title: Cost-benefit of reflectance confocal microscopy in the diagnostic performance of melanoma.
abstract: BACKGROUND
  The sub-optimal diagnostic accuracy for melanoma leads to excise a high number of benign lesions, with consequent costs. Reflectance confocal microscopy (RCM) improves diagnostic specificity, thus possibly inducing a reduction in unnecessary excisions and related costs.
  
  
  OBJECTIVE
  To estimate the influence of RCM on number of benign lesions needed to excise (NNE) a melanoma, in term of clinical outcomes and costs per patient.
  
  
  METHODS
  Skin neoplasms excised by the dermatology public service in the Province of Modena were retrieved form centralized pathology database. Differences in NNE between the territorial service (using dermoscopy only) and the University Hospital (adding also RCM to the patients' workflow) were calculated and cost analysis was performed through a micro-costing approach.
  
  
  RESULTS
  A large reduction in benign lesions excised at University Hospital was evident, leading to NNE of 6.25 for University Hospital, compared to 19.41 for Territorial Dermatology. Since 4320 unnecessary excisions can be saved every million inhabitants, an overall yearly saving of over 280,000 Eur can be expected from the use of RCM.
  
  
  CONCLUSIONS
  The systematic use of RCM was dramatically affecting the number of benign lesions excised, and this can be translated in a significant cost-benefit advantage.
authors.affiliation: Department of Dermatology, University of Modena, Reggio Emilia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pellacani
authors.affiliation: Department of Dermatology, University of Modena, Reggio Emilia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Witkowski
authors.affiliation: Department of Pathology, University of Modena, Reggio Emilia, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Cesinaro
authors.affiliation: Department of Dermatology, University of Modena, Reggio Emilia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Losi
authors.affiliation: Department of Drug Sciences, University of Pavia, Pavia, Italy.
authors.forename: G L
authors.initials: GL
authors.lastname: Colombo
authors.affiliation: General Direction, Policlinico Hospital, Modena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Campagna
authors.affiliation: Dermatology and Skin Cancer Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Longo
authors.affiliation: Department of Pathology, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Piana
authors.affiliation: Department of Dermatology, University of Modena, Reggio Emilia, Italy.
authors.forename: N
authors.initials: N
authors.lastname: De Carvalho
authors.affiliation: Department of Dermatology, University of Modena, Reggio Emilia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Giusti
authors.affiliation: Department of Dermatology, University of Modena, Reggio Emilia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Farnetani
mesh_terms: D003362:Cost-Benefit Analysis; D003880:Dermatology / Q000191:economics*; D046169:Dermoscopy / Q000191:economics; D006801:Humans; D008545:Melanoma / Q000473:pathology*; D018613:Microscopy, Confocal / Q000191:economics*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*