Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study
Lentigo maligna melanoma mapping using reflectance confocal microscopy correlates with staged excision: A prospective study
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DOI：
10.1016/j.jaad.2019.11.058
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发表时间：
2023-01-11
影响因子：
13.8
通讯作者：
Nehal, Kishwer S.
中科院分区：
文献类型：
--
作者：
Navarrete-Dechent, Cristian;Cordova, Miguel;Nehal, Kishwer S.
背景资料：恶性雀斑样痣/恶性雀斑样痣黑色素瘤（LM/LMM）可表现为亚临床扩展，术前可能难以确定，并导致不完全切除和潜在复发。临床研究已使用反射共聚焦显微镜（RCM），以评估LM/LMM margins.Objective：评估相关性LM/LMM亚临床扩展定义的RCM相比，金标准的组织病理学。RCM进行临床定义的初始手术边缘，然后边缘控制分期切除石蜡包埋的组织，组织病理学与RCM results.Results：72例患者被列入。平均年龄为66.8岁（标准差，11.1;范围，38-89）; 69.4%为男性。72个病灶中有70个（97.2%）位于头颈部，平均最大临床直径为1.3 cm（范围，0.3-5）。与组织病理学相比，肿瘤切除（活检后）中检测残留黑色素瘤的诊断准确性的敏感性为96.7%，特异性为66.7%。RCM边缘评估显示与最终组织病理学的总体一致性为85.9%（k = 0.71; P <0.001）。局限性：在最初计划的边缘之外没有进行RCM成像。结论：LM/LMM的RCM成像与分期切除边缘的组织病理学之间的总体一致性为中度至极好。
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% (k = 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.