ACCORDING to the results of a clinical trial, the adjunctive utilisation of reflectance confocal microscopy (RCM) for suspected melanoma lesions could lessen avoidable excisions. The researchers from Sapienza University of Rome, Italy, demonstrated that RCM allows an in vivo cutaneous evaluation, which involves a high, precise, and specific diagnostic improvement of equivocal lesions. Furthermore, RCM has proven to be more effective than dermoscopy alone.
Approximately 3,165 participants were randomly selected on a 1:1 ratio to receive either the standard therapeutic treatment alone or standard therapeutic and adjunctive RCM imaging. The study was set to test the efficacy of adjunctive RCM imaging. Approximately half of the patients in the RCM group underwent lesion surgical removal. About 17.9% patients who followed up in the short-term had undergone excisions compared with the 7.2% who underwent a long-term follow-up. The researchers could confirm theat melanoma was found in that 33.2% of removed lesions were completed with RCM. Additionally, 51.8% of the confirmed melanoma was classified as in situ melanoma. In the standardised therapeutic group, all the patients underwent surgery, except three patients, who refused treatment. In the lesions from the standard therapy group, the researchers used histopathology to diagnose 18.6% as melanoma and, in that group, 60.5% was classified as in situ melanoma.
The use of adjunctive of RCM had a slightly lower rate compared with standard therapeutic care only in rate of melanoma detection (278 and 294, respectively). However, the use of RCM had a two-fold higher positive predictive rate compared with standard therapeutic care. The rate of malignant melanoma to benign was halved by RCM, compared with standard therapy, and reduced the number of patients needing to excision by 43.2% (5.3% versus 3.0%). The trial results prove that the enhanced diagnostic precision with adjunctive RCM as most melanomas were accurately found at baseline.
“Skin cancer management exerts a sizable burden on health systems,” Giovanni Pellacani, Sapienza University of Rome, Italy, and colleagues wrote. “The systematic application of RCM in the triage of high-risk patients should improve diagnostic accuracy and reduce unnecessary excisions for histopathological diagnostic confirmation, thereby reducing costs, surgical waiting lists, and delayed diagnoses.”