title: Diagnostic accuracy of reflectance confocal microscopy using VivaScope for detecting and monitoring skin lesions: a systematic review.
abstract: BACKGROUND
  Skin cancer is one of the most common cancers in the UK. Patients with suspicious skin lesions are assessed clinically with/without dermoscopy, and lesions still considered suspicious are then surgically removed or have the diagnosis confirmed by a punch biopsy.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy of the in vivo VivaScope©reflective confocal microscopy (RCM) system, a noninvasive technology designed to provide a more accurate presurgical diagnosis, leading to fewer biopsies of benign lesions, or to provide greater accuracy for lesion margins.
  
  
  METHODS
  MEDLINE, EMBASE and the Cochrane Library were searched to identify studies evaluating dermoscopy plus RCM, or RCM alone, with histopathology as the reference test. Clinical experts were also contacted for information on unpublished studies.
  
  
  RESULTS
  Eleven studies met the inclusion criteria but were too heterogeneous to be combined by meta-analysis. Results indicated that VivaScope subsequent to dermoscopy may improve diagnostic accuracy of malignant melanomas compared with dermoscopy. For margin delineation, the data suggest that mapping using VivaScope 1500 for lentigo maligna (LM) and LM melanoma may improve accuracy in terms of complete excision of lesions compared with dermoscopically determined margins. For basal cell carcinoma, the limited data show high diagnostic accuracy with both VivaScope 1500 and VivaScope 3000. Evidence on the effectiveness of VivaScope in diagnosing cutaneous squamous cell carcinomas was very limited.
  
  
  CONCLUSIONS
  The use of VivaScope 1500 following dermoscopy may improve patient care and management of suspicious skin lesions, although the generalizability of these results to the UK population remains unclear.
authors.affiliation: BMJ Technology Assessment Group, BMJ, London, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Edwards
authors.affiliation: BMJ Technology Assessment Group, BMJ, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Osei-Assibey
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Patalay
authors.affiliation: BMJ Technology Assessment Group, BMJ, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Wakefield
authors.affiliation: BMJ Technology Assessment Group, BMJ, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Karner
mesh_terms: D046169:Dermoscopy / Q000379:methods* / Q000592:standards; D003937:Diagnosis, Differential; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000175:diagnosis; D008545:Melanoma / Q000175:diagnosis; D018613:Microscopy, Confocal / Q000295:instrumentation / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis*