Skip to main content

Advertisement

SpringerLink
Log in

Comparison of dermoscopy and reflectance confocal microscopy for the diagnosis of malignant skin tumours: a meta-analysis

  • Review – Cancer Research
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Dermoscopy and reflectance confocal microscopy (RCM) are non-invasive methods for diagnosis of malignant skin tumours. The aim of this study was to compare the accuracy of dermoscopy and RCM for the diagnosis of malignant skin tumours.

Methods

Systematic electronic literature searches were conducted to include PubMed, Medline, Embase, the Cochrane Library database, and Web of Science, up to 26 April 2016. Pooled additional detection rate (ADR), diagnostic accuracy, and 95% confidence intervals (CIs) were calculated using STATA and Meta-Disc analysis.

Results

Eight published studies were included in the analysis, involving 1141 skin lesions, which reported a per-lesion analysis of dermoscopy and RCM. Within the same patient group and at the per-lesion level, RCM significantly increased the detection rate of malignant skin tumours by 7.7% (95% CI 0.01–0.14). The pooled sensitivity of dermoscopy was similar to RCM [88.1% (95% CI 0.85–0.91) vs. 93.5% (95% CI 0.91–0.96)]. The specificity of dermoscopy was significantly lower than that of RCM [52.9% (95% CI 0.49–0.57) vs. 80.3% (95% CI 0.77–0.83)]. The pooled ADR of RCM for melanoma detection was 4.3% (95% CI 0.002–0.08). Pooled sensitivity and specificity of dermoscopy for melanoma detection were 88.4% (95% CI 0.84–0.92) and 49.1% (95% CI 0.45–0.53), respectively. The pooled sensitivity and specificity of RCM were 93.5% (95% CI 0.90–0.96) and 78.8% (95% CI 0.75–0.82), respectively.

Conclusions

When compared with dermoscopy, RCM has a significantly greater diagnostic specificity for malignant skin tumours and so could improve their detection rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • Ahlgrimm-Siess V, Horn M, Koller S, Ludwig R, Gerger A, Hofmann-Wellenhof R (2009) Monitoring efficacy of cryotherapy for superficial basal cell carcinomas with in vivo reflectance confocal microscopy: a preliminary study. J Dermatol Sci 53:60–64. doi:10.1016/j.jdermsci.2008.08.005

    Article  PubMed  Google Scholar 

  • Alarcon I, Carrera C, Palou J, Alos L, Malvehy J, Puig S (2014) Impact of in vivo reflectance confocal microscopy on the number needed to treat melanoma in doubtful lesions. Br J Dermatol 170:802–808. doi:10.1111/bjd.12678

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Argenziano G et al (2006) Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol 24:1877–1882. doi:10.1200/JCO.2005.05.0864

    Article  PubMed  Google Scholar 

  • Bafounta ML, Beauchet A, Aegerter P, Saiag P (2001) Is dermoscopy (epiluminescence microscopy) useful for the diagnosis of melanoma? Results of a meta-analysis using techniques adapted to the evaluation of diagnostic tests. Arch Dermatol 137:1343–1350

    Article  CAS  PubMed  Google Scholar 

  • Balch CM et al (2009) Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 27:6199–6206. doi:10.1200/JCO.2009.23.4799

    Article  PubMed  PubMed Central  Google Scholar 

  • Binder M, Kittler H, Steiner A, Dawid M, Pehamberger H, Wolff K (1999) Reevaluation of the ABCD rule for epiluminescence microscopy. J Am Acad Dermatol 40:171–176

    Article  CAS  PubMed  Google Scholar 

  • Birch-Johansen F, Jensen A, Mortensen L, Olesen AB, Kjaer SK (2010) Trends in the incidence of nonmelanoma skin cancer in Denmark 1978–2007: rapid incidence increase among young Danish women. Int J Cancer 127:2190–2198. doi:10.1002/ijc.25411

    Article  CAS  PubMed  Google Scholar 

  • Bono A et al. (2002) Melanoma detection. A prospective study comparing diagnosis with the naked eye, dermatoscopy and telespectrophotometry Dermatology (Basel, Switzerland) 205:362–366. doi: 10.1159/000066436

    Article  Google Scholar 

  • de Vries E, Coebergh JW (2004) Cutaneous malignant melanoma in Europe. Eur J Cancer 40:2355–2366. doi:10.1016/j.ejca.2004.06.003

    Article  PubMed  Google Scholar 

  • DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Controll Clin Trials 7:177–188

    Article  CAS  Google Scholar 

  • Dummer W, Doehnel KA, Remy W (1993) Videomicroscopy in differential diagnosis of skin tumors and secondary prevention of malignant melanoma Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete 44:772–776

