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Diagnostic accuracy of reflectance confocal microscopy for lesions typified by dermoscopic island
Author(s) -
FigueroaSilva O.,
Cinotti E.,
Almeida Silva T.,
Moscarella E.,
Lallas A.,
Ciardo S.,
Argenziano G.,
Pellacani G.,
Piana S.,
Longo C.
Publication year - 2016
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/jdv.13632
Subject(s) - pagetoid , medicine , atypia , diagnostic accuracy , medical diagnosis , confocal microscopy , nevus , melanoma , pathology , dermatology , confocal , cytology , nuclear medicine , radiology , immunohistochemistry , cancer research , geometry , mathematics , biology , microbiology and biotechnology
Dermoscopic island ( DI ) is a dermoscopic clue for the diagnosis of thin melanoma ( MM ). However, its positive predictive value is about 50% and several naevi with DI are unnecessarily excised. Reflectance confocal microscopy ( RCM ) is a second level non‐invasive imaging tool that increases diagnostic accuracy for MM . Objective To evaluate diagnostic RCM features of pigmented lesions typified by the presence of DI and calculate RCM diagnostic accuracy for MM diagnosis. Methods All lesions with DI were retrieved from a database of 1964 cases. RCM diagnoses were given without being aware of the histopathological diagnoses. The number of MM s among lesions presenting with DI and the sensitivity and specificity of RCM for MM were assessed. The frequencies of dermoscopic and RCM features were calculated to evaluate significant differences in naevi and MM s showing DI (Chi‐square test). Independently significant RCM criteria for MM were identified by discriminant analysis. Results Sixty‐three (3.2%) out of 1964 lesions presented DI . Among them, 30.2% were in situ MM s and 12.7% invasive MM s. Sensitivity and specificity of RCM for the diagnosis of MM in case of DI was 88.9%. Pagetoid cells (Wilks' lambda .804, P < 0.001) and atypical cells at dermo‐epidermal junction (Wilks' lambda .762, P < 0.001) were identified to differentiate MM from naevi. Conclusion Our study confirmed that DI could be a sign of early MM s and underlined that RCM could be a good tool to discriminate MM s and naevi in the presence of DI because it can identify the presence of cytological atypia.