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In vivo dermoscopic and confocal microscopy multistep algorithm to detect in situ melanomas
Author(s) -
Borsari S.,
Pampena R.,
Benati E.,
Bombonato C.,
Kyrgidis A.,
Moscarella E.,
Lallas A.,
Argenziano G.,
Pellacani G.,
Longo C.
Publication year - 2018
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.16364
Subject(s) - pagetoid , melanoma , in situ , medicine , confidence interval , confocal microscopy , confocal , atypia , breslow thickness , multivariate statistics , pathology , dermatology , sentinel lymph node , cancer , biology , statistics , mathematics , breast cancer , chemistry , geometry , organic chemistry , cancer research , microbiology and biotechnology
Summary Background Although several dermoscopic features of in situ melanoma have been identified, data on confocal features of in situ melanoma are still lacking. Objectives To identify reflectance confocal microscopy ( RCM ) features of in situ melanoma and to develop a diagnostic score combining dermoscopy and RCM . Methods In total, 120 in situ melanoma and 213 nevi (test set) were retrospectively analysed to assess the presence of dermoscopic and RCM criteria. Facial and acral lesions were excluded. Spearman's correlation, univariate and multivariate regression models were used to identify features significantly correlated with in situ melanoma diagnosis. Multivariate results on the test set allowed the development of a multistep algorithm, that was tested on a validation set of 100 lesions. Results The dermoscopic findings of an atypical network and regression were independent predicting factors for in situ melanoma diagnosis [odds ratio ( OR ) 3·44, 95% CI (confidence interval) 1·70–6·97 and OR 4·17, 95% CI 1·93–9·00, respectively]. Significant confocal predictors for malignancy were epidermal pagetoid spread ( OR 2·83, 95% CI 1·32–6·04) and junctional cytological atypia ( OR 3·39, 95% CI 1·38–8·30 if focal, OR 8·44, 95% CI 3·21–22·16 if widespread). A multistep diagnostic algorithm able to predict in situ melanoma with a sensitivity of 92·5% and a specificity of 61% was developed. The validation set confirmed the high diagnostic value (sensitivity 92%, specificity 58%). Conclusions An easy and reproducible multistep algorithm for in situ melanoma detection is suggested, that can be routinely used in tertiary centres.