Publication date: Oct 08, 2024

Cutaneous confocal microscopy (CCCM) facilitates in vivo visualisation of skin at a cellular level. Use of a “store and forward” approach for remote CCM interpretation (Remote-CCM) across multiple sites has not been tested and may increase access to non-invasive diagnosis. To test the diagnostic accuracy and safety of Remote-CCM. We prospectively recruited lesions selected for biopsy for skin malignancy across five Australian tertiary dermatology centres. CCM, clinical and dermoscopy images were acquired pre-biopsy and accessed by a cloud-based platform for interpretation by CCM readers. CCM diagnosis was compared to histopathology results. Amongst the 201 lesions included, melanoma was the most common malignancy (34/72, 47. 2%). Of the 89 lesions (44. 8%) potentially ‘saved’ from biopsy, 80 (90%) were truly benign lesions and 9 (10. 1%) were missed malignant lesions of MIS (n=7) and SCC (n=2). No invasive melanomas were missed. Sensitivity of remote-CCM for detection of malignancy was 89% (95%CI 79-95%) and specificity was 64% (95%CI 55-73%). The study recruited from high-risk populations and excluded lesions that were not biopsied. Remote-CCM has comparable accuracy to bedside-CCM and safely reduces unnecessary biopsies. Potential SCCs are not appropriate for remote-CCM. Follow-up of borderline melanocytic lesions is recommended.

Semantics

Original Article