REDUCTION OF OPERATIVE PROCEDURES IN DERMATOLOGICAL PRACTICE USING REFLECTANCE CONFOCAL MICROSCOPY IN THE CONTEXT OF SKIN CANCER SCREENING FOR MELANOCYTIC LESIONS OF UNCERTAIN MALIGNANCY.

Background: The specificity in the detection of atypical and malignant melanocytic lesions in the context of skin cancer screening is very low, so that numerous unnecessary operations are performed. The extent to which complementary diagnosis using confocal laser scanning microscopy (CLSM, RCM) in skin cancer diagnosis can reduce the number of excisions is investigated. Patients and Methods: Prospective real-world study conducted in an outpatient dermatological practice. Out of 521 consecutive patients with an average age of 56 years, 173 atypical melanocytic lesions were examined using a three-step diagnostic chain: clinical examination, digital dermatoscopy, and confocal laser scanning microscopy. Results: After supplementary confocal microscopic examination, only 18 of the 173 suspicious melanocytic lesions were excised. 89.6 % of the previously planned excisions could be saved. 12 of the 18 excised lesions were dysplastic, a Spitz nevus or a melanoma in situ in the dermatohistopathological findings. Conclusion: By reducing skin surgeries in our study by nearly 90%, it was demonstrated that patients in an outpatient dermatological practice significantly benefit from the additional pain-free, imaging histological diagnostics at the cellular level using Confocal Laser Scanning Microscopy in skin cancer early detection. This diagnostic method needs to be learned and could be widely used for a substantially improved skin cancer screening. [ABSTRACT FROM AUTHOR]