{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:55:05Z","timestamp":1790733305372,"version":"4.1.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T00:00:00Z","timestamp":1725926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Mavig GmbH"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Previous work with reflectance confocal microscopy (RCM) has shown high sensitivity and specificity for malignant melanoma (MM); however, to date, there have been no studies with a UK cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To use RCM prospectively to accurately diagnose MM and lentigo maligna (LM) in a private UK secondary care, single-clinician setting; and to assess the potential of RCM to be used as a routine screening procedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In total, 597 patients with a differential clinical diagnosis of MM or LM were consecutively recruited. A sequential record was made of the clinical, dermoscopy and RCM findings by a single dermatologist prior to biopsy. Imaging was done with an arm-mounted confocal microscope unless there was restricted access to a lesion that required a handheld probe. The likelihood of MM was scored for each diagnostic modality, with each diagnosis building on the last. Histology was assessed by a single blinded histopathologist. The trial was registered with ClinicalTrials.gov (NCT03508297).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Altogether, 733 lesions were included in the analysis, including 86 MM and LM (median diameter 7.0\u2005mm). The benign-to-malignant ratio was 3 : 1 (nonmelanocytic malignancies included) and 8.3 : 1 for MM and LM only. The sensitivity and specificity for MM and LM, respectively, was 62.8% [95% confidence interval (CI) 51.7\u201373.0] and 63.1% (95% CI 59.3\u201366.8) for clinical examination; 91.9% (95% CI 84.0\u201396.7) and 42.0% (95% CI 38.1\u201345.9), respectively, for dermoscopy; and 94.2% (95% CI 87.0\u201398.1) and 83.0% (95% CI 79.9\u201385.8), respectively, for RCM. The positive predictive value of RCM in diagnosing MM and LM was 42.4% (95% CI 38.1\u201346.8) and the negative predictive value was 99.1% (95% CI 97.9\u201399.6).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study demonstrates that RCM can reliably diagnose MM and is fast enough to be integrated into UK pigmented lesion clinics by dermatologists trained in RCM. The number needed to treat decreased from 3.86 with clinical examination to 2.96 with dermoscopy to 1.30 with RCM.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjd\/ljae354","type":"journal-article","created":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T16:06:53Z","timestamp":1725984413000},"page":"27-35","source":"Crossref","is-referenced-by-count":10,"title":["Reflectance confocal microscopy to diagnose malignant melanoma and lentigo maligna in the UK: a single-centre prospective observational trial"],"prefix":"10.1093","volume":"192","author":[{"given":"Howard P","family":"Stevens","sequence":"first","affiliation":[{"name":"The Skin Care Network , Barnet, London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Pellacani","sequence":"additional","affiliation":[{"name":"University La Sapienza , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0529-4135","authenticated-orcid":false,"given":"Colin","family":"Angus","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, University of Sheffield , Sheffield ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph N","family":"El-Jabbour","sequence":"additional","affiliation":[{"name":"Cellular Pathology Services , Watford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,9,10]]},"reference":[{"key":"2024122223515797100_ljae354-B1","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1016\/j.jid.2018.12.006","article-title":"Trends in melanoma incidence rates in eight susceptible populations to 2015","volume":"139","author":"Olsen","year":"2018","journal-title":"J Invest Dermatol"},{"key":"2024122223515797100_ljae354-B2","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1111\/jdv.15322","article-title":"Time trends in incidence and mortality of cutaneous melanoma in Germany","volume":"33","author":"Garbe","year":"2019","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2024122223515797100_ljae354-B3","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1001\/jamadermatol.2016.4512","article-title":"Analysis of trends in US melanoma incidence and mortality","volume":"153","author":"Glazer","year":"2017","journal-title":"JAMA Dermatol"},{"key":"2024122223515797100_ljae354-B4","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1097\/CMR.0000000000000551","article-title":"What has changed in the epidemiology of skin melanoma in central Italy during the past 20\u2005years?","volume":"30","author":"Bianconi","year":"2020","journal-title":"Melanoma Res"},{"key":"2024122223515797100_ljae354-B5","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1468-3083.2007.02388.x","article-title":"Melanoma epidemic across the millennium: time trends of cutaneous melanoma in Emilia-Romagna (Italy) from 1997 to 2004","volume":"22","author":"Pellacani","year":"2008","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2024122223515797100_ljae354-B6","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s10198-008-0127-0","article-title":"Cost of skin cancer in England","volume":"10","author":"Morris","year":"2009","journal-title":"Eur J Health Econ"},{"key":"2024122223515797100_ljae354-B7","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1093\/pubmed\/fdt032","article-title":"Measuring current and future cost of skin cancer in England","volume":"36","author":"Vallejo-Torres","year":"2014","journal-title":"J Public Health"},{"key":"2024122223515797100_ljae354-B8","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.jaad.2019.12.063","article-title":"Meta-analysis of number needed to treat for diagnosis of melanoma by clinical setting","volume":"82","author":"Petty","year":"2020","journal-title":"J\u00a0Am Acad Dermatol"},{"key":"2024122223515797100_ljae354-B9","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1016\/S0959-8049(01)00153-8","article-title":"Compliance with follow-up and prognosis among patients with thin melanomas","volume":"37","author":"Kittler","year":"2001","journal-title":"Eur J Cancer"},{"key":"2024122223515797100_ljae354-B10","doi-asserted-by":"crossref","DOI":"10.5070\/D3202021537","article-title":"Compliance with follow-up among patients with melanoma and non-melanoma skin cancers","volume":"20","author":"Kalimullah","year":"2014","journal-title":"Dermatol Online J"},{"key":"2024122223515797100_ljae354-B11","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ejca.2019.11.014","article-title":"European consensus-based interdisciplinary guideline for melanoma. 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