title: The diagnostic accuracy of in vivo confocal scanning laser microscopy compared to dermoscopy of benign and malignant melanocytic lesions: a prospective study.
abstract: BACKGROUND
  The diagnosis of melanoma at an early, curable stage is an important challenge for clinicians. Confocal scanning laser microscopy (CSLM) is a high-resolution, noninvasive technology that may facilitate improved diagnostic accuracy over clinical examination. The aim of this study was to evaluate the diagnostic accuracy of CSLM compared to dermoscopy in a prospective examination of benign and malignant melanocytic lesions.
  
  
  METHODS
  125 patients with suspicious pigmented lesions were prospectively recruited to undergo a clinical, dermoscopic and CSLM examination. A diagnosis was made preoperatively with each technique, and the lesion was then excised and diagnosed using histopathology.
  
  
  RESULTS
  125 patients with 125 lesions were studied comprising 88 melanocytic nevi and 37 melanomas. Dermoscopy had a sensitivity of 89.2%, a specificity of 84.1%, a positive predictive value of 70.2% and a negative predictive value of 94.9%. CSLM was found to have a sensitivity of 97.3%, a specificity of 83.0%, a positive predictive value of 70.6% and a negative predictive value of 98.6%. No melanomas were misidentified when both techniques were used together.
  
  
  CONCLUSIONS
  CSLM had a relatively higher sensitivity than dermoscopy; however, the specificity was similar with CSLM and dermoscopy. These results suggest that dermoscopy and CSLM are complementary.
authors.affiliation: Division of Dermatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada. richard.langley@dal.ca
authors.forename: Richard G B
authors.initials: RG
authors.lastname: Langley
authors.forename: Noreen
authors.initials: N
authors.lastname: Walsh
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Sutherland
authors.forename: Iva
authors.initials: I
authors.lastname: Propperova
authors.forename: Laura
authors.initials: L
authors.lastname: Delaney
authors.forename: Steven F
authors.initials: SF
authors.lastname: Morris
authors.forename: Christopher
authors.initials: C
authors.lastname: Gallant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D046169:Dermoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008544:Melanocytes / Q000473:pathology*; D008545:Melanoma / Q000473:pathology*; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012878:Skin Neoplasms / Q000473:pathology*