title: The value of reflectance confocal microscopy in diagnosis of flat pigmented facial lesions: a prospective study.
abstract: BACKGROUND
  Flat pigmented facial lesions are difficult to diagnose even with dermatoscopy. It is controversial how additional information obtained by in vivo reflectance confocal microscopy (RCM) impacts the diagnosis and management.
  
  
  OBJECTIVE
  To examine what in vivo reflectance confocal microscopy of flat pigmented facial lesions adds to clinical examination using dermatoscopy including digital dermatoscopic monitoring.
  
  
  METHODS
  We prospectively collected 70 cases of flat pigmented facial lesions and recorded diagnoses and management decisions by experts based on direct clinical examination aided by dermatoscopy including digital dermatoscopic monitoring and by remote experts who reviewed the corresponding confocal images. The expert confocal readers were blinded to the clinical and dermatoscopic appearance of the lesion.
  
  
  RESULTS
  The sensitivity of dermatoscopy plus digital dermatoscopic monitoring was 95.0% (95% CI 75.13% to 99.87%) and the specificity was 84.0% (95% CI 70.89% to 92.83%). The sensitivity of RCM was 95.0% (95% CI 75.13% to 99.87%) and the specificity was 82.0% (95% CI 68.56% to 91.42%).
  
  
  CONCLUSIONS
  Although most flat pigmented facial lesions can be managed by clinical examination and dermatoscopy alone, confocal microscopy is a useful adjunct in selected lesions. If RCM is not correlated with clinical and dermatoscopic information, there is risk of overdiagnosis of actinic keratosis, however.
authors.affiliation: Department of General Dermatology, Medical University of Vienna, Vienna General Hospital (AKH), Vienna, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Wurm
authors.affiliation: Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pellacani
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria, Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Longo
authors.affiliation: Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, QLD, Australia.
authors.forename: H P
authors.initials: HP
authors.lastname: Soyer
authors.affiliation: Medicine Department, Alcalá University, Madrid, Spain.|Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: S
authors.initials: S
authors.lastname: Gonzalez
authors.affiliation: Department of Dermatology, Medical University of Graz, Graz, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Hofmann-Wellenhof
authors.affiliation: Department of Dermatology, University Clinic Salzburg, Salzburg, Austria.
authors.forename: V
authors.initials: V
authors.lastname: Ahlgrimm-Siess
authors.affiliation: Melanoma Institute Australia and the Sydney Melanoma Diagnostic Centre, and the Faculty of Dermatology, University of Sydney, Sydney, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Guitera
authors.affiliation: Department of General Dermatology, Medical University of Vienna, Vienna General Hospital (AKH), Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Sinz
authors.affiliation: Department of General Dermatology, Medical University of Vienna, Vienna General Hospital (AKH), Vienna, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Kittler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046169:Dermoscopy / Q000379:methods; D005145:Face / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D010859:Pigmentation Disorders / Q000175:diagnosis*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012871:Skin Diseases / Q000175:diagnosis*