Planning slow Mohs excision margins for lentigo maligna: a retrospective non‐randomised cohort study comparing reflectance confocal microscopy margin mapping versus visual inspection with dermoscopy

2020 ◽  
Author(s):  
J.M. Gao ◽  
J.J. Garioch ◽  
M. Fadhil ◽  
E. Tan ◽  
N. Shah ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confocal Microscopy ◽  
Visual Inspection ◽  
Reflectance Confocal Microscopy ◽  
Lentigo Maligna ◽  
Excision Margins ◽  
Mapping Versus

scholarly journals Evaluating the Diagnostic Accuracy of Reflectance Confocal Microscopy to Diagnose Skin Cancer: A Research Protocol (Preprint)

2017 ◽  
Author(s):  
Naomi D Herz ◽  
Anastasia Chalkidou ◽  
Fiona Reid ◽  
Stephen Keevil ◽  
Andrew Coleman ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Confocal Microscopy ◽  
Surgical Excision ◽  
Reflectance Confocal Microscopy ◽  
Lentigo Maligna ◽  
Recurrence Rates ◽  
Skin Cancer Screening ◽  
Lentigo Maligna Melanoma ◽  
Excision Margins ◽  
The Uk

UNSTRUCTURED Skin cancer is the most common type of cancer in the UK, with over 100,000 cases diagnosed each year. Melanoma is a type of skin cancer that can develop from a mole. However, moles that are suspicious histologically are often difficult to diagnose clinically by eye, even for experts working in specialist skin cancer screening clinics. In the UK, 350,000 patients per year are referred to hospital clinics with suspicious moles, and approximately half undergo a biopsy to identify the 5-10% who require further treatment. If cancer cannot be ruled out clinically and on the basis of biopsy results, the lesion is surgically removed. One type of pre-cancerous mole, called lentigo maligna, is particularly challenging to treat. It develops insidiously, can become large, and is difficult to assess when it transforms into a lentigo maligna melanoma. It is also difficult to identify the margins by eye or with the aid of a dermatoscope. This results in high excision rates. Excision is often incomplete despite large areas of tissue removal (5 mm around tumour’s visible margin), and there are high recurrence rates even when the lesion is considered successfully removed. Reflectance confocal microscopy is an imaging technique that can supplement dermoscopy in identifying if a clinically suspicious mole is malignant and can better assess lentigo maligna margins. It allows clinicians to see the skin lesion in greater detail than dermoscopy and therefore better guide more accurate diagnoses. This prospective study will examine patients with suspicious moles and lentigo maligna to determine whether confocal microscopy can both reduce the number of unnecessary biopsies of moles and more accurately guide the surgical excision margins of lentigo maligna.

Reflectance confocal microscopy detects residual or recurrent lentigo maligna after surgery

2021 ◽  
Author(s):  
Paul J Shim ◽  
Margaret L Dowd ◽  
Paul Kang ◽  
Faramarz H Samie ◽  
Nathalie C Zeitouni
Keyword(s):  
Confocal Microscopy ◽  
Reflectance Confocal Microscopy ◽  
Lentigo Maligna

Reflectance Confocal Microscopy for Margin Assessment and Management of Lentigo Maligna

2017 ◽  
Vol 6 (3) ◽  
pp. 222-229
Author(s):  
Tyler D. Menge ◽  
Brian P. Hibler ◽  
Miguel Cordova ◽  
Anthony M. Rossi
Keyword(s):  
Confocal Microscopy ◽  
Reflectance Confocal Microscopy ◽  
Margin Assessment ◽  
Lentigo Maligna

scholarly journals Comparing preoperative mapping with reflectance confocal microscopy to surgical markings in lentigo maligna excision of the face: a pilot study

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Lipi Shukla ◽  
Louise Photiou ◽  
Alan Pham ◽  
Catriona McLean ◽  
Raquel Ruiz ◽  
...  
Keyword(s):  
Pilot Study ◽  
Confocal Microscopy ◽  
Surgical Margin ◽  
Surgical Excision ◽  
Reflectance Confocal Microscopy ◽  
Histopathological Analysis ◽  
Lentigo Maligna ◽  
Complete Excision ◽  
Preoperative Mapping

Background: Lentigo maligna (LM) characteristically has an ill-defined margin and may require multiple excisions to achieve complete excision with 5mm margins. In vivo reflectance confocal microscopy (RCM) is a non-invasive tool recognised as useful in the management of LM. The authors aimed to determine whether the use of RCM prior to surgical excision reliably increased the rate of complete excision when compared with standard surgical excision. Methods: This prospective pilot study included patients with biopsy-proven LM of head and neck region who sought consultation for surgical management from May 2017 to May 2019 at the Victorian Melanoma Service, Melbourne. Patients were randomised to two groups based on the availability of RCM — Group 1, RCM-guided surgical excision, and Group 2, standard surgical excision. Outcomes were measured based on clinical markings and histopathological margins achieved and reported as RCM or surgical margin excess or deficit. Ethics approval for the study was obtained from the Research Governance Unit of The Alfred Hospital, Melbourne. Results: Results demonstrated that RCM marking of lesion margins was in excess in 69 percent of cases, in deficit in 22 per cent and accurate in nine per cent after histopathological analysis of the specimens. In comparison, lesions that were surgically marked were removed with margins in excess in 43 per cent of cases, in deficit in 11 per cent and accurate in 46 per cent. Conclusion: This pilot study demonstrates that RCM did not increase the accuracy of LM surgical excision in comparison with standard surgically marked excisions.

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