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Reflectance Confocal Microscopy for Margin Assessment and Management of Lentigo Maligna

  • Skin Cancer (D Siegel and O Markowitz, Section Editors)
  • Published:
Current Dermatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Lentigo maligna (LM) is a form of melanoma in situ and represents a diagnostic and therapeutic challenge due to its poorly defined, irregular borders; propensity for subclinical extension; and location on the background of severely sun-damaged skin. Reflectance confocal microscopy (RCM) is a non-invasive optical imaging tool that allows clinicians to detect LM and assess margin status in vivo.

Recent Findings

RCM is very accurate for diagnosing LM and guiding biopsies, with sensitivities ranging from 93 to 100% and specificities 71–82%. It has also been used pre-operatively to map lesions, intra-operatively for real-time evaluation of surgical margins, and post treatment to monitor for recurrence.

Summary

The advent of newer technologies, including RCM, has advanced our ability to better diagnose and manage LM. RCM offers clinicians the ability to guide biopsies, accurately detect subclinical disease, and readily map LM margins. Future research is aimed at using RCM to allow clinicians to better spare healthy tissue and to reduce disease recurrence without subjecting patients to the lost time, cost, and potential morbidity associated with multiple surgeries.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Howlader N, Noone AM, Krapcho M, et al. SEER cancer statistics review, 1975–2014. Bethesda: National Cancer Institute. https://seer.cancer.gov/csr/1975_2014/ based on November 2016 SEER data submission, posted to the SEER web site 2017. Accessed March 1, 2017.

  2. Weinstock MA, Sober AJ. The risk of progression of lentigo maligna to lentigo maligna melanoma. Br J Dermatol. 1987;116:303–10.

    Article  CAS  PubMed  Google Scholar 

  3. Penneys NS. Microinvasive lentigo maligna melanoma. J Am Acad Dermatol. 1987;17:675–80.

    Article  CAS  PubMed  Google Scholar 

  4. de Carvalho N, Farnetani F, Ciardo S, et al. Reflectance confocal microscopy correlates of dermoscopic patterns of facial lesions help to discriminate lentigo maligna from pigmented nonmelanocytic macules. Br J Dermatol. 2015;173:128–33.

    Article  PubMed  Google Scholar 

  5. 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. 2017 doi:10.1007/s00432-017-2391-9.

  6. Rajadhyaksha M, Marghoob A, Rossi A, et al. Reflectance confocal microscopy of skin in vivo: from bench to bedside. Lasers Surg Med. 2017;49:7–19.

    Article  PubMed  Google Scholar 

  7. Ardigo M, Agozzino M, Franceschini C, et al. Reflectance confocal microscopy algorithms for inflammatory and hair diseases. Dermatol Clin. 2016;34:487–96.

    Article  CAS  PubMed  Google Scholar 

  8. Lacarrubba F, Verzi AE, Pippione M, et al. Reflectance confocal microscopy in the diagnosis of vesicobullous disorders: case series with pathologic and cytologic correlation and literature review. Skin Res Technol. 2016;22:479–86.

    Article  CAS  PubMed  Google Scholar 

  9. Cinotti E, Perrot JL, Labeille B, et al. Reflectance confocal microscopy for cutaneous infections and infestations. J Eur Acad Dermatol Venereol. 2016;30:754–63.

    Article  CAS  PubMed  Google Scholar 

  10. Ardigo M, Prow T, Agozzino M, et al. Reflectance confocal microscopy for inflammatory skin diseases. G Ital Dermatol Venereol. 2015;150:565–73.

    CAS  PubMed  Google Scholar 

  11. Hoogedoorn L, Peppelman M, van de Kerkhof PC, et al. The value of in vivo reflectance confocal microscopy in the diagnosis and monitoring of inflammatory and infectious skin diseases: a systematic review. Br J Dermatol. 2015;172:1222–48.

    Article  CAS  PubMed  Google Scholar 

  12. Pellacani G, Cesinaro AM, Seidenari S. Reflectance-mode confocal microscopy of pigmented skin lesions—improvement in melanoma diagnostic specificity. J Am Acad Dermatol. 2005;53:979–85.

    Article  PubMed  Google Scholar 

  13. Guitera P, Pellacani G, Crotty KA, et al. The impact of in vivo reflectance confocal microscopy on the diagnostic accuracy of lentigo maligna and equivocal pigmented and nonpigmented macules of the face. J Invest Dermatol. 2010;130:2080–91.

    Article  CAS  PubMed  Google Scholar 

  14. Champin J, Perrot JL, Cinotti E, et al. In vivo reflectance confocal microscopy to optimize the spaghetti technique for defining surgical margins of lentigo maligna. Dermatol Surg. 2014;40:247–56.

    Article  CAS  PubMed  Google Scholar 

  15. Alani A, Ahmad K. Diagnosis of amelanotic lentigo maligna by using in vivo reflectance confocal microscopy. Acta Derm Venereol. 2016;96(3):406–7. doi:10.2340/00015555-2267.

  16. • Menge TD, Hibler BP, Cordova MA, et al. Concordance of handheld reflectance confocal microscopy (RCM) with histopathology in the diagnosis of lentigo maligna (LM): a prospective study. J Am Acad Dermatol. 2016;74:1114–20. This study demonstrates the effectiveness of handheld reflectance confocal microscopy in the diagnosis of lentigo maligna.

    Article  PubMed  Google Scholar 

  17. Hazan C, Dusza SW, Delgado R, et al. Staged excision for lentigo maligna and lentigo maligna melanoma: a retrospective analysis of 117 cases. J Am Acad Dermatol. 2008;58:142–8.

