Elshot Y S, Lasso Peña D J P, Zupan-Kajcovski B, Bekkenk M W, Balm A J M, Klop W M C, de Rie M A
Department of Dermatology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.
Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
J Eur Acad Dermatol Venereol. 2025 Mar;39(3):604-611. doi: 10.1111/jdv.20210. Epub 2024 Jun 26.
Reflectance confocal microscopy (RCM) has shown promise in predicting surgical outcomes by non-invasively detecting subclinical lentigo maligna (melanoma) (LM/LMM).
To assess the effects of presurgical mapping using handheld RCM (HH-RCM) on surgical treatment, follow-up outcomes and management decisions.
A total of 117 consecutive LM/LMM cases (2015-2023) were included. The diagnostic accuracy of HH-RCM in detecting subclinical LM and invasive components was evaluated. The primary endpoints included histological margin status and changes in management based on the outcomes of the HH-RCM mapping procedure. Margin and follow-up outcomes were compared to a historical cohort before HH-RCM was introduced in our center (n = 94) (2003-2014).
HH-RCM detected subclinical LM in 60% (n = 60) of cases. The median mapping duration was 14 min (range 4-50). In 27% (n = 33), the mapping procedure resulted in modified management, the majority consisting of limited surgery with adjuvant imiquimod (n = 15) or imiquimod monotherapy (n = 14). The remaining cases (n = 84) underwent HH-RCM-assisted surgery. Histological margins were cleared in 96.5% of the patients with a median histological margin of 3.0 mm, significantly higher than 81% in the historical cohort (median 2.0 mm) (p = 0.001). The sensitivity and specificity for detecting the extent of subclinical LM were 94% (95% CI 80.4-99.3) and 84% (95% CI 70.3-92.7), respectively. The negative predictive value for the detection of LMM was 94% (95% CI 84.4-97.7), and 75% of the initially missed LMM (n = 12) were identified during the HH-RCM mapping procedure. The study cohort had a 1.6% local recurrence rate compared with 25% in the historical cohort.
Integrating HH-RCM as the standard of care could lead to more personalized treatment strategies for LM/LMM and allows for the selection of patients suitable for nonsurgical treatment.
反射式共聚焦显微镜（RCM）已显示出通过非侵入性检测亚临床恶性雀斑样痣（黑色素瘤）（LM/LMM）来预测手术结果的前景。
评估使用手持式RCM（HH-RCM）进行术前绘图对手术治疗、随访结果和管理决策的影响。
纳入了2015年至2023年期间连续的117例LM/LMM病例。评估了HH-RCM检测亚临床LM和浸润成分的诊断准确性。主要终点包括组织学切缘状态以及基于HH-RCM绘图程序结果的管理变化。将切缘和随访结果与本中心引入HH-RCM之前的历史队列（n = 94）（2003年至2014年）进行比较。
HH-RCM在60%（n = 60）的病例中检测到亚临床LM。中位绘图持续时间为14分钟（范围4至50分钟）。在27%（n = 33）的病例中，绘图程序导致管理方式改变，大多数包括有限手术联合咪喹莫特辅助治疗（n = 15）或咪喹莫特单药治疗（n = 14）。其余病例（n = 84）接受了HH-RCM辅助手术。96.5%的患者组织学切缘清除，中位组织学切缘为3.0毫米，显著高于历史队列中的81%（中位2.0毫米）（p = 0.001）。检测亚临床LM范围的敏感性和特异性分别为94%（95%CI 80.4 - 99.3）和84%（95%CI 70.3 - 92.7）。检测LMM的阴性预测值为94%（95%CI 84.4 - 97.7），并且在HH-RCM绘图程序中识别出了75%最初漏诊 的LMM（n = 12）。研究队列的局部复发率为1.6%，而历史队列中为25%。
将HH-RCM作为标准治疗方法可导致针对LM/LMM的更个性化治疗策略，并允许选择适合非手术治疗的患者。
