Improvement of diagnostic confidence and management of equivocal skin lesions by integration of reflectance confocal microscopy in daily practice: Prospective study in 2 referral skin cancer centers

Abstract

Reflectanceconfocal microscopy (RCM) allows accurate, noninvasive, invivo diagnosis for skin cancer. However, its impact on physicians' diagnostic confidence and management is unknown. We sought to assess the physicians' diagnostic confidence and management before and after RCM of equivocal skin lesions. Prospective, 2-center, observational study. During clinical practice, 7 dermatologists recorded their diagnostic confidence level (measured in a scale from 0 to 10), diagnosis, and management before and after RCM of clinically/dermoscopically equivocal lesions that raised concern for skin cancer. We also evaluated the diagnostic accuracy before and after RCM. We included 272 consecutive lesions from 226 individuals (mean age, 53.5years). Diagnostic confidence increased from 6.2 to 8.1 after RCM (P<.001) when RCM confirmed or changed the diagnosis.Lesion management changed in 33.5% cases after RCM (to observation in 51 cases and to biopsy/excision in 31 cases). After RCM, the number needed to excise was 1.2. Sensitivity for malignancy before and after RCM was 78.2% and 85.1%, respectively. Specificity before and after RCM was 78.8% and 80%, respectively. Small sample size, real-life environment, and different levels of expertise among RCM users. Physicians' diagnostic confidence and accuracy increased after RCM when evaluating equivocal tumors, frequently resulting in management changes while maintaining high diagnostic accuracy.