Correlation of handheld reflectance confocal microscopy with radial video mosaicing for margin mapping of lentigo maligna and lentigo maligna melanoma Journal Article

   


Authors: Yélamos, O.; Cordova, M.; Blank, N.; Kose, K.; Dusza, S. W.; Lee, E.; Rajadhyaksha, M.; Nehal, K. S.; Rossi, A. M.
Article Title: Correlation of handheld reflectance confocal microscopy with radial video mosaicing for margin mapping of lentigo maligna and lentigo maligna melanoma
Abstract: IMPORTANCE The management of lentigo maligna (LM) and LM melanoma (LMM) is challenging because of extensive subclinical spread and its occurrence on cosmetically sensitive areas. Reflectance confocal microscopy (RCM) improves diagnostic accuracy for LM and LMM and can be used to delineate their margins. OBJECTIVES To evaluate whether handheld RCM with radial video mosaicing (HRCM-RV) offers accurate presurgical assessment of LM and LMM margins. DESIGN, SETTING, AND PARTICIPANTS This prospective study included consecutive patients with biopsy-proven LM and LMM located on the head and neck area who sought consultation for surgical management from March 1, 2016, through March 31, 2017, at the Dermatology Service of the Memorial Sloan Kettering Cancer Center. Thirty-two patients underwent imaging using HRCM-RV, and 22 patients with 23 LM or LMM lesions underwent staged surgery and contributed to the analysis. MAIN OUTCOMES AND MEASURES Clinical lesion size and area, LM and LMM area based on HRCM-RV findings, surgical defect area estimated by HRCM-RV, and observed surgical defect area. In addition, the margins measured in millimeters estimated for tumor clearance in each quadrant based on HRCM-RV findings were calculated and compared with the surgical margins. RESULTS Among the 22 patients (12 men and 10 women; mean [SD] age, 69.0 [8.6] years [range, 46-83 years]) with 23 lesions included in the final analysis, the mean (SD) surgical defect area estimated with HRCM-RV was 6.34 (4.02) cm(2) and the mean (SD) area of surgical excision with clear margins was 7.74 (5.28) cm(2). Overall, controlling for patient age and previous surgery, surgical margins were a mean of 0.76 mm(95% CI, 0.67-0.84 mm; P < .001) larger than the HRCM-RV estimate. CONCLUSIONS AND RELEVANCE Mapping of LM and LMM with HRCM-RV estimated defects that were similar to but slightly smaller than those found in staged excision. Thus, mapping of LM using HRCM-RV can help spare healthy tissue by reducing the number of biopsies needed in clinically uncertain areas and may be used to plan treatment of LM and LMM and counsel patients appropriately.
Keywords: surgical excision; face; management; efficacy; staged excision; situ; skin in-vivo; spaghetti technique; optimize; cutaneous head
Journal Title: JAMA Dermatology
Volume: 153
Issue: 12
ISSN: 2168-6068
Publisher: American Medical Association  
Date Published: 2017-12-01
Start Page: 1278
End Page: 1284
Language: English
ACCESSION: WOS:000417934900015
DOI: 10.1001/jamadermatol.2017.3114
PROVIDER: wos
PMCID: PMC5730495
PUBMED: 29049429
Notes: Article -- Source: Wos
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MSK Authors
  1. Kishwer S Nehal
    278 Nehal
  2. Stephen Dusza
    288 Dusza
  3. Erica H Lee
    135 Lee
  4. Milind Rajadhyaksha
    222 Rajadhyaksha
  5. Anthony Rossi
    233 Rossi
  6. Kivanc Kose
    81 Kose
  7. Miguel A Cordova
    88 Cordova
  8. Oriol Yelamos Pena
    32 Yelamos Pena
  9. Nina Blank
    9 Blank
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