    Article  PubMed  Google Scholar 

  18. Chen CS, Elias M, Busam K, et al. Multimodal in vivo optical imaging, including confocal microscopy, facilitates presurgical margin mapping for clinically complex lentigo maligna melanoma. Br J Dermatol. 2005;153:1031–6.

    Article  PubMed  Google Scholar 

  19. Guitera P, Moloney FJ, Menzies SW, et al. Improving management and patient care in lentigo maligna by mapping with in vivo confocal microscopy. JAMA Dermatol. 2013;149:692–8.

    Article  PubMed  Google Scholar 

  20. Hibler BP, Cordova M, Wong RJ, et al. Intraoperative real-time reflectance confocal microscopy for guiding surgical margins of lentigo maligna melanoma. Dermatol Surg. 2015;41:980–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. • Hibler BP, Yelamos O, Cordova M, et al. Handheld reflectance confocal microscopy to aid in the management of complex facial lentigo maligna. Cutis. 2017;99:346–52. This case series outlines the utility of reflectance confocal microscopy for managing complex cases of lentigo maligna both surgically and non-surgically.

    PubMed  PubMed Central  Google Scholar 

  22. • Kose K, Cordova M, Duffy M, et al. Video-mosaicing of reflectance confocal images for examination of extended areas of skin in vivo. Br J Dermatol. 2014;171(5):1239–41. doi:10.1111/bjd.13050. This manuscript describes the approach for creating confocal video mosaics to increase the field of view. This technique is often applied to create maps of the periphery of lesions in a clockwise fashion.

  23. Gaudy-Marqueste C, Perchenet AS, Tasei AM, et al. The “spaghetti technique”: an alternative to Mohs surgery or staged surgery for problematic lentiginous melanoma (lentigo maligna and acral lentiginous melanoma). J Am Acad Dermatol. 2011;64:113–8.

    Article  PubMed  Google Scholar 

  24. Ali FR, Craythorne EE. Gummed rings as the outer marker of microscopically examined tissue (GROMMETs) as mapping adjuncts to in vivo reflectance confocal microscopy (RCM). J Am Acad Dermatol. 2016;75:e103–4.

    Article  PubMed  Google Scholar 

  25. Marino ML, Rogers T, Sierra Gil H, et al. Improving lesion localization when imaging with handheld reflectance confocal microscope. Skin Res Technol. 2016;22:519–20.

    Article  CAS  PubMed  Google Scholar 

  26. Hibler BP, Connolly KL, Cordova M, et al. Radiation therapy for synchronous basal cell carcinoma and lentigo maligna of the nose: response assessment by clinical examination and reflectance confocal microscopy. Pract Radiat Oncol. 2015;5(5):e543–7. doi:10.1016/j.prro.2015.03.006.

  27. Nadiminti H, Scope A, Marghoob AA, et al. Use of reflectance confocal microscopy to monitor response of lentigo maligna to nonsurgical treatment. Dermatol Surg. 2010;36:177–84.

    Article  CAS  PubMed  Google Scholar 

  28. Erfan N, Kang HY, Cardot-Leccia N, et al. Reflectance confocal microscopy for recurrent lentigo maligna. Dermatol Surg. 2011;37:1519–24.

    Article  CAS  PubMed  Google Scholar 

  29. Guitera P, Haydu LE, Menzies SW, et al. Surveillance for treatment failure of lentigo maligna with dermoscopy and in vivo confocal microscopy: new descriptors. Br J Dermatol. 2014;170:1305–12.

    Article  CAS  PubMed  Google Scholar 

  30. Alarcon I, Carrera C, Alos L, et al. In vivo reflectance confocal microscopy to monitor the response of lentigo maligna to imiquimod. J Am Acad Dermatol. 2014;71:49–55.

    Article  CAS  PubMed  Google Scholar 

  31. Kai AC, Richards T, Coleman A, et al. 5 year recurrence rate of lentigo maligna after treatment with imiquimod. Br J Dermatol. 2016;174(1):165–8. doi:10.1111/bjd.14311.

  32. Edwards SJ, Mavranezouli I, Osei-Assibey G, et al. VivaScope® 1500 and 3000 systems for detecting and monitoring skin lesions: a systematic review and economic evaluation. Southampton: NIHR Journals Library; 2016. Health Technology Assessment, No. 20.58. https://www.ncbi.nlm.nih.gov/books/NBK378819/. doi:10.3310/hta20580.

    Google Scholar 

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Authors and Affiliations

  1. Transitional Year Residency Program, Saint Joseph Mercy Health System, 5333 McAuley Drive, Suite 3009, Ann Arbor, MI, 48106, USA

    Tyler D. Menge

  2. Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 E. 60th Street, 4th Floor Dermatology, New York, NY, 10022, USA

    Brian P. Hibler, Miguel Cordova & Anthony M. Rossi

Authors
  1. Tyler D. Menge
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  2. Brian P. Hibler
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  3. Miguel Cordova
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  4. Anthony M. Rossi
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Corresponding author

Correspondence to Anthony M. Rossi.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

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

Funding/Support

This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

Additional information

This article is part of the Topical Collection on Skin Cancer

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Menge, T.D., Hibler, B.P., Cordova, M. et al. Reflectance Confocal Microscopy for Margin Assessment and Management of Lentigo Maligna. Curr Derm Rep 6, 222–229 (2017). https://doi.org/10.1007/s13671-017-0194-5

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  • DOI: https://doi.org/10.1007/s13671-017-0194-5

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