By Marilynn Larkin
NEW YORK (Reuters Health) – Handheld reflectance confocal microscopy with radial video mosaicing (HRCM-RV) may improve diagnostic accuracy and facilitate margin mapping for lentigo maligna and lentigo maligna melanoma, researchers suggest.
Dr. Anthony Rossi of Memorial Sloan Kettering Cancer Center in New York City told Reuters Health, “Historically, melanoma on the head and neck can have very indistinct margins and subclinical extension. We used novel video mosaic technology to evaluate the margins circumferentially to estimate the margins pre-surgically.”
“The margins calculated (were accurate) when compared to the margins needed to clear the melanoma surgically,” he said by email. “The accurate prediction has allowed us to use this technique preoperatively to better counsel patients regarding surgery and reconstruction, and it has also allowed us to better guide non-surgical treatment options if surgery is not pursued.”
Dr. Rossi and colleagues prospectively assessed 23 lentigo maligna and lentigo maligna melanoma lesions from 22 patients (mean age, 69; 12 men) who underwent both HRCM-RV and staged surgery. He and two coauthors performed staged excisions blinded to the HRCM-RV calculations with an initial 5-mm margin beyond the clinical margin, which the surgeons determined using dermoscopy and examination by Wood lamp.
As reported in JAMA Dermatology, online October 11, the mean surgical defect area as estimated by HRCM-RV was 6.34 cm2, compared to 7.74 cm2 for surgical excision with clear margins.
Overall, after adjustment for patient age and previous surgery, surgical margins were a mean of 0.76 mm larger than the HRCM-RV estimate.
“Our results suggest that HRCM-RV margin mapping correlates well with histologic findings and can estimate the subclinical extension and presurgical margins,” the authors state. “Thus, we believe that our approach can result in sparing of healthy tissue by reducing the number of biopsies in clinically uncertain areas.”
Dr. Daniel J. Aires, director of the dermatology division at the University of Kansas Health System in Kansas City, told Reuters Health by email, “At present RCM still appears to be somewhat cumbersome, but as it becomes more efficient it could potentially be useful for preoperative planning of superficial melanoma excisions.”
“While the study is interesting, it does have some limitations,” he added. “The number of lesions and the number of valuators were both small. At this point, sensitivity and specificity have not been established.”
“While it may be valuable in the future,” Dr. Aires concluded, “at this point it is not ready for clinical use.”
One author is a former employee of, and owns equity in, the company that manufactures and sells the VivaScope confocal microscope.
SOURCE: https://bit.ly/2yH9xGf
JAMA Dermatol 2017.
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