Reflectance Confocal Microscopy More Accurate for AHM Diagnosis Than Dermoscopy

Although both reflectance confocal microscopy and dermoscopy provide good diagnostic accuracy for the diagnosis of amelanotic/hypomelanotic melanoma, reflectance confocal microscopy may be slightly more accurate in its approach to non-invasive diagnosis, study results published in the British Journal of Dermatology suggest.

The study was a systematic review and meta-analysis of 7 studies that evaluated the performance of either dermoscopy or reflectance confocal microscopy for diagnosing amelanotic/hypomelanotic melanoma (AHM). In these studies, there were a total of 1111 lesions assessed by the 2 diagnostic strategies.

Dermoscopy featured a sensitivity of 61% [95% CI, 0.37-0.81] and a specificity of 90% (95% CI, 0.74-0.97) for the diagnosis of AHM, according to findings from the pooled analysis. In addition, the sensitivity and specificity of reflectance confocal microscopy for diagnosing AHM was 67% (95% CI, 0.51-0.81) and 89% (95% CI, 0.88-0.92), respectively.

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In 3 studies that evaluated the diagnostic accuracy of both dermoscopy and reflectance confocal microscopy, the pooled diagnostic odds ratio (DOR) to detect AHM was 4.33 (95% CI, 0.96-19.96), whereas the pooled DOR for reflectance confocal microscopy was 16.4 (95% CI, 6.36-42.25). The relative DOR for both strategies was 4.69 (95% CI, 0.81-27.27) (P =.068).

Limitations of the meta-analysis included the high heterogeneity, as well as quality variability in studies.

Although the researchers concluded that reflectance confocal microscopy may be more accurate than dermoscopy, they wrote that “the conclusion wasn’t firm in our study owing to the paucity of inclusive studies” with reflectance confocal microscopy.

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Lan J, Wen J, Cao S, et al. The diagnostic accuracy of dermoscopy and reflectance confocal microscopy for amelanotic/hypomelanotic melanoma: a systematic review and meta-analysis [published online November 20, 2019]. Br J Dermatol. doi:10.1111/bjd.18722