Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study Journal Article
| Authors: | Navarrete-Dechent, C.; Cordova, M.; Aleissa, S.; Liopyris, K.; Dusza, S. W.; Kose, K.; Busam, K. J.; Hollman, T.; Lezcano, C.; Pulitzer, M.; Chen, C. S. J.; Lee, E. H.; Rossi, A. M.; Nehal, K. S. |
| Article Title: | Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study |
| Abstract: | Background: Lentigo maligna/lentigo maligna melanoma (LM/LMM) can present with subclinical extension that may be difficult to define preoperatively and lead to incomplete excision and potential recurrence. Preliminarily studies have used reflectance confocal microscopy (RCM) to assess LM/LMM margins. Objective: To evaluate the correlation of LM/LMM subclinical extension defined by RCM compared with the gold standard histopathology. Methods: Prospective study of LM/LMM patients referred for dermatologic surgery. RCM was performed at the clinically defined initial surgical margin followed by margin-controlled staged excision with paraffin-embedded tissue, and histopathology was correlated with RCM results. Results: Seventy-two patients were included. Mean age was 66.8 years (standard deviation, 11.1; range, 38-89); 69.4% were men. Seventy of 72 lesions (97.2%) were located on the head and neck with mean largest clinical diameter of 1.3 cm (range, 0.3-5). Diagnostic accuracy for detection of residual melanoma in the tumor debulk (after biopsy) had a sensitivity of 96.7% and a specificity of 66.7% when compared with histopathology. RCM margin assessment revealed an overall agreement with final histopathology of 85.9% (κ = 0.71; P < .001). Limitations: No RCM imaging beyond initial planned margins was performed. Conclusion: RCM showed moderate to excellent overall agreement between RCM imaging of LM/LMM and histopathology of staged excision margins. © 2019 American Academy of Dermatology, Inc. |
| Keywords: | immunohistochemistry; adult; controlled study; human tissue; aged; cancer surgery; major clinical study; histopathology; cancer staging; prospective study; sensitivity and specificity; prospective studies; melanoma; reflectance confocal microscopy; confocal microscopy; microscopy, confocal; skin neoplasms; lentigo maligna; dendritic cell; malignant lentigo; hutchinson's melanotic freckle; tumor biopsy; pathology; diagnostic imaging; skin tumor; disease severity; cancer size; clinical evaluation; surgery; intermethod comparison; neck; mohs surgery; margins; patient referral; skin surgery; paraffin embedding; surgical margin; head; diagnostic test accuracy study; procedures; staged excision; humans; human; male; female; article; margins of excision |
| Journal Title: | Journal of the American Academy of Dermatology |
| Volume: | 88 |
| Issue: | 2 |
| ISSN: | 0190-9622 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2023-02-01 |
| Start Page: | 371 |
| End Page: | 379 |
| Language: | English |
| DOI: | 10.1016/j.jaad.2019.11.058 |
| PUBMED: | 31812621 |
| PROVIDER: | scopus |
| PMCID: | PMC10210015 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Kishwer S. Nehal -- Export Date: 1 February 2023 -- Source: Scopus |
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