Dynamic dermoscopic and reflectance confocal microscopic changes of melanocytic lesions excised during follow-up

BACKGROUND: Digital dermoscopy follow-up (DDF) is useful in improving melanoma recognition, catching early changes over time, although benign nevi can also show changes. Reflectance confocal microscopy (RCM) improves melanoma diagnostic accuracy and decreases the number of unnecessary resections.OBJECTIVES: To evaluate dynamic dermoscopic and RCM changes during follow-up of equivocal melanocytic lesions and assess the impact of adjunctive RCM to DDF for melanoma diagnosis.METHODS: A retrospective, multicenter study of extra-facial atypical melanocytic lesions excised during follow-up was performed. Morphological changes were evaluated comparing dermoscopy and RCM baseline and follow-up images.RESULTS: 137 atypical melanocytic lesions were studied, including 14 melanomas and 123 benign nevi. Significantly greater changes in DDF of atypical network, regression, atypical streaks and asymmetrical growth and in dynamic RCM of atypical cells and dermal-epidermal junction (DEJ) disarray were note in melanomas. With adjunctive dynamic RCM and major changes at DDF, sensitivity reached 100% with 40.6% specificity.LIMITATIONS: Selected series of "difficult to recognize" lesions, with both DDF and dynamic RCM images.CONCLUSION: Adjunctive dynamic RCM improves early melanoma recognition sensitivity