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

Area of Science:

• Dermatology
• Oncology
• Medical Imaging

Background:

• Lentigo maligna/lentigo maligna melanoma (LM/LMM) often has subclinical extension, complicating preoperative margin definition and potentially leading to incomplete excision and recurrence.
• Reflectance confocal microscopy (RCM) is a preliminary tool used to evaluate the margins of LM/LMM.
• Accurate margin assessment is crucial for effective surgical treatment of LM/LMM.

Purpose of the Study:

• To evaluate the correlation between subclinical extension of LM/LMM as defined by RCM and the gold standard histopathology.
• To determine the diagnostic accuracy of RCM in identifying residual melanoma at surgical margins.

Main Methods:

• A prospective study involving patients with LM/LMM undergoing dermatologic surgery.
• RCM was performed at the initial surgical margin, followed by margin-controlled staged excision.
• Histopathology of excised tissue was correlated with RCM findings.

Main Results:

• Seventy-two patients were included, with most lesions on the head and neck.
• RCM demonstrated a sensitivity of 96.7% and specificity of 66.7% for detecting residual melanoma in the tumor debulk.
• Overall agreement between RCM margin assessment and final histopathology was 85.9% (κ = 0.71, P < .001).

Conclusions:

• RCM shows moderate to excellent agreement with histopathology for assessing LM/LMM excision margins.
• RCM can be a valuable tool in guiding surgical excision of LM/LMM to achieve clear margins.
• Further studies could explore RCM imaging beyond initial planned margins.