    CAS  PubMed  Google Scholar 

  • Gerger A et al (2005) Diagnostic applicability of in vivo confocal laser scanning microscopy in melanocytic skin tumors. J Investig Dermatol 124:493–498. doi:10.1111/j.0022-202X.2004.23569.x

    Article  CAS  PubMed  Google Scholar 

  • Gerger A et al (2008) In vivo confocal laser scanning microscopy of melanocytic skin tumours: diagnostic applicability using unselected tumour images. Br J Dermatol 158:329–333. doi:10.1111/j.1365-2133.2007.08389.x

    Article  CAS  PubMed  Google Scholar 

  • Gonzalez S (2008) [Clinical applications of reflectance confocal microscopy in the management of cutaneous tumors]. Actas Dermosifiliogr 99:528–531

    Article  CAS  PubMed  Google Scholar 

  • Guitera P, Pellacani G, Longo C, Seidenari S, Avramidis M, Menzies SW (2009) In vivo reflectance confocal microscopy enhances secondary evaluation of melanocytic lesions. J Investig Dermatol 129:131–138. doi:10.1038/jid.2008.193

    Article  CAS  PubMed  Google Scholar 

  • Guitera P et al (2014) Surveillance for treatment failure of lentigo maligna with dermoscopy and in vivo confocal microscopy: new descriptors. Br J Dermatol 170:1305–1312

    Article  CAS  PubMed  Google Scholar 

  • Herschorn A (2012) Dermoscopy for melanoma detection in family practice. Can Fam Phys 58:740–745

    Google Scholar 

  • Kadouch DJ, Schram ME, Leeflang MM, Limpens J, Spuls PI, de Rie MA (2015) In vivo confocal microscopy of basal cell carcinoma: a systematic review of diagnostic accuracy. J Eur Acad Dermatol Venereol 29:1890–1897. doi:10.1111/jdv.13224

    Article  CAS  PubMed  Google Scholar 

  • Kittler H, Pehamberger H, Wolff K, Binder M (2002) Diagnostic accuracy of dermoscopy. Lancet Oncol 3:159–165

    Article  CAS  PubMed  Google Scholar 

  • Langley RG, Walsh N, Sutherland AE, Propperova I, Delaney L, Morris SF, Gallant C (2007) The diagnostic accuracy of in vivo confocal scanning laser microscopy compared to dermoscopy of benign and malignant melanocytic lesions: a prospective study. Dermatology (Basel, Switzerland) 215:365–372. doi:10.1159/000109087

    Article  Google Scholar 

  • Longo C et al (2013) Is confocal microscopy a valuable tool in diagnosing nodular lesions? A study of 140 cases. Br J Dermatol 169:58–67. doi:10.1111/bjd.12259

    Article  CAS  PubMed  Google Scholar 

  • Menzies SW, Zalaudek I (2006) Why perform dermoscopy? The evidence for its role in the routine management of pigmented skin lesions. Arch Dermatol 142:1211–1212. doi:10.1001/archderm.142.9.1211

    Article  PubMed  Google Scholar 

  • Mogensen M, Thrane L, Jorgensen TM, Andersen PE, Jemec GB (2009) OCT imaging of skin cancer and other dermatological diseases. J Biophotonics 2:442–451. doi:10.1002/jbio.200910020

    Article  PubMed  Google Scholar 

  • Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012 doi:10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

  • Moscarella E et al (2013) The role of reflectance confocal microscopy as an aid in the diagnosis of collision tumors. Dermatology (Basel, Switzerland) 227:109–117 doi:10.1159/000351771

    Article  Google Scholar 

  • Moses LE, Shapiro D, Littenberg B (1993) Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med 12:1293–1316

    Article  CAS  PubMed  Google Scholar 

  • Nori S, Rius-Diaz F, Cuevas J, Goldgeier M, Jaen P, Torres A, Gonzalez S (2004) Sensitivity and specificity of reflectance-mode confocal microscopy for in vivo diagnosis of basal cell carcinoma: a multicenter study. J Am Acad Dermatol 51:923–930. doi:10.1016/j.jaad.2004.06.028

    Article  PubMed  Google Scholar 

  • Piccolo D, Ferrari A, Peris K, Diadone R, Ruggeri B, Chimenti S (2002) Dermoscopic diagnosis by a trained clinician vs. a clinician with minimal dermoscopy training vs. computer-aided diagnosis of 341 pigmented skin lesions: a comparative study. Br J Dermatol 147:481–486

    Article  CAS  PubMed  Google Scholar 

  • Rajadhyaksha M, Grossman M, Esterowitz D, Webb RH, Anderson RR (1995) In vivo confocal scanning laser microscopy of human skin: melanin provides strong contrast. J Investig Dermatol 104:946–952

