International expert recommendations on image acquisition for in vivo reflectance confocal microscopy of cutaneous tumors

Abstract

No international recommendations exist for a minimum imaging requirement per lesion using reflectance confocal microscopy (RCM). This may be beneficial given the increasing use of remote RCM interpretation internationally. ObjectiveTo develop international expert recommendations for image acquisition using the tissue-coupled RCM for diagnosis of cutaneous tumor. MethodsUsing a modified Delphi approach, a core group developed the scope and drafted initial recommendations before circulation to a larger group, the Cutaneous Imaging Expert Resource Group (CIERG) of the American Academy of Dermatology. Each review round consisted of a period of open comment, followed by revisions. ResultsThe recommendations were developed following five alternating rounds of review among the core group and CIERG. These were divided into subsections of imaging personnel, recommended lesion criteria, clinical and lesion information to be provided, lesion preparation, image acquisition, mosaic cube settings, and additional captures based on lesion characteristics and suspected diagnosis. LimitationsThe current recommendations are limited to tissue-coupled RCM for diagnosis of cutaneous tumors. It is one component of the larger picture of quality assurance and will require ongoing review. ConclusionsThese recommendations serve as a resource to facilitate quality assurance, economical use of time, accurate diagnosis and international collaboration.