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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diagnosis of pigmented lesions can be complex&#46; While dermoscopy has increased diagnostic accuracy for melanoma&#44; dermatologists are commonly faced with pigmented lesions that are equivocal or difficult to evaluate&#46; Reflectance confocal microscopy &#40;RCM&#41; is a noninvasive diagnostic tool comprising a low-potency coherent laser that is projected through a system of lenses&#44; making it possible to see 2-dimensional structures in vivo with cellular-level resolution and a depth of approximately 300<span class="elsevierStyleHsp" style=""></span>&#956;m &#40;superficial dermis&#41;&#46; Diagnosis of melanoma using RCM is based on identification of pagetoid cells in the epidermis&#44; atypical nests at the dermal&#8211;epidermal junction&#44; nonedged dermal papillae&#44; cells with atypical nuclei&#44; neoangiogenesis&#44; and inflammatory infiltrate in the superficial dermis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Two recent meta-analyses estimated that RCM would be more sensitive and specific than dermoscopy for diagnosis of melanoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The findings from the first clinical trial of RCM to date were published in June 2022&#46; The study population comprised 3165 patients with equivocal&#47;unclear pigmented lesions&#44; and mean follow-up was 9&#46;6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Patients were randomly assigned 1&#58;1 to clinical examination and dermoscopy with or without RCM&#46; Depending on the findings&#44; the authors decided to remove the lesion or follow the patient up&#46; Compared with the non-RCM group&#44; data for the RCM group revealed a higher positive predictive value for melanoma in the lesions removed &#40;33&#46;3 vs&#46; 18&#46;9&#41;&#44; a lower benign-to-malignant ratio &#40;1&#46;8 vs&#46; 3&#46;7&#41;&#44; and a 43&#46;4&#37; reduction in the number needed to excise for diagnosis of melanoma &#40;3&#46;0 vs&#46; 5&#46;3&#41;&#46; None of the lesions under follow-up in the group without RCM proved to be malignant&#44; although melanoma was detected during follow-up in 1&#46;8&#37; of patients in the RCM group&#46; The Breslow depth of these tumors did not exceed 0&#46;5<span class="elsevierStyleHsp" style=""></span>mm &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The study also revealed that the medical team&#39;s experience in the use of RCM was correlated with higher diagnostic accuracy&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">According to these results&#44; which constitute the highest-quality evidence available to date&#44; incorporating RCM in the diagnostic algorithm for equivocal&#47;unclear pigmented lesions would reduce the frequency of excision by almost half&#46; This in turn could reduce the surgical waiting list and prioritize patients with melanoma&#46; Furthermore&#44; it would reduce iatrogenic effects and decrease costs&#46; In this sense&#44; a retrospective analysis of costs compared data from the University Hospital of Modena&#44; where RCM is performed in the case of equivocal pigmented lesions&#44; with data from other centers in the region that do not use RCM&#46; With a number needed to excise of 6&#46;25 vs&#46; 19&#46;41&#44; respectively&#44; the estimated saving was approximately &#8364;262<span class="elsevierStyleHsp" style=""></span>000 per million persons per year with RCM when indirect costs were excluded&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However&#44; it is important to consider the false negatives generated by RCM&#44; which delayed excision of 15 melanomas in the clinical trial&#44; although none was higher than stage IA&#46; The difference in the proportion of lesions analyzed using histology between both groups could lead to information bias and underdiagnosis of melanomas&#44; especially in the RCM group&#46; Therefore&#44; affected patients should be regularly assessed and clinical studies with long follow-up periods should be performed to evaluate the impact on survival&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">RCM complements dermoscopy&#44; thus increasing diagnostic accuracy in melanoma and potentially reducing costs&#46; However&#44; the technique is limited in terms of its availability and generation of false negatives&#46;</p></span>"
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                  \t\t\t\t">Lesions in follow-up &#40;&#37; of total no&#46; of lesions analyzed&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">853 &#40;53&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Excisions during follow-up &#40;&#37; of the total no&#46; of lesions in follow-up&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Melanoma in situ&nbsp;\t\t\t\t\t\t\n
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RF-Reflectance Confocal Microscopy for the Diagnosis of Equivocal Pigmented Lesions
FR-Microscopia confocal de reflectancia en el diagnóstico de lesiones pigmentadas equívocas
L. Corbella-Bagot, M. Luque-Luna, D. Morgado-Carrasco
Corresponding author
morgadodaniel8@gmail.com

Corresponding author.
