In vivo reflectance confocal microscopy role for early to advanced lentigo maligna melanoma spectrum: A systematic review and pooled analysis

Bruna Melhoranse Gouveia; Peter M Ferguson; Serigne N Lo; Helena Collgros; Linda K Martin; Christoph Sinz; Amelia K Smit; Bruna Gallo; Genevieve Ho; Amanda Glanz; Richard A Scolyer; Anne E Cust; Pascale Guitera

doi:10.1111/jdv.20389

In vivo reflectance confocal microscopy role for early to advanced lentigo maligna melanoma spectrum: A systematic review and pooled analysis

J Eur Acad Dermatol Venereol. 2024 Nov 13. doi: 10.1111/jdv.20389. Online ahead of print.

Authors

Bruna Melhoranse Gouveia^{1

2

3}, Peter M Ferguson^{1

2

4}, Serigne N Lo^{1

2}, Helena Collgros^{1

5}, Linda K Martin^{2

3

6}, Christoph Sinz^{1

2}, Amelia K Smit^{1

2

6}, Bruna Gallo^{1

2}, Genevieve Ho^{1

2

3}, Amanda Glanz^{1

5}, Richard A Scolyer^{1

2

4}, Anne E Cust^{1

2

6}, Pascale Guitera^{1

2

5}

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
² Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.
³ School of Clinical Medicine, Faculty of Medicine & Health, UNSW, Sydney, New South Wales, Australia.
⁴ Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia.
⁵ Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁶ The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia.

PMID: 39535326
DOI: 10.1111/jdv.20389

Abstract

Lentigo maligna (LM) is a growing problem worldwide and the main type of melanoma in situ in some Caucasian populations. It presents as a spectrum from atypical intraepidermal melanocytic proliferation (AIMP) to invasive lentigo maligna melanoma (LMM). Accurate diagnosis and staging are crucial for determining appropriate management strategies. To assess the role of in vivo reflectance confocal microscopy (RCM) in differentiating early and advanced stages of lentigo maligna. A systematic search was conducted on Medline, PubMed, Scopus, Web of Science, Proquest Central, Embase, Cochrane and Google Scholar. References of included and excluded studies were reviewed for additional sources. Studies involving RCM for AIMP, LM and LMM diagnosis published until 1 December 2023, were selected for analysis. Publications on other non-invasive imaging techniques, other skin diseases or those addressing only RCM surgical margins and therapeutic response without reporting RCM features were excluded. Each article was reviewed by two experts, with disagreements resolved by a third expert. Data for each RCM feature were pooled, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Features were stratified for architecture, cellular morphology and distribution. Twenty-seven articles involving 303 lesions were included. Features favouring LM over AIMP included (1) Architecture: the presence of non-edged papillae (OR 4.50, 95% CI 1.92-10.52) and (2) Cellular distribution: widespread pagetoid cells and junctional atypical cells (OR 25.06, 95% CI 4.19-148.45) and junctional nests (OR 18.06, 95% CI 3.04-106.32). Features favouring LMM over LM included (1) Architecture: epidermal disarray (OR 5.03, 95% CI 1.90-13.22), junctional disarray (OR 4.19, 95% CI 1.54-11.33) and destroyed collagen fibres (OR 3.91, 95% CI 1.80-8.44) and (2) cellular distribution: widespread pagetoid and junctional atypical cells (OR 2.71, 95% CI 1.27-5.75) and junctional nests (OR 4.48, 95% CI 2.12-9.43). This study identifies the RCM features associated with the LM/LMM spectrum.

Publication types

Review