Improvement of diagnostic confidence and management of equivocal skin lesions by integration of reflectance confocal microscopy in daily practice: Prospective study in 2 referral skin cancer centers Journal Article
| Authors: | Yélamos, O.; Manubens, E.; Jain, M.; Chavez-Bourgeois, M.; Pulijal, S. V.; Dusza, S. W.; Marchetti, M. A.; Barreiro, A.; Marino, M. L.; Malvehy, J.; Cordova, M. A.; Rossi, A. M.; Rajadhyaksha, M.; Halpern, A. C.; Puig, S.; Marghoob, A. A.; Carrera, C. |
| Article Title: | Improvement of diagnostic confidence and management of equivocal skin lesions by integration of reflectance confocal microscopy in daily practice: Prospective study in 2 referral skin cancer centers |
| Abstract: | Background: Reflectance confocal microscopy (RCM) allows accurate, noninvasive, in vivo diagnosis for skin cancer. However, its impact on physicians' diagnostic confidence and management is unknown. Objectives: We sought to assess the physicians' diagnostic confidence and management before and after RCM of equivocal skin lesions. Methods: Prospective, 2-center, observational study. During clinical practice, 7 dermatologists recorded their diagnostic confidence level (measured in a scale from 0 to 10), diagnosis, and management before and after RCM of clinically/dermoscopically equivocal lesions that raised concern for skin cancer. We also evaluated the diagnostic accuracy before and after RCM. Results: We included 272 consecutive lesions from 226 individuals (mean age, 53.5 years). Diagnostic confidence increased from 6.2 to 8.1 after RCM (P < .001) when RCM confirmed or changed the diagnosis. Lesion management changed in 33.5% cases after RCM (to observation in 51 cases and to biopsy/excision in 31 cases). After RCM, the number needed to excise was 1.2. Sensitivity for malignancy before and after RCM was 78.2% and 85.1%, respectively. Specificity before and after RCM was 78.8% and 80%, respectively. Limitations: Small sample size, real-life environment, and different levels of expertise among RCM users. Conclusion: Physicians' diagnostic confidence and accuracy increased after RCM when evaluating equivocal tumors, frequently resulting in management changes while maintaining high diagnostic accuracy. © 2019 American Academy of Dermatology, Inc. |
| Keywords: | adult; controlled study; human tissue; middle aged; excision; major clinical study; united states; diagnostic accuracy; prospective study; sensitivity and specificity; melanoma; reflectance confocal microscopy; actinic keratosis; basal cell carcinoma; skin biopsy; skin defect; nevus; differential diagnosis; skin cancer; acanthoma; cancer center; seborrheic keratosis; skin scar; dermatitis; dysplastic nevus; physician attitude; observational study; management; cyst rupture; quantitative study; dermatologist; spain; lentigo; pigmented nevus; keratosis; epidermolysis; lichenoid; human; male; female; priority journal; article; squamous cell skin carcinoma; skin cyst; diagnostic confidence level; hemangiofibroma |
| Journal Title: | Journal of the American Academy of Dermatology |
| Volume: | 83 |
| Issue: | 4 |
| ISSN: | 0190-9622 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2020-10-01 |
| Start Page: | 1057 |
| End Page: | 1063 |
| Language: | English |
| DOI: | 10.1016/j.jaad.2019.05.101 |
| PUBMED: | 31202873 |
| PROVIDER: | scopus |
| PMCID: | PMC8285925 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 October 2020 -- Source: Scopus |
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MSK Authors
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385Halpern -
255Dusza -
507Marghoob -
219Rajadhyaksha -
207Rossi -
149Marchetti -
84Cordova -
65Jain -
32
Yelamos Pena -
3
Pulijal
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