Dermatofluoroscopy accurate in cutaneous melanoma detection
March 31, 2018
Abstract
Background: Early detection is a key factor in improving survival from melanoma. Today, the clinical diagnosis of cutaneous melanoma is mostly based on visual inspection and dermoscopy. Preclinical studies in freshly excised or paraffin‐embedded tissue have shown that the melanin fluorescence spectra after stepwise two‐photon excitation, a process termed dermatofluoroscopy, differ between cutaneous melanoma and melanocytic nevi. However, confirmation from a larger prospective clinical study is lacking.
Objectives: The primary endpoint of this study was to determine the diagnostic accuracy of dermatofluoroscopy in melanoma detection. Secondary endpoints included the collection of data for improving the computer algorithm that classifies skin lesions based on melanin fluorescence and the assessment of safety aspects.
Study design: A prospective, blinded, multicentre clinical study in patients with pigmented skin lesions (PSL) indicated for excision to either rule out or to confirm cutaneous melanoma. All included lesions underwent dermoscopy and dermatofluoroscopy in‐vivo before lesions were excised and subjected to histopathological examination.
Results: A total of 369 patients and 476 PSL were included in the final analysis. In 101 of 476 lesions (21.2%) histopathology revealed melanoma. The observed sensitivity of dermatofluoroscopy was 89.1% (90 of 101 melanomas identified) with an observed specificity of 44.8%. The positive and negative predictive values were 30.3% and 93.9%, respectively. No adverse events occurred.
Conclusion: Dermatofluoroscopy is a safe and accurate diagnostic method to aid physicians in diagnosing cutaneous melanoma. Limitations arise from largely amelanotic or regressing lesions lacking sufficient melanin fluorescence.
Source:
Forschner, A., Keim, U., Hofmann, M., Spänkuch, I., Lomberg, D., Weide, B., . . . Haenssle, H. A. (2018). Diagnostic accuracy of dermatofluoroscopy in cutaneous melanoma detection: Results of a prospective multicentre clinical study in 476 pigmented lesions. British Journal of Dermatology. doi:10.1111/bjd.16565