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Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study

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. To evaluat...

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Published in:Journal of the American Academy of Dermatology 2023-02, Vol.88 (2), p.371-379
Main Authors: Navarrete-Dechent, Cristian, Cordova, Miguel, Aleissa, Saud, Liopyris, Konstantinos, Dusza, Stephen W., Kose, Kivanc, Busam, Klaus J., Hollman, Travis, Lezcano, Cecilia, Pulitzer, Melissa, Chen, Chih-Shan J., Lee, Erica H., Rossi, Anthony M., Nehal, Kishwer S.
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Language:English
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Summary: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. To evaluate the correlation of LM/LMM subclinical extension defined by RCM compared with the gold standard histopathology. 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. 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 
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2019.11.058