    Article  CAS  PubMed  Google Scholar 

  • Rajadhyaksha M, Menaker G, Flotte T, Dwyer PJ, Gonzalez S (2001) Confocal examination of nonmelanoma cancers in thick skin excisions to potentially guide mohs micrographic surgery without frozen histopathology. J Investig Dermatol 117:1137–1143 doi:10.1046/j.0022-202x.2001.01524.x

    Article  CAS  PubMed  Google Scholar 

  • Rajpara SM, Botello AP, Townend J, Ormerod AD (2009) Systematic review of dermoscopy and digital dermoscopy/artificial intelligence for the diagnosis of melanoma. Br J Dermatol 161:591–604. doi:10.1111/j.1365-2133.2009.09093.x

    Article  CAS  PubMed  Google Scholar 

  • Stanganelli I et al (2015) Integration of reflectance confocal microscopy in sequential dermoscopy follow-up improves melanoma detection accuracy. Br J Dermatol 172:365–371. doi:10.1111/bjd.13373

    Article  CAS  PubMed  Google Scholar 

  • Stevenson AD, Mickan S, Mallett S, Ayya M (2013) Systematic review of diagnostic accuracy of reflectance confocal microscopy for melanoma diagnosis in patients with clinically equivocal skin lesions. Dermatol Pract Concept 3:19–27 doi:10.5826/dpc.0304a05

    Article  PubMed  PubMed Central  Google Scholar 

  • Trakatelli M, Ulrich C, del Marmol V, Euvrard S, Stockfleth E, Abeni D (2007) Epidemiology of nonmelanoma skin cancer (NMSC) in Europe: accurate and comparable data are needed for effective public health monitoring and interventions. Br J Dermatol 156(Suppl 3):1–7. doi:10.1111/j.1365-2133.2007.07861.x

    Article  PubMed  Google Scholar 

  • Venturini M, Sala R, Gonzalez S, Calzavara-Pinton PG (2013) Reflectance confocal microscopy allows in vivo real-time noninvasive assessment of the outcome of methyl aminolaevulinate photodynamic therapy of basal cell carcinoma. Br J Dermatol 168:99–105. doi:10.1111/bjd.12052

    Article  CAS  PubMed  Google Scholar 

  • Vestergaard ME, Macaskill P, Holt PE, Menzies SW (2008) Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol 159:669–676. doi:10.1111/j.1365-2133.2008.08713.x

    CAS  PubMed  Google Scholar 

  • Wanders LK, East JE, Uitentuis SE, Leeflang MM, Dekker E (2013) Diagnostic performance of narrowed spectrum endoscopy, autofluorescence imaging, and confocal laser endomicroscopy for optical diagnosis of colonic polyps: a meta-analysis. Lancet Oncol 14:1337–1347. doi:10.1016/S1470-2045(13)70509-6

    Article  PubMed  Google Scholar 

  • Whiting PF et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536. doi:10.7326/0003-4819-155-8-201110180-00009

    Article  PubMed  Google Scholar 

  • Witkowski AM, Ludzik J, DeCarvalho N, Ciardo S, Longo C, DiNardo A, Pellacani G (2016) Non-invasive diagnosis of pink basal cell carcinoma: how much can we rely on dermoscopy and reflectance confocal microscopy? Skin Res 22:230–237

    Article  CAS  Google Scholar 

  • Xiong YD, Ma S, Li X, Zhong X, Duan C, Chen Q (2016a) A meta-analysis of reflectance confocal microscopy for the diagnosis of malignant skin tumours. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.13712

    PubMed  Google Scholar 

  • Xiong YQ, Ma SJ, Zhou JH, Zhong XS, Chen Q (2016b) A meta-analysis of confocal laser endomicroscopy for the detection of neoplasia in patients with Barrett’s esophagus. J Gastroenterol Hepatol 31:1102–1110 doi:10.1111/jgh.13267

    Article  PubMed  Google Scholar 

  • Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31. doi:10.1186/1471-2288-6-31

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, 1838 Guangzhou North Road, Guangzhou, 510515, China

    Yi-Quan Xiong, Yun Mo, Shu-Ting Huo, Yu-Qi Wen & Qing Chen

  2. School of Public Health, Central South University, Changsha, Hunan, 410008, China

    Shu-Juan Ma

Authors
  1. Yi-Quan Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shu-Juan Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yun Mo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shu-Ting Huo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yu-Qi Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qing Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qing Chen.

Ethics declarations

Funding

None reported.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xiong, YQ., Ma, SJ., Mo, Y. et al. Comparison of dermoscopy and reflectance confocal microscopy for the diagnosis of malignant skin tumours: a meta-analysis. J Cancer Res Clin Oncol 143, 1627–1635 (2017). https://doi.org/10.1007/s00432-017-2391-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-017-2391-9

Keywords

Search

Navigation