Integration of reflectance confocal microscopy in sequential dermoscopy follow-up improves melanoma detection accuracy

Summary Background Successful treatment of melanoma depends on early diagnosis, but its varied clinical presentation means that no single noninvasive method or criterion can provide reliable detection in all cases. Objectives To determine whether combining sequential dermoscopy imaging with reflectance confocal microscopy (RCM) can improve melanoma detection and reduce the burden of unnecessary excisions. Methods We conducted a retrospective study with median follow‐up of 25 months. We included equivocal pigmented lesions that lacked clear dermoscopy criteria for melanoma at baseline but were excised subsequently because of changes during digital monitoring. RCM imaging was performed before excision. Main melanoma dermoscopy features, seven‐point checklist score at baseline, and changes in structure and/or colour, and development of new melanoma‐specific criteria at follow‐up (scored as major, moderate or minor) were considered. Main melanoma RCM criteria were evaluated and diagnosis was made. Histopathological diagnosis was the reference standard for defining parameter frequency and diagnostic accuracy. Results Seventy lesions were included. Major changes were more frequently correlated with melanoma diagnosis, although one‐third (four of 12) of melanomas showed moderate or minor changes. Cytological atypia and architectural disarrangement on RCM were correlated with melanoma diagnosis. A correct melanoma diagnosis was achieved with RCM in almost all cases (11 of 12, 92%). Referring for excision only those lesions with RCM‐positive features and/or presenting major changes at digital dermoscopy follow‐up, theoretically 27 of 58 naevi could be saved from surgery. Conclusions Integration of RCM in the clinical and instrumental strategy for managing difficult pigmented lesions provided additional diagnostic information useful in the decision‐making process. What's already known about this topic? Short‐term and long‐term sequential digital dermoscopy is useful for monitoring atypical melanocytic lesions for diagnosing featureless melanoma. Reflectance confocal microscopy (RCM) provides a real‐time noninvasive optical method and improves the diagnostic accuracy of melanoma, thus reducing unnecessary excisions. What does this study add? Combining sequential dermoscopy imaging with RCM may help to reduce the burden of unnecessary excisions of lesions (false‐positive) revealing minor dermoscopic changes at follow‐up and RCM‐negative score.