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Original Investigation |

Precise Longitudinal Tracking of Microscopic Structures in Melanocytic Nevi Using Reflectance Confocal Microscopy A Feasibility Study

Alon Scope, MD1,2; Limor Selinger, BA1; Margaret Oliviero, ARNP3; Francesca Farnetani, MD4; Elvira Moscarella, MD5; Caterina Longo, MD, PhD5; Harold S. Rabinovitz, MD3; Giovanni Pellacani, MD4
[+] Author Affiliations
1Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
2Dermatology Service, Memorial Sloan Kettering Cancer Center, New York
3Skin and Cancer Associates, Plantation, Florida
4Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
5Dermatology and Skin Cancer Unit, Arcispedale S. Maria Nuova–IRCCS, Reggio Emilia, Italy
JAMA Dermatol. 2016;152(3):299-304. doi:10.1001/jamadermatol.2015.4993.
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Importance  Reflectance confocal microscopy (RCM), a cellular-level, in vivo imaging technique, may be potentially used for monitoring melanocytic neoplasms for microscopic stability vs changes over time.

Objective  To test feasibility of using RCM to track specific microscopic structures within nevi over 1 year.

Design, Setting, and Participants  This was an observational study, a review of prospectively acquired RCM images, performed at a tertiary academic medical center. Seventeen patients were enrolled from adult patients presenting to pigmented lesion clinic; from each participant, 3 confirmed benign nevi were randomly selected from the upper and lower back and from the lower extremity.

Exposures  Nevi underwent standardized RCM imaging at baseline and after 1 year.

Main Outcomes and Measures  We tested interobserver reproducibility in recognition of tissue anchors, RCM structures that can be identified at 2 time points. We used 2 tests to measure concordance between independent readers: (1) In the multiple choice matching test (n = 43 nevi), readers were shown a tissue anchor in a baseline RCM image (≤1 ×  1-mm field-of-view) and asked to identify the same structure in 1 of 4 equally sized RCM images obtained from the same nevus at follow-up. (2) In the annotation test (n = 29 nevi), readers were shown a tissue anchor in a follow-up RCM image (≤1× 1-mm field-of-view) and asked to annotate the corresponding location of this structure in the baseline RCM mosaic image (≤5 × 5-mm field-of-view) from the same nevus; good agreement was defined as annotations deviant by less than 10% of the mosaic's width.

Results  In total, 17 patients (mean age, 45 years [range, 28-70 years]; 10 [59%] were women) contributed a total of 51 nevi, of which 44 nevi (86%) were used for the study. Images from 7 nevi (14%) were suboptimal in quality. Tissue anchors were identified at both time points in all 44 nevi. Selected tissue anchors were located at a mean depth of 54.3 µm; the most commonly selected anchors (37 of 44 images [84.1%]) were dermal papillae. In the multiple choice matching test, compared with a reference reader, 2 readers correctly matched baseline to follow-up tissue anchors in 40 of 43 nevi (93%; P < .01) and 42 of 43 nevi (98%; P < .01), respectively. In the annotation test, there was good agreement between 2 readers in all 29 cases (100%); the mean deviation was 2% (range, 0%-7.5%).

Conclusions and Relevance  Precise longitudinal tracking of microscopic structures in melanocytic nevi using RCM is feasible.

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Figure 1.
Tissue Anchors

A and B, Baseline and corresponding 1-year follow-up reflectance confocal microscopy (RCM) images (0.5 × 0.5 mm), respectively, at dermal-epidermal junction level showing a constellation of 3 adjacent dermal papillae (asterisks). C and D, Baseline follow-up RCM images (0.5 × 0.5 mm), respectively, showing nests in adjacent dermal papillae (arrowheads). E and F, Baseline and follow-up RCM images (0.5 × 0.5 mm), respectively showing corresponding arrangement of glyphics (arrowheads) and surface depressions (asterisks).

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Figure 2.
Multiple Choice Matching Test

A and B, Reflectance confocal microscopy images at the dermal-epidermal junction level (0.5 × 0.5 mm) from a lower back nevus of a woman in her 40s. An hourglass shape made of 2 dermal papillae from baseline (A, asterisks and circle) can be recognized (at a slight rotation) in 1 of 4 follow-up images (B, asterisks and circle).

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Figure 3.
Annotation Test

A and B, Reflectance confocal microscopy images at the dermal-epidermal junction level from an upper back nevus of a woman in her 60s. A. Baseline mosaic image (5 × 5 mm). Two independent readers' annotations (squares) deviate by 2%. B, Follow-up image (1.25 × 1.25 mm). The same tissue anchor composed of a constellation of 6 dermal papillae (asterisks) can be recognized in both images.

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