Abstract Number: 16

Reflectance confocal microscopy as a diagnosticaid in determined invasion in lentigo malignaclinical presentations

G. Carlos, P. Luk, R.A. Scolyer, P. Guitera

Meeting: 2015 Dermcoll

Session Information

Date: -

Session Title: Melanoma Symposium

Session Time: -

Australia has the highest incidence of lentigo maligna (LM)
in the world and it represents the most prevalent in-situ
form of melanoma. Location, extension and polymorphic
clinical presentations of these lesions represent a diagnostic
and management challenge for clinicians and pathologists.
Often Wood’s lamp and dermoscopy are insufficient for
accurate demarcation of peripheral margins. Reflectance
confocal microscopy (RCM) may improve the accuracy of
diagnosis and margin mapping. In order to treat wider
areas, reduce recurrence and improve cosmesis, radiotherapy
and imiquimod have been proposed as alternatives
to surgery. The challenge of these treatments is the risk of
inadequately treating a micro-invasive component. The aim
of this study was to determine whether RCM is a reliable
tool to detect invasion in LM.
RCM is able to access large lesions in vivo non-invasively. On
the other hand, in RCM it is difficult to determine the exact
site of the cells (junctional or dermal) on a en face field of
view, due to a partially disrupted dermoepidermal junction.
From 2007 to 2014, 213 patients with clinically suspicious
lesions for LM or LM melanoma (initial diagnosis or recurrence)
were retrieved from a confocal database of the
Sydney Melanoma Diagnostic Centre and Melanoma Institute
Australia. On review of the RCM images, 39 of 213
(18%) patients had atypical cells extending into the dermis.
Fifteen out of these 39 patients had invasive melanoma
confirmed on histopathological examination. Pathology correlation
of RCM findings and data on false negative and
false positive cases will be analysed and presented.