Adjunctive use of reflectance confocal microscopy (RCM) for suspect lesions reduces unnecessary excisions in a real-life setting, according to a study published online June 1 in JAMA Dermatology .

Giovanni Pellacani, M.D., from the University of Modena and Reggio Emilia in Italy, and colleagues conducted a randomized clinical trial involving 3,165 patients enrolled from three dermatology referral centers in Italy, with a mean follow-up of 9.6 months. Patients were randomly assigned to standard therapeutic care with or without adjunctive RCM. A diagnostic analysis was included for 3,078 patients.

The researchers found that adjunctive RCM was associated with a higher positive predictive value (18.9 versus 33.3), a lower benign-to-malignant ratio (3.7:1.0 versus 1.8:1.0), and a 43.2 percent reduction in the number needed to excise (5.3 versus 3.0) compared with standard therapeutic care alone. All 15 lesions with delayed melanoma diagnoses were thinner than 0.5 mm.

"This randomized interventional trial assessed the applicability of adjunctive RCM for equivocal lesions suspected of melanoma in a clinical setting and proves that unnecessary excisions can be reduced by almost half, with greater accuracy of in vivo identification of benign lesions," the authors write.

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