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Different dermoscopic presentations of typical seborrheic keratosis (SK) have been widely described,1 but atypical SKs have not yet been distinguished from cutaneous neoplasms. Despite a retrospective design and absence of control lesions, this study shows that in a reference centre for RCM diagnosis differential diagnosis with RCM of atypical SK facial lesions equivocal upon dermoscopy can significantly reduce unnecessary facial lesion excisions. Facial seborrheic keratosis with unusual dermoscopic patterns can be differentiated from other skin malignancies by in vivo reflectance confocal microscopy. [Extracted from the article]

Background: The diagnostic accuracy of reflectance confocal microscopy (RCM) of cutaneous malignant melanoma (MM) seems promising. However, clinical scenarios in which RCM is most useful are still to be established. Objectives: To assess the diagnostic accuracy of RCM for MM diagnosis according to study design, lesion type and diagnostic modality. Secondary outcomes include a comparison with dermoscopy. Methods: A systematic literature search was conducted on PubMed, Embase, Scopus and Cochrane Public Library Databases for English articles published prior to January 2019. Statistical analyses were conducted with Meta‐Disc v. 1.4, STATA 14.0 software and the QUADAS‐2 tool. Results: A total of 32 studies (7352 lesions) were included in the meta‐analysis. Pooled sensitivity and specificity resulted 92% (95% CI: 0.91–0.93) and 70% (95% CI: 0.69–0.71), respectively. According to study design, diagnostic sensitivity was high for all study types, confirming a lower specificity for prospective interventional studies. Diagnostic accuracy remained high for all lesion types, with the highest specificity obtained for consecutive lesions of 77% (95% CI: 0.75–0.78) vs. 65% (95% CI: 0.63–0.66) for lesions highly suspicious for MM. RCM diagnostic accuracy was superior to dermoscopy, most notably in terms of specificity of 56% (95% CI: 0.52–0.60) vs. 38% (95% CI: 0.34–0.42), respectively. Studies were generally assessed across all domains as low or unclear risk of bias with a mainly low concern regarding applicability of evidence. Publication bias was asymmetrical (11.2 ± 4.0; 95% CI 2.97–19.43; P < 0.01). Conclusions: Independent of study design, RCM has a high diagnostic power for MM detection, and unnecessary excisions are reduced compared to dermoscopy. This reduction is most evident in non‐decisional RCM scenarios and for lesions analysed at RCM consecutively compared to those selected highly suspicious for MM. However, the scarcity, heterogeneity and bias associated with the data in literature should be considered when interpreting present conclusions. [ABSTRACT FROM AUTHOR]

The aim of this preliminary study was to better define the implication of globules/dots for differential diagnosis of flat-pigmented facial lesions without any other highly suggestive dermoscopy melanocytic features, correlated with RCM morphological features. Flat-pigmented facial lesions with RCM images and histological diagnosis ( I n i = 256) were retrospectively selected from a dedicated database of consecutive lesions at the Dermatology Unit of Modena, Italy, between February 2013 and February 2019. RCM lesion evaluation enables the identification of morphological melanocytic criteria, and if the RCM is unavailable, biopsy should be considered. [Extracted from the article]

Background: Nodular lesions have common clinical appearance but different prognoses. Differential diagnosis between melanoma (MM), basal cell carcinoma (BCC) and dermal naevus (DN) poses a challenge in clinical practice. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) are promising non‐invasive imaging techniques, potentially able to decrease redundant biopsies. RCM allows in vivo visualization of skin down to the papillary dermis at almost histological resolution, while OCT, particularly dynamic OCT (D‐OCT), provides images deeper within the dermis and reveals the vascular pattern. Objectives: To identify correlating features observed with RCM and OCT associated with the different nodular lesion diagnoses. Methods: We retrospectively assessed 68 nodular lesions (30 MM, 20 BCC and 18 DN) with RCM and subsequently OCT. At the end of the study, evaluations were matched with histopathological diagnosis and statistical analysis was performed. Results: In MM, 57% (17/30) evidenced both cerebriform nests at RCM and icicle‐shaped structures at OCT, with higher average Breslow index. In 80% of BCCs with basaloid islands at RCM, OCT showed ovoid structures. More than half of DN (56%) showed hyporeflective nests at OCT and either dense nests or dense and sparse nests at RCM. Conclusions: The combined use of RCM and OCT offers a better understanding of the morphological architecture of nodular lesions, correlating RCM parameters with OCT and vice versa, assisting in turn with early differential diagnosis of malignant and benign nodular lesions. The correlation between icicle‐shaped structures and cerebriform nests in MM and their association with Breslow index requires future research. [ABSTRACT FROM AUTHOR]

Background: Negative pigment network (NPN) is a dermoscopic structure observed more frequently among melanomas than naevi. Precise tissue correlates of NPN are still elusive. Objective: To describe the reflectance confocal microscopy (RCM) findings underlying NPN in melanocytic neoplasms. Methods: We retrospectively identified all melanocytic neoplasms displaying dermoscopic NPN that were imaged with RCM and subsequently biopsied between 2011 and 2015. Images from study lesions (n = 50) were evaluated for dermoscopic and RCM Criteria. Histopathological correlational study was performed in a subset of cases (n = 15). Results: The study data set consisted of 21 melanomas (42%) and 29 naevi (58%). Melanomas showed more frequently irregularly shaped globules than naevi (62% vs. 28%, P = 0.03); NPN also tended to be more asymmetrically located among melanomas (86%) than naevi (62%), albeit not significant (P = 0.06). Under RCM, we observed three patterns of dermal papillae (DP): (i) 'Dark DP' – whereby DP were devoid of nests and often surrounded by a junctional proliferation as thick‐Rings – this pattern was less common among melanomas (n = 10, 48%) than naevi (n = 23, 79%, P = 0.02); (ii) 'Bulging DP' – whereby junctional nests of melanocytes protrude into the DP, often in association with junctional proliferation as Meshwork – with comparable frequency among melanomas (n = 12, 57%) and naevi (n = 23, 79%, P = 0.09) and (iii) 'Expanded DP' – whereby junctional and/or dermal nests filled and expanded the DP, often in association with dermal–epidermal junction (DEJ) Clod pattern – seen more commonly among melanomas (n = 15, 71%) than naevi (n = 6, 21%, P < 0.001). Dermoscopy–RCM correlation and comparison to histopathological findings show that the hypo‐pigmented lines of NPN correlate with broadened epidermal retes, which often show overlying surface dells and wedge‐shaped hypergranulosis, while the pigmented globules of NPN correlate with a predominantly‐junctiona of melanocytes along and between the elongated retes. Conclusions: Dermoscopic NPN correlates with three DEJ RCM patterns with differing frequency between naevi and melanomas. [ABSTRACT FROM AUTHOR]

Congenital nevi (CN) are pigmented lesions that undergo a morphological evolution during patient growth.1,2 Few data are available regarding CN and the correlation between dermoscopy and reflectance confocal microscopy (RCM) throughout life stages. This cross-sectional study aimed to correlate CN dermoscopy and RCM patterns and identify the prevalent patterns according to age groups. [Extracted from the article]