title: [Clinical utility of reflectance confocal microscopy for the non-invasive diagnosis of lentigo maligna melanoma].
abstract: BACKGROUND
  Lentigo maligna melanoma (LMM), a melanoma subtype that arises on sun-damaged facial skin, is difficult to diagnose clinically. Patients and physicians are reluctant to perform unnecessary facial biopsies. Reflectance confocal microscopy (RCM) is a novel technique for non-invasive skin imaging at cellular-level resolution. RCM increases the accuracy of melanoma diagnosis.
  
  
  OBJECTIVE
  To describe the diagnostic utility of RCM in cases of clinically and dermatoscopically equivocal pigmented skin lesions suspicious for LMM.
  
  
  METHODS
  This is a retrospective case series derived from the population of patients undergoing periodic skin cancer screening at a tertiary hospital clinic that specializes in skin cancer diagnosis. All patients consented to RCM imaging as an ancillary test prior to the decision on performing a biopsy in the facial lesion.
  
  
  RESULTS
  We report on four patients who presented clinically and dermatoscopically equivocal pigmented skin lesions in the head and neck region, with differential diagnosis of LMM. Furthermore, in two patients, a prior incisional biopsy indicated a benign diagnosis upon histopathological analysis. In all cases, RCM examination showed specific criteria for LMM. The RCM diagnosis of LMM allowed direct referral for excisional surgery in three patients. In another patient, RCM findings guided incisional biopsy-site selection to a focus that revealed histopathology clear-cut criteria for LMM.
  
  
  CONCLUSIONS
  RCM is a very useful adjunct to the non-invasive diagnosis of LMM.
authors.forename: Alon
authors.initials: A
authors.lastname: Scope
authors.forename: Aviv
authors.initials: A
authors.lastname: Barzilai
authors.forename: Isaac
authors.initials: I
authors.lastname: Zilinsky
mesh_terms: D001706:Biopsy / Q000379:methods*; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer; D005145:Face / Q000473:pathology; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000175:diagnosis / Q000473:pathology; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology; D012880:Skin Pigmentation; D019564:Unnecessary Procedures