We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Clinical Indications for Use of Reflectance Confocal Microscopy for Skin Cancer Diagnosis ONLINE FIRST

Stefania Borsari, MD1; Riccardo Pampena, MD1; Aimilios Lallas, MD1; Athanassios Kyrgidis, MD1; Elvira Moscarella, MD1; Elisa Benati, MD1; Margherita Raucci, ARNP1; Giovanni Pellacani, MD2; Iris Zalaudek, MD3; Giuseppe Argenziano, MD4; Caterina Longo, MD, PhD1
[+] Author Affiliations
1Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
2Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy
3Nonmelanoma Skin Cancer Unit, Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
4Dermatology Unit, Second University of Naples, Naples, Italy
JAMA Dermatol. Published online August 31, 2016. doi:10.1001/jamadermatol.2016.1188
Text Size: A A A
Published online

Importance  Reflectance confocal microscopy (RCM) improves diagnostic accuracy in skin cancer detection when combined with dermoscopy; however, little evidence has been gathered regarding its real impact on routine clinical workflow, and, to our knowledge, no studies have defined the terms for its optimal application.

Objective  To identify lesions on which RCM performs better in terms of diagnostic accuracy and consequently to outline the best indications for use of RCM.

Design, Setting, and Participants  Prospectively acquired and evaluated RCM images from consecutive patients with at least 1 clinically and/or dermoscopically equivocal skin lesion referred to RCM imaging, from January 2012 to October 2014, carried out in a tertiary referral academic center.

Main Outcomes and Measures  A total of 1279 equivocal skin lesions were sent for RCM imaging. Spearman correlation, univariate, and multivariate regression models were performed to find features significantly correlated with RCM outcome.

Results  In a total of 1279 lesions in 1147 patients, RCM sensitivity and specificity were 95.3% and 83.9%, respectively. The number of lesions needed to excise to rule out a melanoma was 2.4. After univariate and multivariate regression analysis, head and neck resulted as the most appropriate body location for confocal examination; RCM showed a high diagnostic accuracy for lesions located on sun-damaged skin (adjusted odds ratio [aOR], 2.13; 95% CI, 1.37-3.30; P=.001) and typified by dermoscopic regression (aOR, 2.13; 95% CI, 1.31-3.47; P=.002) or basal-cell carcinoma specific criteria (aOR, 9.35; 95% CI, 1.28-68.58; P=.03).

Conclusions and Relevance  Lesions located on the head and neck, damaged by chronic sun-exposure, and dermoscopically typified by regression represent best indications for the use of RCM.

Figures in this Article


Place holder to copy figure label and caption
Figure 1.
A Lesion Located on the Face

A, Pink facial plaque in a woman in her 70s. B, On dermoscopic examination the lesion revealed fine vasculature and chrysalis. C, Reflectance confocal microscopy (magnification 0.5 × 0.5 mm) showed nucleated dendritic pagetoid cells (arrowheads) suggestive for the diagnosis of melanoma that was confirmed by histologic examination.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
An In Situ Melanoma Dermoscopically Typified by Regression

A, The lesion, located on the sun-damaged chest of a man in his 80s, is clinically inconspicuous. B, Dermoscopic regression; original magnification ×20. C, Reflectance microscopic examination was able to highlight roundish pagetoid melanocytes (arrowhead) that were diagnostic for melanoma.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles