approval status: Not applicable.