Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Weitzer, F.
Reflectance Confocal Microscopy - A helpful tool for diagnosing benign and malignant facial lesions?
[ Diplomarbeit ] Medical University of Graz; 2013. pp. 67
[OPEN ACCESS]
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- Autor*innen der Med Uni Graz:
- Weitzer Friedrich
- Betreuer*innen:
- Ahlgrimm-Siess Verena
- Arzberger Edith Johanna
- Hofmann-Wellenhof Rainer
- Altmetrics:
- Abstract:
- Introduction: Clinical differentiation between benign and malignant lesions of the skin may be difficult even for experienced dermatologists. In clinical equivocal cases a biopsy is often required to rule out malignancy. Facial lesions are an even greater diagnostic challenge because of site specific clinical features which reflect the unique histomorphology of facial skin and the limitations for biopsy in this cosmetically and functionally sensitive area. Non-invasive measures to improve the detection rate of malignant skin lesions include the use of dermoscopy, computer image analysis and in vivo reflectance confocal laser microscopy (RCM), as a promising new imaging technique. There are only few RCM- studies in the literature which included equivocal facial skin lesions to demonstrate the benefit of using this technology in this specific body area. Objective: The aim of the present retrospective study was to demonstrate the additional ability of RCM to differentiate between benign and malignant facial skin lesions. Furthermore, considering the unique histomorphology of facial skin, we investigated the difference between a novice observer and two expert observers using this new technology. Patients and methods: 160 facial skin lesions were imaged in 148 patients. Patients were aged from 5 to 93 years with a mean age of 65.1 years. 42 patients (28%) were male and 106 (72%) were female. 12 lesions were labial lesions. Images were evaluated two times by a single novice observer and one time consensually by two expert observers. Results: The first course of image evaluation done by the single novice observer, showed a low sensitivity (43%), but a high specificity (81%) for detection of malignant skin lesions when assessing clinical, dermoscopic and RCM images together. Sensitivity and specificity for evaluation of clinical and dermoscopic images alone were 65% and 79%, respectively. In the second course of image evaluation done by the single novice observer, a good sensitivity (71%) and specificity (87%) for detection of malignant skin lesions was obtained for evaluation of all images together. Sensitivity and specificity for evaluation of clinical and dermoscopic images was 68% and 71%, respectively. Image evaluation done consensually by the two expert observers showed a good sensitivity (80%) and specificity (84%) for detection of malignant skin lesions when assessing clinical, dermoscopic and RCM images together and a sensitivity and specificity of 71% and 82%, respectively, for assessment of clinical and dermoscopic images alone. Conclusion: Our study clearly shows the advantage of using RCM as adjunct to clinical and dermoscopic examination over clinical and dermoscopic examination alone. A second course of image evaluation done by the single novice observer showed a better sensitivity and specificity than for the first course, clearly representing a short learning curve. However, the two experienced observers still showed better sensitivities and specificities compared to the single novice observer.