Dermatology Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
Int J Dermatol. 2023 Jun;62(6):805-811. doi: 10.1111/ijd.16688. Epub 2023 Apr 19.
The detection of subclinical margin in lentigo maligna/lentigo maligna melanoma (LM/LMM) can be challenging for the dermatologist. Reflectance confocal microscopy (RCM) enables to observe in vivo atypical melanocytes beyond the clinical margins. The aim of this study is to establish which of these methods (clinical examination and dermoscopy versus "Paper tape - RCM") is more precise to define the lesion margin and to reduce the number of re-intervention and overtreatments in cosmetically sensitive areas.
Fifty-seven cases of LM/LMM were analyzed during 2016-2022. Pre-surgical mapping procedures in 32 lesions were effectuated with dermatoscopy. Furthermore, pre-surgical mapping procedures in 25 lesions were effectuated with RCM and paper tape.
RCM method's accuracy to detect subclinical margins was 92.0%. In 24 of 25 cases, the lesions were excised completely during the first intervention. In 20 of 32 cases analyzed with dermoscopy, a second surgical intervention was effectuated.
The RCM paper method allows us to delineate subclinical margin more accurately and reduce overtreatment, especially in sensitive areas, such as the face and neck.
对于皮肤科医生来说，检测良性色素痣/恶性黑色素瘤（LM/LMM）的亚临床边缘具有一定挑战性。反射共聚焦显微镜（RCM）可用于观察临床边缘以外的活体不典型黑素细胞。本研究旨在确定这些方法（临床检查和皮肤镜检查与“纸带-RCM”）中哪一种更能精确地确定病变边缘，并减少美容敏感区域的再次干预和过度治疗的次数。
分析了 2016 年至 2022 年期间的 57 例 LM/LMM 病例。对 32 例病变进行了术前皮肤镜检查，对 25 例病变进行了术前 RCM 和纸带检查。
RCM 方法检测亚临床边缘的准确率为 92.0%。在 25 例接受 RCM 检查的病例中，有 24 例在第一次干预时完全切除了病变。在 32 例接受皮肤镜检查的病例中，有 20 例进行了第二次手术干预。
RCM 纸带法可以更精确地描绘亚临床边缘，减少过度治疗，特别是在面部和颈部等敏感区域。