Servicio de Dermatología, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
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        "titulo" => "FR - Microscopia confocal de reflectancia en el diagn&#243;stico de lesiones pigmentadas equ&#237;vocas"
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    "titulo" => " RF-Reflectance Confocal Microscopy for the Diagnosis of Equivocal Pigmented Lesions"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diagnosis of pigmented lesions can be complex&#46; While dermoscopy has increased diagnostic accuracy for melanoma&#44; dermatologists are commonly faced with pigmented lesions that are equivocal or difficult to evaluate&#46; Reflectance confocal microscopy &#40;RCM&#41; is a noninvasive diagnostic tool comprising a low-potency coherent laser that is projected through a system of lenses&#44; making it possible to see 2-dimensional structures in vivo with cellular-level resolution and a depth of approximately 300<span class="elsevierStyleHsp" style=""></span>&#956;m &#40;superficial dermis&#41;&#46; Diagnosis of melanoma using RCM is based on identification of pagetoid cells in the epidermis&#44; atypical nests at the dermal&#8211;epidermal junction&#44; nonedged dermal papillae&#44; cells with atypical nuclei&#44; neoangiogenesis&#44; and inflammatory infiltrate in the superficial dermis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Two recent meta-analyses estimated that RCM would be more sensitive and specific than dermoscopy for diagnosis of melanoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The findings from the first clinical trial of RCM to date were published in June 2022&#46; The study population comprised 3165 patients with equivocal&#47;unclear pigmented lesions&#44; and mean follow-up was 9&#46;6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Patients were randomly assigned 1&#58;1 to clinical examination and dermoscopy with or without RCM&#46; Depending on the findings&#44; the authors decided to remove the lesion or follow the patient up&#46; Compared with the non-RCM group&#44; data for the RCM group revealed a higher positive predictive value for melanoma in the lesions removed &#40;33&#46;3 vs&#46; 18&#46;9&#41;&#44; a lower benign-to-malignant ratio &#40;1&#46;8 vs&#46; 3&#46;7&#41;&#44; and a 43&#46;4&#37; reduction in the number needed to excise for diagnosis of melanoma &#40;3&#46;0 vs&#46; 5&#46;3&#41;&#46; None of the lesions under follow-up in the group without RCM proved to be malignant&#44; although melanoma was detected during follow-up in 1&#46;8&#37; of patients in the RCM group&#46; The Breslow depth of these tumors did not exceed 0&#46;5<span class="elsevierStyleHsp" style=""></span>mm &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The study also revealed that the medical team&#39;s experience in the use of RCM was correlated with higher diagnostic accuracy&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">According to these results&#44; which constitute the highest-quality evidence available to date&#44; incorporating RCM in the diagnostic algorithm for equivocal&#47;unclear pigmented lesions would reduce the frequency of excision by almost half&#46; This in turn could reduce the surgical waiting list and prioritize patients with melanoma&#46; Furthermore&#44; it would reduce iatrogenic effects and decrease costs&#46; In this sense&#44; a retrospective analysis of costs compared data from the University Hospital of Modena&#44; where RCM is performed in the case of equivocal pigmented lesions&#44; with data from other centers in the region that do not use RCM&#46; With a number needed to excise of 6&#46;25 vs&#46; 19&#46;41&#44; respectively&#44; the estimated saving was approximately &#8364;262<span class="elsevierStyleHsp" style=""></span>000 per million persons per year with RCM when indirect costs were excluded&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However&#44; it is important to consider the false negatives generated by RCM&#44; which delayed excision of 15 melanomas in the clinical trial&#44; although none was higher than stage IA&#46; The difference in the proportion of lesions analyzed using histology between both groups could lead to information bias and underdiagnosis of melanomas&#44; especially in the RCM group&#46; Therefore&#44; affected patients should be regularly assessed and clinical studies with long follow-up periods should be performed to evaluate the impact on survival&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">RCM complements dermoscopy&#44; thus increasing diagnostic accuracy in melanoma and potentially reducing costs&#46; However&#44; the technique is limited in terms of its availability and generation of false negatives&#46;</p></span>"
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        "fuente" => "Adapted from Pellacani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviation</span>&#58; RCM&#44; reflectance confocal microscopy&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Lesions removed<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;&#37; of all lesions analyzed&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1556 &#40;98&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">836 &#40;52&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Melanomas removed &#40;&#37; of all lesions removed&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">294 &#40;18&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">278 &#40;33&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Positive predictive value for melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Benign-to-malignant ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number needed to excise for diagnosis of melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Lesions in follow-up &#40;&#37; of total no&#46; of lesions analyzed&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;0&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Excisions during follow-up &#40;&#37; of the total no&#46; of lesions in follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">116 &#40;13&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Melanomas diagnosed during follow-up &#40;&#37; of the total number of lesions in follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;1&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Melanoma in situ&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;53&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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ISSN: 00017310
Original language: English
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