title: Clinical Indications for Use of Reflectance Confocal Microscopy for Skin Cancer Diagnosis.
abstract: Reflectance confocal microscopy (RCM) improves diagnostic accuracy in skin cancer detection when combined with dermoscopy; however, little evidence has been gathered regarding its real impact on routine clinical workflow, and, to our knowledge, no studies have defined the terms for its optimal application.
  
  
  
  To identify lesions on which RCM performs better in terms of diagnostic accuracy and consequently to outline the best indications for use of RCM.
  
  
  
  Prospectively acquired and evaluated RCM images from consecutive patients with at least 1 clinically and/or dermoscopically equivocal skin lesion referred to RCM imaging, from January 2012 to October 2014, carried out in a tertiary referral academic center.
  
  
  
  A total of 1279 equivocal skin lesions were sent for RCM imaging. Spearman correlation, univariate, and multivariate regression models were performed to find features significantly correlated with RCM outcome.
  
  
  
  In a total of 1279 lesions in 1147 patients, RCM sensitivity and specificity were 95.3% and 83.9%, respectively. The number of lesions needed to excise to rule out a melanoma was 2.4. After univariate and multivariate regression analysis, head and neck resulted as the most appropriate body location for confocal examination; RCM showed a high diagnostic accuracy for lesions located on sun-damaged skin (adjusted odds ratio [aOR], 2.13; 95% CI, 1.37-3.30; P=.001) and typified by dermoscopic regression (aOR, 2.13; 95% CI, 1.31-3.47; P=.002) or basal-cell carcinoma specific criteria (aOR, 9.35; 95% CI, 1.28-68.58; P=.03).
  
  
  
  Lesions located on the head and neck, damaged by chronic sun-exposure, and dermoscopically typified by regression represent best indications for the use of RCM.
authors: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors: Stefania
authors: S
authors: Borsari
authors: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors: Riccardo
authors: R
authors: Pampena
authors: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors: Aimilios
authors: A
authors: Lallas
authors: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors: Athanassios
authors: A
authors: Kyrgidis
authors: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors: Elvira
authors: E
authors: Moscarella
authors: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors: Elisa
authors: E
authors: Benati
authors: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors: Margherita
authors: M
authors: Raucci
authors: Dermatology Unit, University of Modena and Reggio Emilia, Modena, Italy.
authors: Giovanni
authors: G
authors: Pellacani
authors: Nonmelanoma Skin Cancer Unit, Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria.
authors: Iris
authors: I
authors: Zalaudek
authors: Dermatology Unit, Second University of Naples, Naples, Italy.
authors: Giuseppe
authors: G
authors: Argenziano
authors: Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors: Caterina
authors: C
authors: Longo
mesh_terms: D002280:Basal Cell Carcinoma / Q000175:diagnosis* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000601:surgery; D046169:Dermoscopy / Q000379:methods; D003937:Diagnosis, Differential; D006785:Hospitals, University; D006801:Humans; D008545:Melanoma / Q000175:diagnosis* / Q000601:surgery; D018613:Microscopy, Confocal / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000601:surgery