The following is a summary of “Combination of dermoscopy and reflectance confocal microscopy increases the diagnostic confidence of amelanotic/hypomelanotic lentigo maligna,” published in the January 2024 issue of Dermatology by Pizzichetta, et al.
For a study, researchers sought to evaluate the diagnostic performances of dermoscopy and reflectance confocal microscopy (RCM) in distinguishing amelanotic/hypomelanotic lentigo maligna/lentigo maligna melanoma (AHLM/LMM) from other skin lesions.
Dermoscopic and RCM images of histopathologically confirmed AHLM/LMMs, amelanotic/hypomelanotic basal cell carcinoma and squamous cell carcinoma (AHBCCs/AHSCCs), amelanotic/hypomelanotic benign lesions (AHBLs), and actinic keratoses (AKs) were analyzed from five participating centers. Sensitivity, specificity, accuracy, predictive values, and diagnostic confidence levels were calculated for dermoscopy and RCM.
Both dermoscopy and RCM demonstrated diagnostic performances exceeding 97% in distinguishing AHLM/LMMs from AHBCC/AHSCC and combining dermoscopy and RCM slightly improved accuracy to 99.1%. Additionally, the combination of RCM with dermoscopy showed a modest enhancement in diagnostic accuracy in differentiating AHLM/LMMs from AHBLs (accuracy increased from 87.2% to 88.8%) and AKs (accuracy increased from 91.4% to 93.4%). While the increase in diagnostic performance due to RCM was marginal, the integration of dermoscopy and RCM significantly elevated diagnostic confidence. The confidence in diagnosing AHLM/LMMs versus AHBLs rose from 36.2% with dermoscopy alone to 76.6% with the combination of dermoscopy and RCM.
The study underscored the complementary roles of dermoscopy and RCM in improving diagnostic accuracy and confidence in distinguishing AHLM/LMMs from other skin lesions. Combining these modalities should be considered to enhance diagnostic certainty in the clinical assessment of AHLM/LMMs.
Reference: onlinelibrary.wiley.com/doi/10.1111/1346-8138.17075