Non-invasive diagnosis of pink basal cell carcinoma: How much can we rely on dermoscopy and reflectance confocal microscopy?

A. M. Witkowski, J. Łudzik, N. Decarvalho, S. Ciardo, C. Longo, A. Dinardo, G. Pellacani

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: Non-pigmented 'pink' cutaneous lesions in differential diagnosis with basal cell carcinoma may present a challenge for clinicians. Our objective was to determine the potential improvement of diagnostic accuracy using combined dermoscopy-reflectance confocal microscopy (RCM) image evaluation. Methods: Two hundred and sixty clinically equivocal 'pink' cutaneous lesions were evaluated retrospectively. Reader accuracy was tested with dermoscopy images only vs. RCM and combined dermoscopy-RCM images. Results: Out of 260 equivocal 'pink' cutaneous lesions, there were 114 basal cell carcinomas within a total of 140 malignancies that included 12 melanomas, 13 squamous cell carcinomas, and 1 other malignancy type. Dermoscopy only evaluation resulted in an overall sensitivity of 85.1% and specificity of 92.4%, resulting in a positive predictive value (PPV) of 89.8%, with 1 of 12 melanomas misdiagnosed. RCM evaluation resulted in an overall sensitivity of 85.1% and specificity of 93.8%, resulting in a PPV of 91.5%, with no melanomas misdiagnosed. Combined dermoscopy-RCM evaluation resulted in an overall sensitivity of 77.2% and specificity of 96.6%, resulting in a PPV of 94.6%. Conclusion: The combination of dermoscopy-RCM evaluation significantly improves the accuracy and safety threshold in equivocal 'pink' cutaneous lesions in the differential diagnosis of basal cell carcinoma.

Original languageEnglish (US)
Pages (from-to)230-237
Number of pages8
JournalSkin Research and Technology
Volume22
Issue number2
DOIs
StatePublished - May 1 2016
Externally publishedYes

Keywords

  • Basal cell carcinoma
  • Dermoscopy
  • Melanoma
  • Reflectance confocal microscopy

ASJC Scopus subject areas

  • Dermatology

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